If health IT were fully implemented in 30% of community-based physicians' offices, the gains in efficiency would reduce demand for physicians by 4% to 9%, according to a new study in Health Affairs.
Using health IT to support the delegation of work from physicians to midlevel practitioners and from specialists to primary care doctors could reduce demand for physicians by 6% to 12%. And increasing the amount of IT-enabled remote care and asynchronous care could cut the percentage of overall care that physicians provide by 2% to 5% and 4% to 7%, respectively, the study found.
If 70% of office-based physicians adopted comprehensive health IT -- including interoperable EHRs, clinical decision support, provider order entry and patient Web portals with secure messaging -- the impact on physician workforce requirements would be twice as large, the study said.
These conclusions are based on the most extensive review of the literature performed up to now, according to the study. While that might seem like a large claim coming from most researchers, the authors of this paper have an unusual amount of credibility. David Blumenthal, MD, the president of the Commonwealth Fund, was formerly National Coordinator of Health IT. Jonathan Weiner, professor of health policy and management at Johns Hopkins' Bloomberg School of Public Health, is a leading workforce and health IT expert. The third author, Susan Yeh, is a doctoral candidate in economics at Johns Hopkins.
Despite the recent adoption of EHRs in some form by the vast majority of physicians, the study pointed out, the comprehensive use of health IT by even 30% of office-based doctors is at least five years away. "The transformation could occur to a significant degree by 2020, but it is also possible that health IT adoption will not be widespread until later," the authors said.
In an interview with InformationWeek Healthcare, Weiner estimated that the timeline for this transformation is probably in the range of five to 15 years. Nevertheless, he said, workforce projections should start taking the future impact of health IT into account.
The American Association of Medical Colleges' Center for Workforce Studies currently estimates that there will be a shortage of about 63,000 doctors by 2015, partly due to the effects of healthcare reform. AAMC forecasts shortfalls of 91,500 physicians in 2020 and 130,600 in 2025. But Weiner said that these projections are based mostly on past trends in care delivery rather than the ongoing transformation of the healthcare system.
Weiner admitted that most studies show a decrease in provider productivity after EHRs are introduced. But he said that he and Blumenthal have no doubt that the picture will change over time. As physicians are forced to increase their efficiency, he said, they'll find ways to use their EHRs to do that. And today's young doctors, who are generally tech savvy, will be leading the way in the future.
There's evidence that improved communications between physicians and patients, facilitated by eHealth in all its aspects, can reduce the number of unnecessary office visits. Researchers at Scripps Health recently made a similar point in the Journal of the American Medical Association (JAMA). But couldn't the increased amount of doctor-patient communications between office visits increase the physician workload? "It possibly can," Weiner said, noting that the evidence in this area is very limited. But he expects that patients and nonphysician clinicians will do much of the work, reducing the amount of physician time required.
A major factor in decreasing physician demand, the paper predicted, will be the delegation of many duties from physicians to nurse practitioners (NPs) and physician assistants (PAs), and from specialists to primary care doctors. According to Weiner, NPs and PAs are capable of doing 50% to 60% of what primary care physicians do. The IT-enhanced ability of patients to communicate with their care teams accounts for most of the projected reductions in demand here, he said.
In addition, the study pointed out, 5% to 10% of real-time "office-based care" could be delivered remotely by providers whose patients are not in the physician's office. And 5% to 15% of care "could involve interactions between consumers and providers not only from separate locations, but at different points in time." Together, these factors could reduce regional shortages of physicians by 12%, the study said.
It's likely that the kind of telehealth interactions currently occurring between patients and doctors who are not their personal physicians will also play a role, Weiner said. Moreover, the number of telemedicine consults between patients in rural areas and big-city specialists is on the rise, he pointed out. As this becomes the norm, he said, the trend will increase access to doctors everywhere, despite the current and expected future maldistribution of physicians across the country.
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