A colleague of mine recently told me about a new "innovation" in her electronic health records (EHR) system, or more precisely, a new metric for the evaluation of workflow in the office.
It seems that a color code has been devised that identifies a patient’s relative "position" in the clinic. For example, a white dot next to the patient’s name on the EHR schedule means "checked in" and green means "patient in room." When the fellow or nurse sees the patient, she or he is supposed to change the dot color to blue. The attending physician is then supposed to change the color to yellow when in the room with the patient, followed by red if an ECG is ordered. Finally, the attending is supposed to change the color to black when the session with the patient is over. Or something like that.
I’ll call it death by metrics. Administrators, however, will delight in being able to report mean times in white vs. blue vs. green vs. red vs. yellow ... you get the point.
Question: Do patients feel better as a consequence of these color changes? Will the practice increase referrals if we decrease the time from blue to yellow?
This reminds me of the recent publicity generated over surgeon and author Atul Gawande’s latest lesson to us all from the real world. It seems we can learn a lot from the Cheesecake Factory and its mechanisms to bring about cost and quality control (Big Med, The New Yorker, Aug. 13, 2012).
A stirring example, no doubt. But of course, during the Roosevelt years, academic progressives told Americans how to run their farms and factories (if you don’t believe me, read Amity Shlaes’s remarkable book, The Forgotten Man). Today’s versions think they know what’s best for the delivery of health care using rather inane examples. While physicians may now be paying the price for a failure to police themselves, we have been instructed – without buy-in, rigorous testing, or scientific evaluation – that electronic health record keeping (along with vertical integration, measurement of quality indicators, etc.) will improve both cost and efficiency. It’s a "feel good" approach, but is really nothing more than a natural experiment.
Blue Dot, Red Dot, Green Dot. I am not sure if the Cheesecake Factory uses a similar system to track the delivery of food platters: I’ll have to ask Dr. Seuss’s Thing One and Thing Two the next time I see them. In the meantime, let’s just hope that experts of a similar ilk are not running our foreign policy and national security apparatus.
Dr. Hauptman is professor of internal medicine and assistant dean of clinical-translational research at Saint Louis University and director of heart failure at Saint Louis University Hospital, and a member of the Cardiology News Editorial Advisory Board.