The journey of transforming rheumatology practice must begin with setting aside our attachment to individualism. “Doing it my way” won’t work much longer. This perspective is, in fact, a major reason for our current performance problems. It produces high variance and lowers efficiency and effectiveness in healthcare and all other complex systems. The commitment to process standardization is a characteristic of the high performing practices described in Great Health Care.
Other high-priority initiatives cannot be pursued if each physician’s practice is a one-off. Medical practice is not sustainable as a cottage industry. Solo practice will wither before the demands for system-based integration, such as accountable care organizations (ACOs), and the need to achieve economies of scale to maintain profitability. Process improvements at the practice and system levels cannot occur without physicians’ shared commitment to standardize around best practices and then to improve these continuously.
As one example, consider how staff in a rheumatology practice struggle to do things differently for each rheumatologist. How can we justify care being determined by which physician a patient sees more than their disease itself and the documented best practice protocols?
Standardizing what clinical data we collect will be paramount, as will how we document it, analyze it, and share it with others. The information sharing advantages of EHRs will only happen if the formatting and content of information is predictable. Not long ago, physicians scribbled illegible notes in paper charts until Medicare declared, “If we can’t read it, we won’t pay for it.” So we started dictating narrative notes and paying transcriptionists to word process them. “Not good enough,” the payers said. “You need to document specific elements of care to earn different levels of payment,” and physicians’ dictation time increased. High-performing practices have not only standardized their data but have transformed how they collect, document, and use data: patient- and physician-generated data questionnaires, direct electronic entry, auto-generated clinical notes, clinical data tables and flow charts, and so on. Collecting more robust clinical data more efficiently and improving its organization will improve the providers’ critical problem defining and solving functions.
Measuring Processes and Outcomes of Care
In Great Health Care, we assert, “What we don’t measure, we can’t manage, and we don’t.” Our clinical processes are measurable, but we seldom measure them and therefore don’t have the data required to track and improve them. High-performing practices measure routinely, and we must all imbed measurement into our practice management if we are to improve, even transform, our practices within increasingly integrated local health systems.