Back to the Future: A 2008 Presentation Is Still Super Relevant

Primary Care Redesign, Past and Present

I know I’ve become a healthcare IT nerd because stumbling upon a great presentation, paper, or useful stat gives me a nice little rush—like finding a hint of gold after days of panning. That’s because, despite the trillions of data points available online, it’s a challenge to sift through the volume and find really solid, actionable information. Adding to my research challenge is that much of what we’re doing at healthfinch is new, which means we have to create our own data or map new meanings in past paths.

So you will understand that I was really thrilled to come across a presentation from 2008, created by a Mary S. Applegate, MD, FAC, FAAP, who was at the time a Clinical Assistant Professor of Medicine at The Ohio State University College of Medicine. Her talk, titled Practice Efficiency: Improving Quality and Patient Satisfaction was likely groundbreaking then, and holds up quite nicely seven years later. (On a side note I’m trying to get in touch with her to see what she’s up to now!)

If you are interested in Primary Care Redesign, I encourage you to scan Applegate’s presentation. Dr. Applegate gives both strategic and tactical advice, including suggested office layouts, appointment timings, etc. She sketched out a very nice roadmap to guide practice leaders in reaching these goals: increased productivity, improved quality, and higher physician job and patient satisfaction.

Applegate rightly focused on physician productivity and time. Why? Because the physician rests at the nexus of the medical and financial needs of a practice. He or she is the most valuable asset in a medical practice because of the years of advanced training and, importantly, is also the “primary financial driver of profits.”

Said the healthfinch way, doctors should not be performing the repeatable, routine and non-reimbursable tasks that could be safely delegated to a more appropriate staff member. We need to keep doctors focused on top-of-license care and free them up to manage the patients who need them most. And yes, the need billable activities too. The reality is that healthcare is a business and the bills must get paid.

To get physicians thinking about their time and task load, Applegate posed a challenge to physicians. She encouraged them to look at their tasks lists and divide them into one of three categories:

• “Productive, only-I-can-do-tasks
• Wasted, of-no-value-to-office-tasks
• Delegated, someone-can-help-me-do-tasks”

Her last category, delegated tasks, is the one that we relentlessly focus on. Physicians must be willing to delegate tasks, when appropriate. Most physicians have a talented staff of well-trained nurse practitioners, registered nurses, physician’s assistants and medical assistants, all of whom have a role to play in alleviating the physician workload. This is the way toward more efficient, more productive clinical environments and paves the way for physicians–and their staff–to be happier.

I’m excited that we now have the technology to put Applegate’s and other care redesign experts’ ideas into practice and, more importantly, at scale!   Finally, using the power of the EMR and precision apps, we are able to automate, delegate and simplify many of the clinical processes that have hindered provider productivity to date.

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