Balancing Efficiency and Efficacy in a Doctor Visit

Mobile apps are the newest tool in a health care provider’s toolbox to encourage patient self-care and health management. Earlier this year, I worked with an active-duty family physician in a primary care clinic on Joint Base Lewis-McChord to pilot a process for prescribing a sleep app during a patient visit. The project included mapping a patient visit workflow, training staff on the mobile app, and developing patient handouts and provider guides.

However, we found that it was just too difficult for a provider or clinic support staff to take even a few minutes out of a patient visit to teach them about an app. The clinic team has many responsibilities to deliver a high standard of care and the high patient caseloads stretch even the most experienced staffs. As a behavioral health provider, I realized the luxury of having much more time with a patient compared to a relatively short, primary care visit.

This March, I attended the session on practice management at the annual conference of Uniformed Services Academy of Family Physicians (USAFP) to better understand what goes on day-to-day in the clinic. What I learned comes down to one word: Efficiency. The struggle for physicians is how best to utilize their time throughout the day and during each patient visit.

There’s a lot that goes on behind the scenes to ensure a high quality, productive patient visit. A simplified list usually includes:

  • Staff huddle to plan the day (or next few days)
  • Back-to-back patient appointments of approximately 20 minutes each (includes reviewing patient notes, examining and educating the patient, and writing notes)
  • Telephone consultations
  • Answering questions for clinic support staff
  • Administrative tasks like peer evaluations, quality monitoring of care, and tracking professional development

The biggest pain point is documenting patient visits in a timely manner. Writing notes can take a long time, and needs to be accurate to ensure that a patient’s condition is tracked and the appropriate care can be done along the way.

The physicians who spoke in the session emphasized over and over that their success in treating their patients is heavily dependent of the efficiency and support of their clinic staff. The overall consensus was that each physician needs to find a system that works for them and their clinic, and continue to make improvements along the way.

Between what I learned from this session and my experience during the pilot, I understand that relying on a physician to prescribe mobile apps (let alone educate patients how to use them) does not fit well with how practices are run today. However, I’m also convinced that apps may help with a patient’s self-care and health management. My call to action for all of us is to use our collective creativity to develop new approaches to practice management in primary care to be able to prescribe new technology tools like mobile apps.

Kelly Blasko, Ph.D. is a psychologist and the Mobile Web Program Lead at the National Center for Telehealth & Technology (T2).

The views expressed are those of the author and do not reflect the official policy or position of the National Center for Telehealth & Technology, the Defense Centers of Excellence for Psychological Health & Traumatic Brain Injury, the Department of Defense, or the U.S. Government.


Read other posts by Dr. Kelly Blasko