In this episode, Dr. Naik sits down for an in-depth conversation with Dr. Muthu Alagappan, CMO at Notable. Among several other things, the two discuss the value and limitations of the electronic health record, the role of automation in delivering better patient care, and Dr. Naik’s dual role as Chief Medical Officer and CMIO.
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Manish M. Naik, MD, joined ARC in 1996. He has served as Associate Chief of ARC Internal Medicine since 2011 and Chief Medical Information Officer since 2014. He was named Chief Medical Officer in June, 2021, providing leadership to ARC physicians and clinicians. Under his leadership, ARC continues to explore new technologies that allow physicians to optimize clinical and administrative work flows for better physician wellness and patient care. He serves as Chairman of the ARC Executive Board and is a member of the ARC Clinical Quality Committee.
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0:04:03.9: Dr. Naik: “Right now, in many cases, the technology is a hindrance, it's interfering with the patient-physician interaction because it's now in the room with you and you're interacting with it and you may be losing eye contact with the patient. And one of the great promises of these electronic systems was if we spent all day entering data into them, there would be some return on that investment. These systems would help us do tasks in an easier way, they would help us with clinical guidance. And I think that is still, in my mind, in many ways, an unfulfilled promise. So I think there's a lot of opportunity still there.”
0:06:01.4: Dr. Naik: “So again, we have better access to information but my own assessment is that in the current state of things, in no way shape or form has the electronic health record made us more efficient. And that's the challenge that we deal with today.”
0:09:21.8: Dr. Naik on what the impact of the EHR is on both older and younger physicians. “I think they recognize the value of digitalization, but both the younger and the more senior physician are being impacted by the electronic health record in a negative way, because the screens are very busy. There's a lot of clicking, there's a lot of scrolling. It has added a significant cognitive load to the brain in getting through the day, and that's on top of all of the cognition that happens evaluating patients and deciding on what is the differential diagnosis, what is the treatment plan.”
0:13:46.1 Dr. Naik: “So I definitely think there are components of the workflow that can be automated. And actually some of these components like the medication reconciliation, for example, can be automated with the help of the patient. In other words, the patient can do some of that work for you, and ideally some of that work can be done even before the patient shows up in your office.”
0:15:28.8 Dr. Naik: “Healthcare has always been behind in terms of leveraging technology in a way that actually improves efficiency, improves quality of care, and reduces the staffing need.”
0:16:45.1 Dr. Naik: “The other challenge in our healthcare system is the payment model. We live in a healthcare system in this country where you're reimbursed for everything that you do, if you do something, you get paid for it. And I think, increasingly, we're recognizing that we need to move to a model where we're rewarded for keeping patients healthy.”
0:17:26.3 Dr. Naik: “...I do think the future of healthcare is bright. We have to better leverage technology to accomplish the goals that we have set for ourselves, not that somebody else has set for us.”
0:18:24.0 Dr. Alagappan asks about the staffing shortage and whether or not we’ve seen the worst of it.
0:18:58.6 Dr. Naik, “So I think there's a long and a short-term problem there, but I think it's solvable. I think that we're also recognizing, and in any healthcare organization this is true, that the staffing and the people are the most expensive resource. And I think as there continues to be downward pressure on reimbursement, it's going to make sense to think about where are the places where actually you know what, I don't need a staff member here, what I need is a technology so that I can have that staff member do some higher level tasks and as we grow as an organization. We don't need to add as many staff and that will be part of the staffing solution as well. So we at ARC, we are turning to technology to try to bridge that gap.”
0:22:24.2 Dr. Naik on transitioning into the chief medical officer role: “As you know, the electronic health record touches every part of the organization. And as a result, I quickly found myself spreading from something that was purely electronic health records into other operational and clinical issues across the organization. And to be honest, it was a perfect match because you really have to look at things through both lenses to really get a holistic view of what's happening in the organization.”
0:23:26.2 Dr. Muthu Alagappan asks about the role of a CMIO.
0:23:44.5 Dr. Naik: “So really and truly, it boils down to one primary concept. And that is, I'm somewhat of a translator between the technical teams who do the build in the electronic health record system and the clinical folks who want to take care of patients, and I do the translating.”
0:25:09.0 Dr. Naik on taking a multidisciplinary approach to technology: “So before we actually put something into production, depending on what pieces it touches, we get input from our operations teams, from our nursing teams, from our business office teams. It really is important to have a multidisciplinary approach and not exclude anybody that might be impacted. And it's a much smoother process if you approach it that way.”
0:29:13.8 Dr. Alagappan asks about how CMIOs interact with one another.
0:29:37.4 Dr. Naik: “But I also have developed a network of CMIO contacts through those engagements and will not infrequently reach out to them when we have new ideas, new thoughts, questions, ‘How are you dealing with this challenge?’ And those conversations have been very productive. So we do have a network of sorts that each of us have developed over time.”
0:31:08.4 Dr. Naik on the notion that people don’t want to see their PCP anymore. It’s not true, it’s that it’s too hard and cumbersome in many cases: “So as healthcare organizations, we need to understand that it's not just the relationship we have with our patients, but patients care about access. Patients care about convenience. And we need to continue to move the ball forward and not get behind on our technology capabilities or our access.”
0:33:41.4 Dr. Alagappan asks if there is a concern with non-traditional entrants coming into healthcare like Amazon.
0:34:00.4 Dr. Naik, “In order to really deliver high-quality care, it needs to be what I would call connected care. So when a patient gets seen for an urgent care visit, they should then follow up with their primary care doctor, and I need to be able to see what that visit was all about. I need to be able to see the results of that visit. I need to be able to then refer that patient to somebody who can also see all of that stuff and whoever that specialist is that patient needs to see next. So it all needs to be done in a very coordinated fashion to deliver high-quality care.”
0:35:17.3 Dr. Alagappan asks what Dr. Naik is most optimistic about.
0:35:32.1 Dr. Naik says one is a shift in payment models to focus on rewarding those who keep patients healthy. The second, “My other hope is that we can really start to better leverage a lot of this digital technology to improve efficiency and take some of the load off of physicians and their clinical staff. Right now, it's a bit of a challenge.”
0:36:54.4 Dr. Alagappan asks about the best piece of advice that Dr. Naik has ever received.
0:37:06.7 Dr. Naik says, “One of the best pieces of advice I've gotten is, ‘Don't spend too much time worrying about an outcome of something you're working on. Spend more of your time focusing on what it is that you can do and what it is that you can control. So, give it your personal best and the outcome will take care of itself.’ I think people sometimes get so caught up in focusing on what will the outcome be that they lose sight of the path to get there. And so just give it your best.”
0:38:04.7: END
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