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The Changing Role of the Physician

The Changing Role of the Physician

Dr. Rick Holloway, Chief Medical Officer of Ozarks Medical Center, shares his views

The requirements of today’s electronic age have had a major impact on physicians and hospitals. The days of physicians working independently in their own practice and simply using the resources of the hospitals as a place to treat their patients, have come to an end. With the Health Care Reform Act, the advent of the Electronic Health Record (EHR), Computerized Physician Order Entry (CPOE), and the emerging use of hospitalists, physicians and hospitals are being linked together in many new ways.

Historically, physicians and hospitals were autonomous entities. “This is the way I practice what I do, and the hospital has what I need to practice, and I utilize their resources to do my job,” said Dr. Rick Holloway, Chief Medical Officer and Urologist at Ozarks Medical Center (OMC), in describing how things were done in the past. “Now, the line between physicians and hospitals is blurred in how we are evaluated for performance.” explained Holloway. “There are new paradigms including change in service reimbursement that will link docs and hospitals. Quality isn’t just measured independently anymore, but more as a healthcare team.”

“It is a hard shift for physicians. As a whole, we became doctors because we want to help people. We value our independence, and we were trained to be autonomous. We are making the shift, and physicians and hospitals are now working together in looking at the big picture of cost containment while providing quality care. Being a physician and working in a hospital have always been a ‘people business’. No matter what else changes, our human relationship with our patients is very important.”

“In the past, when a person got sick, they came to the hospital. They got the care they needed, and then went home. With new legislation, hospitals are now penalized for a patient being readmitted within 30 days of being released from the hospital. In an effort to prevent such readmissions, OMC is developing a more comprehensive team care approach, essentially expanding the continuum of care to look for ways to make sure that even at home, patients will have the resources available to optimize their health” Holloway explained. “To a degree this will bank on many of the resources we have had for years: home health nursing, medication assistance, social workers to name just a few. But we recognize that a patient centered healthcare experience will go beyond what we know and are currently comfortable with. We want to use contemporary technology to communicate with patients as well as unconventional delivery of care with virtual visits and the like. Thinking outside the box in how and where we interact to better care for our patients is no longer a luxury but will be essential.” Holloway said.

Instead of just treating patients while they are ill, things are changing within the healthcare system to a more proactive approach. “We ask what we can do to educate and then ultimately prevent disease.” Holloway says. OMC has answered that question by offering education classes, free health screenings, support groups and more. Most of OMC’s education classes are free and are presented by physicians. “We are going from being reactive to proactive in trying to prevent long-term health complications,” Holloway explained. “We are constantly looking at data to help us identify ways to improve community health.”

With the implementation of Electronic Health Record (EHR) and Computerized Physician Order Entry (CPOE) software, OMC is able to provide accurate, up-to-date, and complete information about patients at the point of care. Benefits to the EHR include more reliable prescribing; coordinated, efficient care; and legible, complete documentation. “The physicians and staff at OMC have stepped up to the plate, worked through the learning curve with the software, and have seen the value of the EHR, but the transition has not been painless” Holloway added.

Computerized Physician Order Entry (CPOE) software allows health care providers to directly enter medical orders electronically in inpatient and outpatient settings and replaces the more traditional order method of paper, verbal, telephone and fax. This reduces the margin of error and improves patient care and safety. With the addition of a clinical decision support system, the software provides real-time support on a wide range of diagnosis and treatments. “It also provides tools to check for drug interactions and allergies, takes away legibility issues and provides standardization for best practices. Complexity in medical care has never been as great as it is now. One of the promises of standardization is the ability to apply a process that reduces the potential for harm.” Holloway explained.

“We are incorporating here at OMC, the best practices established elsewhere at places like the Mayo Clinic. In a digital environment we have the capacity to build on successful programs and systems established elsewhere and apply that success locally. It is a challenge to figure out how to implement all of these things in such a busy environment. We are not seeing fewer patients. We are all just as busy as we have been in the past,” Holloway said.

Another trend in healthcare today is the use of hospitalists to provide in-hospital patient care in place of the patient’s primary care physician. Hospitalist is the term used for doctors who are specialized in the care of patients in the hospital. Most hospitalists are board-certified internists, who have undergone the same training, residency, and board certification exam as other internal medicine doctors. The only difference is that hospitalists have chosen to exclusively do hospital care.

“Because of all of the new regulations, many family physicians and primary care physicians are stepping back from hospital practice utilizing the hospitalist’s expertise to treat their patients while they are inpatients.” Holloway explained. Hospitalists keep the patient’s primary care physician informed with the progress of the patient. Once the patient is released, they return to the primary care physician for follow-up appointments and treatment as needed.

“OMC has strongly positioned itself to be well prepared for change. The pieces were all here to take us to the next level. OMC has a very qualified and innovative administration, exceptional medical and support staff, an active and involved board of directors, and all the reporting structures in place to successfully transition to this new world. The physician’s task is to figure out how to function in a much more regulated environment, optimize the technology available. Always, the first priority is to perform safe, quality care to our patients.”

“Our physicians and staff at OMC are working hard to move forward and comply with the new world. Survival depends on being flexible and learning how to participate in these new processes,” Holloway explained. “I am proud to be a part of the OMC family during these fast-changing times. I am confident that we can meet and surpass the needs of our community.”

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