Monday, January 31, 2011

(some)Hospital emergency departments re-discover concept of opportunity cost

Back in the day,physicians would often see patients in their office and then dictate the clinical notes and have them transcribed and placed in the clinical record often in a matter of a few hours. Then came computers and later electronic medical records (EMR) and as stupid as it was, the physicians were called upon to key in their notes themselves. At least that was the case for those physicians who worked for large organizations.Private practice docs in 1-5 person practices were not forced into that.But wait-now the big federal push for EMR for all and we will see more physician-typists slogging away often to the chagrin of the patient who would like the doc to look at him.

David Henderson, writing in the Concise Encyclopedia of Economics,says this about the economic concept of opportunity cost. "Its [the term] value is to remind us that the cost of using a resource arises from the value of what it could be used for instead." In this case what could the physician's time be used for instead. If she spend less time keying stuff into the clinical record, she could be seeing and evaluating more patients in a given time period and in the language of the administrators- generating more income.

Investipedia put it this way : Opportunity cost is the cost of an action that must be forgone to pursue a certain action. The physician is forgoing caring for patients in the time she takes to enter in the data, even if she is can enter data at a world class speed, it does not make economic sense for the doc to spend time typing. Economists love to say things like "economics is just about incentives"

I still get updates from placement agencies regarding locum tenems. A recent one described a position at a VA hospital. One of the job requirements was the ability to key in information .In this setting the above economic incentives may not apply.The doctors gets a set salary and he will not generate more income for the VA (they don't generate income at all) by seeing more patients so why not have the doc spend his time typing.

Some emergency departments (EDs) apparently caught on and not just recently. See here for an article on that topic as early as 2009. The EDs are hiring scribes to sit in on the physician-patient encounter and key in the relevant details freeing the doc to do all those doctor things and not appear distracted with his computer while he talks to the patient. Of course this would also work in other practice situations.

Many physicians who may have never hear the term opportunity cost when introduced to the notion that they would key in clinical encounters said in effect " why should I waste my time doing that" operationally knew all about that concept.However, some of the suits in HMOs and large clinics "run like businesses" who hired self appointed experts in IT must have slept through the economics course they must have taken to get the MBA.

1 comment:

Hal Dall, MD said...

To medicrats, the highest and best use of anyone's time is paperwork and its computer equivalent.