The High Cost of Keystrokes in Healthcare – and the Single-Sign-on Solution

May 12th, 2013 by Rod Baird

Our healthcare system runs on third-party payments. Third-party payments are authorized by a physician/extender’s orders, and frequently require a signature (or the electronic equivalent).

Having a single sign-on for multiple healthcare information systems may seem like a really petty thing to be talking about.

But not when you consider what single sign-on really means – time. And in the case of LTPAC, we’re talking about a physician’s time. In the healthcare system, no matter what organizational structure you’re in, the odds are that the most expensive people are going to be physicians and extenders.

In almost all situations, these are the people who are responsible for generating revenue or managing overall cost of care for the patient. So if these are one of the scarcest, most expensive resources in the healthcare system, how do you want to deploy those resources?

I’m in a unique position that I manage both a large longterm care (LTC) physicians’ group and an electronic health record (EHR) company.

When I first started developing an EHR, I thought the physicians and I would be having conversations about creating rules for clinical guidelines or implementing quality measures – all the things that an EHR could offer to enhance the overall care environment. Instead, because all our providers are more or less compensated on production, their focused is on having an EHR that supports their productivity.

In fact, when we have physician focus groups about product enhancement, a major issue is always – “How can you redesign the product to make it get to the end result quicker?” Many physicians have actually figured out alternate workflows that have saved maybe four keystrokes during an encounter. Yes, we are talking about seconds.

This feedback has caused our developers to continuously find ways to shave keystrokes needed for an encounter. Because when you have 20 or 30 encounters a day – 30 seconds added to each encounter starts to add up. A couple of seconds here and there, and you end up adding 30 seconds to each encounter. That’s 15 minutes a day – an entire encounter!

This has led me to reflect on how all these really great ideas, programmed by so many talented people into an EHR can actually become a “little tax” for physicians. Nobody sees their tax as being particularly burdensome. That’s because no single one of them is. But in aggregate, they all become little friction points that eventually slows down the physician’s day so they’re losing encounters.

That brings me to the issue of single sign-on. LTPAC physicians frequently work in multiple locations. Each facility has its own medical record, and a separate pharmacy. Each of these locations is beginning to ask the physician to directly enter information into their records system. Physicians are pushing back, because this is a significant tax on their time.

If we who are developing EHRs want physicians to do things electronically – which arguable is for the best – you can’t put a tax on the physician when they go from one system to the next, and have to continually reenroll or re-authenticate.

All EHR companies must start developing and offering single sign-on for physicians and their staffs.

We do it with our EHR. And it’s time for it to become an industry standard.

Rod Baird

About Rod Baird

Rod Baird is the Founder and President of Geriatric Practice Management (GPM). Since 1977, he’s led provider and management organizations that deliver care to Medicare/Medicaid beneficiaries. Past programs he’s overseen include home health, personal care, hospice, rehabilitation hospitals, adult and psych daycare, alcohol/drug rehabilitation, industrial medicine and primary care practices. The Centers for Medicare and Medicaid Services (CMS) selected Baird as one of only 73 individuals to serve with its InnovationProgram. His educational background includes a Master’s Degree in Physical Chemistry from the American University, Washington, D.C.

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