Guest post Ken Perez, vice president of healthcare policy, Omnicell.
One of the Affordable Care Act’s overarching goals is to lower cost, and one way it intended to accomplish this was by providing Medicaid coverage to more low-income adults, giving them greater access to and ability to pay for sources of care outside the emergency department (ED), resulting, in theory, in reduced ED use.
ED use is a significant driver of cost, accounting for 5 percent to 6 percent of U.S. health expenditures. Medicaid alone spends $23 billion to $47 billion each year on ED care.
There have been a number of different studies on the impact of providing Medicaid coverage to previously uninsured adults.
Some high-level research suggests that Medicaid coverage does not affect ED use. Pines, et al. analyzed ED use in 36 states—some of which were Medicaid expansion states and some were nonexpansion—for 2014, the first year of expanded Medicaid eligibility. The researchers concluded that there were no significant differences in overall ED use between expansion and nonexpansion states, though Medicaid-paid ED visits rose by 27.1 percent in the expansion states, while uninsured visits dropped by 31.4 percent and privately insured visits fell by 6.7 percent.
Most importantly, the researchers admitted, “…we do not know which visits were by patients who obtained new health insurance (Medicaid) in 2014, as opposed to those who were continuously enrolled, were uninsured, or may have switched insurance type” (Pines, et al., “Medicaid Expansion In 2014 Did Not Increase Emergency Department Use Bud Did Change Insurance Payer Mix,” Health Affairs, Aug. 2016).
In contrast, a randomized, controlled study by Finkelstein, et al. in involving 24,646 lottery-selected uninsured individuals in Oregon who were granted Medicaid coverage in 2008 showed that they increased their ED visits by 40 percent in the first 15 months after receiving coverage. Many observers speculated that the rise in ED use was due to pent-up demand and would therefore dissipate over time as the newly insured found and used other sites of care or as their health needs were met and their health improved. However, the researchers were unable to find any evidence that the increase in ED use due to Medicaid coverage is driven by pent-up demand that decreases over time; in fact, they found that the effect on ED use appears to persist over the first two years of coverage.
In addition, the study determined that Medicaid coverage increased the joint probability of a person’s having both an ED visit and an office visit by 13.2 percentage points, indicating that expanded coverage will not necessarily drive material substitution of office visits for ED use (Finkelstein, et al., “Effect of Medicaid Coverage on ED Use—Further Evidence from Oregon’s Experiment,” New England Journal of Medicine, Oct. 20, 2016).
As the randomized, controlled trial is the gold standard of research, Oregon’s study and its conclusions get the nod in the debate about the impact of Medicaid coverage on ED use.
Mobile technology is impacting every element of American healthcare–from insurance and billing to documentation and caregiving, the impacts are being felt. The truly transformative element of the mobile revolution is not the technology itself, or the way it changes the look and feel of the tasks it affects. Despite complaints of the depersonalizing effect of technology, the ultimate value of mobile in the sector will be how it enhances and encourages communication.
Providers are Going Mobile
Already, flexibility and functionality have already drawn providers to mobile devices and solutions. Voice-to-text technology and similar automated solutions are in the offing to relieve the documentation burden that has dampered some amount of enthusiasm toward digitization. Bolstered by these advancements, caregivers will go from subjects of their EHRs to masters of patient encounters.
One of the huge benefits of mobility–as opposed to simply being networked on desktop computers or having a digital health records solution–is the capacity for greater native customization and app development. Native apps are like the currency of the mobile, smart device world providers are entering. Developers can deliver personal, branded interfaces that allow doctors to choose precisely how they want their dashboards to look, giving their EHRs a custom touch that has been sorely lacking throughout their implementation.
App-centric development will further reduce the friction of adoption and utilization, giving doctors a sense of empowerment and investment, rather than the bland inertia that has carried digitization thus far.
The personalization of the technology through app development will help boost adoption, and return the focus to what the technology enables, rather than how it looks or what it has replaced. Mobile technology’s strength will be in reconnecting doctors and patients, and creating bridges of data and communication across the continuum of care.
Guest post by Suzanne Travis, VP, regulatory strategy, McKesson.
Shifting to value-based reimbursement (VBR) is a challenging journey, and trying to proactively manage risk at the same time only makes things more complicated. However, there are simple ways a provider organization can more proactively position their organization for a shift to VBR. While there is no fool-proof method or one-size-fits-all approach, here are four strategies that can help steer providers on the right path, no matter where they are in the VBR transition process.
Start with a program that aligns with organizational goals
Participation in alternative payment and delivery models are on the rise. The American Hospital Association estimates that more than 60,000 providers are participating in a delivery system reform model — and that number is growing. The overarching goal of implementing new health care delivery system models is simple: to provide better, more efficient and coordinated care for patients. However, each model has its own nuances and can sometimes require a different approach. Healthcare organizations should be well-served to take a deliberate path to succeed in their journey to value-based care. First, look at each model to understand how it measures and incentivizes participants and the type of care delivery changes it requires. Select models where you have an alignment on goals, room for improvement, and where you can start with upside-only incentives. It’s better to engage now, when participation can be voluntary and downside risk can be deferred.
Getting started is, of course easier said than done. The American Academy of Family Physicians found that a top barrier to adopting alternative care delivery models is a lack of understanding of the elements and actions for success. There are materials and organizations out there that can help guide the transition. For example, the Global Center for Health Innovation explains the models and provides guidance on questions to ask and tools to consider. The Office of the National Coordinator recently launched the Health IT Playbook that includes a state-by-state listing of federally funded sources of technical assistance to support practice transformation activities. Don’t let a knowledge-gap deter you from achieving your goals.
Be ready to act when new opportunities arise
New payment models continue to be introduced and new cohorts are being added to existing programs. Whether you are impacted by a mandatory model, such as the Episode Payment Model CMS recently proposed, or a new voluntary program is announced, be ready to adapt. Take for example the recently announced Comprehensive Primary Care Plus initiative. Participating practices have a choice of two tracks with the same care delivery requirements, but with different financial risk components. Both tracks aim to provide funding for infrastructure and process transformation. Keeping your finger on the pulse of these opportunities and being prepared to act quickly to engage can help you enter into programs that allow you to learn with less risk. If you know what your goals are, you’ll be able to spot the right opportunity to get started.
Partner with your vendors
As providers adopt new care delivery models and take on more risk, contracted vendors should be expected to engage as partners who can work collaboratively to solve new problems.
Guest post by Abhinav Shashank, CEO and co-founder, Innovaccer.
P.J. Carter in a blog explained how the lack of interoperability resulted in extreme physical pain to his father who had to go into an eye surgery for the repair of a detached retina. His father was told by his eye specialist that and an urgent operation had to carried out. The operation began, but doctors could not access the past medical record of his father. Since doctors were unaware of the medical history, they had to carry out a painful operation of the eye without anesthesia! His father was awake the whole time and had to endure the pain.
Healthcare industry is lagging the most when it comes to advancements. There have been innovations, but equal implementation has been lacking. The cost of care has risen to over $10,000 per person in the US because there is huge expenditure on various digital infrastructures, but not for the meaningful use of them.
Interoperability and Its Types
Interoperability is a term that has no single definition. In broad terms, interoperability is the ability of systems and devices to exchange vital information and interpret it. For healthcare, interoperability is the ability of computer systems in hospitals to communicate, share critical information and put it to use to achieve quality health services delivery.
There are three levels of health information technology interoperability:
1) Foundational: This is the most basic level of interoperability. In this tier, the health information systems are equipped to transmit and receive data, but the HIT system on the receiving end may not be decked up to interpret that information.
2) Structural: The middle level, structural interoperability defines how the data exchange will take place. Structural interoperability is all about how data should be presented in pre-described message standards. This tier is critical to interoperability as it allows a uniform movement of health information from one system to another, avoiding the alteration and promoting the security of data.
3) Semantic: Semantic interoperability is the third tier, and at the top of the communications pyramid. The highest level of interoperability, it provides the systems the ability to exchange data and make use of the information. The message is received in an encoded format and which is later normalized. This normalization of data pushes health IT systems to close in on the technology gaps and create a common platform for secure, uninterrupted machine-to-machine communication.
Scope of Interoperability
There has been a dramatic increase in population, and with that came the need to manage population health. The amount of information increased exponentially with the use of EMRs. They helped in storing the increasing information, but sharing was still doubtful.
In 2005, only about 30 percent of the entire group of office-based physicians and hospitals used basic EHRs which increased to 75 percent for hospitals by the end of 2011. The state of Indiana now connects more than 10 million patients across 80 hospitals, and about 18,000 physicians use this data.
How long until 100 percent interoperability?
It has been accepted that health care, as a single entity, faces challenges in the exchange of information. Even the pioneer EHR vendors admit that although they have some complex connections established, not all of them were successful. According to a report, less than half the providers were satisfied with the way their information exchange was taking place. Stakeholders involved have always been concerned that EHRs, even the ones for Meaningful Use 2, are unable to share data effectively.
In the latest ONC report, it was mentioned that if all the providers were to come down to a common consensus, there happen to be two barriers on the road to complete interoperability. One, discord on how data should be transmitted. Second, a lack of proper infrastructure which is equipped enough to transmit data nationwide. It is very critical that the technology being used is updated and standardized to ease the flow of patients’ vital information to avoid any probable mishap.
Persisting Problems in the Path of Interoperability
1) Inadequate Standards
More often than not even after collecting patients’ data, it cannot be passed on to the members of the healthcare community because of lack of the appropriate standards. Most of the times it happens that two systems trying to exchange data are using a different version of standards. This is because there are varying standards and numerous version for which providers aren’t equipped.
Rohan Kulkarni, vice president of healthcare strategy and portfolio at Conduent,speaks here about Conduent’s healthcare strategy and the company’s move to brand following its separation from Xerox. While doing so, he steps back to look briefly at aspects of healthcare technology’s past then pivots to its future and what he’s most excited about in the space and how he hopes to be part of it. Finally, he describes wheat he would pursue if he were healthcare’s king, and what that would look like and how he would change the sector for the best impact to the patient.
You’re the vice president of healthcare strategy and portfolio at Conduent. Can you explain what the role entails, and how you approach it?
The transformation in healthcare that is occurring is generational and provides for unprecedented opportunities. As the head of healthcare strategy, I am responsible for identifying those opportunities that are relevant to us and help strengthen our portfolio. I then design and develop a strategy in collaboration with our business leaders that will help meet our growth goals.
Tell me how Conduent plays in healthcare and how its solutions specifically impact the point of care.
Conduent has perhaps the broadest solutions portfolio in the healthcare services, allowing us to connect the entire healthcare ecosystem.
Conduent provides solutions that help our clients overcome industry obstacles, including inefficient processes, inaccessible data, regulatory mandates and challenging economics so they can focus on improving patient lives through better, affordable, accessible healthcare. Our solutions are all designed to help our clients manage the health of their patient populations so they can improve healthcare outcomes. We help make the transition to value-based care models a reality, and we work with healthcare professionals to design solutions that meet their specific needs.
Conduent is dedicated to the efficiency of claims accuracy, facilitating bill payments and risk assessments, communicating benefits, driving medication adherence, improving patient engagement and technology education, and delivering on quality and care data across medical systems. Our solutions are designed to reduce preventable readmission rates for defined population sets, control costs by executing proactive engagement and provide ongoing management for patients with chronic conditions.
Conduent just completed its separation from Xerox. What does that mean for your company and for your customers? Why the move and why the rebrand? Why not build on the power of the Xerox brand?
When reviewing the products and services offered across the business, we determined creating two independent, standalone entities – Xerox and Conduent – would give us the ability to create greater shareholder and customer value. The separation is based on a structural view of two of our businesses and with simpler, more focused organizations, we’ll be able to adapt to market demands and ensure we’re positioning the business to deliver tailored solutions based on our clients’ evolving needs.
How has healthcare IT transformed throughout your career? How has Conduent been involved in healthcare’s evolution?
I think most of the healthcare industry expected healthcare IT to be a driving force in improving how providers deliver solutions to their patients, but I don’t think we expected the rate of change to be so dramatic, especially over the last decade or so. We’ve seen vast improvements in how providers use health IT with the advent of electronic health records, mobile health technologies, telemedicine, wearables, analytics, etc., to improve communication with patients, personalize care and drive healthier outcomes. Since our introduction to the healthcare space, we’ve been helping businesses and governments better harness the influx of information to enable transformation. From the back office processes like billing and payments, to using Big Data to drive medication adherence, assessing risk and improving patient engagement, our solutions meet today’s challenges and prepare healthcare organizations to meet tomorrow’s needs.
What are you most concerned about in regard to healthcare’s future?
Healthcare economics continue to be single dimensional in that the focus is on the demand side, i.e., insurance. The Affordable Care Act (ACA), while it has streamlined the demand side, it has not addressed supply side, e.g., hospital charges, cost of medication etc. in any meaningful manner. As such, much of the debate in the public domain about healthcare is unlikely to make progress until both sides of the equation are discussed.
For years, major healthcare and patient safety organizations in both the public and private sectors have discussed how patient identification errors have led to medical emergencies and patient harm in hospitals around the globe. This situation has been mitigated to some degree by the use of barcode print and scan technology.
In this Q&A, David Crist, president of Brother Mobile Solutions, explains how today’s newer and more innovative mobile technology can empower physicians, nurses and technicians to improve patient identification procedures to reduce errors and improve the quality of patient care. Anton Ansalmar, founder and CEO of Rapid Healthcare describes how one application of advanced mobile technology at the actual point of care has successfully identified and prevented potential breast milk misfeed incidents in a U.S. hospital’s busy neonatal intensive care unit (NICU).
First, how do today’s mobile patient ID and verification solutions serve to reduce risk and enhance patient safety and regulatory compliance risk in hospitals and other clinical healthcare environments?
Crist: While most hospitals use barcode scanning and wristband printing systems for incoming patients, many are not leveraging mobile technology to its fullest potential. Today’s next-generation patient identification and authentication solutions use on-demand wristband and label printers help to ensure optimal accuracy and patient safety at all points of care. These wireless mobile systems enable caregivers to administer care whenever and wherever it is needed throughout the facility.
For example, nurses can take samples, infuse blood or administer medications and, at the same time, print out or verify the patient wristband and print a matching label for the samples, blood and medication bags. The matching wristband and labels contain legible human- and machine-readable data (barcode plus text). Following these patient identification validation and authentication procedures at the actual point of care—whether in the ER, operating suite, or at the bedside—not only saves time and improves efficiency, but also significantly reduces the risk of misidentification and human error. It also helps ensure the hospital’s compliance with EHR regulations and the five rights of patients: the right patient, right drug, right dose, right route, and right time.
What are some of the problems created by patient misidentification, and how pervasive are they in today’s healthcare system in which virtually every hospital and ambulatory care center uses patient ID wristbands upon admission?
Crist: Even though patient ID wristbands are pretty much universal, at least in the U.S. and other medically advanced nations, incidents of misidentification are still more common than you’d think. For example, a 2016 article in Beckers Hospital Review cites an ECRI Institute report which states: “Failing to associate the right patient with the appropriate action, referred to as wrong-patient errors, is a prevalent occurrence with potentially fatal consequences.” The article notes that ECRI examined more than 7,600 wrong-patient events occurring from January 2013 to July 2015 and found that about nine percent of these had led to temporary or permanent harm or even death.
The study notes that more than half of the wrong-patient events involved either diagnostic procedures or medical treatments. Had these healthcare providers employed mobile patient ID and authentication procedures at the actual point of care, perhaps most of these wrong-patient incidents could have been avoided.
Ansalmar: Misidentification problems are global in scope as we learned in conducting market research for our Mother’s Milk mobile application for patient identification and authentication. We found numerous international reports of errors related to the misfeeding of bottled breast milk to premature and at-risk newborn infants. For example, in several Australian hospitals where the wrong bottle was given, the error was quickly discovered, but the infant’s stomach had to be pumped to prevent a potentially adverse reaction.
These kinds of incidents clearly show why patient identification and verification is so important. It is especially critical for premature infants and full-term babies born with conditions requiring intensive care, because their delicate systems can be harmed or compromised by being fed the wrong bottle of expressed mother’s breast milk.
What is the Mother’s Milk mobile application and why was it developed? Is the app being used by any hospital here in the U.S.?
Healthcare is experiencing major breakthroughs in technology with the rise in digital transformation. mHealth – a terminology that combines mobile technology with healthcare is proliferating and bringing up an opportunity to revamp public health.
Mobile technology is playing a vital role in delivering healthcare seamlessly, with ease of access to both providers as well as consumers.
The magnitude and scope of development of mHealth is beyond explanation. As per GreatCall, mHealth is projected to be a $26 billion industry by the end of 2017. Surely, 10 years from now healthcare mobile devices will become smarter than they already are.
This technology has a potential to reduce the risk of errors and save the time and money that is often wasted. As more and more care providers are shifting to mobile health technologies, consumers have a plethora of options to choose from. Its adoption rate is at an all-time high since it has a variety of utilities to offer.
Development of point of care medical devices, fitness and wellness smartphone apps, clinical medication apps, medical resources, journals and patient records is on the surge. Mobile technology is helping increase patient engagement and connected care. Almost, 83 percent physicians believe in the power of mHealth for patients.
There is a whole new world of possibilities and challenges that mobile has opened for healthcare along with its growing development and support. For instance, end point app security, data breaches and HIPAA violations have sharply increased and there is a need to regulate them. Despite these, mHealth proves to be the most promising industry trend for caregivers and consumers alike.
To understand the general consumer response, usage trends security concerns governing mHealth, Kays Harbor has come up with an infographic. This infographic depicts interesting facts and numbers reported by surveys conducted by firms like SkyCure, Research2Guidance, Great Call, etc.
Guest post by Abhinav Shashank, CEO and co-founder, Innovaccer.
The US healthcare is getting costlier every day, and it is without a doubt true that most of the US citizens live in fear that they won’t get access to the care when the illness strikes. The sad truth is that every year more than 100,000 deaths occur because of medical errors. All this when we see horrifying figures even after adjusting the America’s higher per capita GDP; US spends roughly $500 billion more than other developed countries.
The Problems with Coordination
13 years ago, way back in 2003, the Institute of Medicine had identified the most persistent problem in the healthcare industry, and it was coordination. The idea behind implementing EHRs was to create digital data that is easy to share, but that did not happen. According to a study, 63 percent of primary care physicians and 35 percent specialist are not satisfied with the information they receive from other physicians within the adult referral system.
The above graph shows how poorly coordinated care has affected the adults. The US stands second when it comes to high-need patients. This is when US spends more than $10,000 on one person’s health.
According to a research article, the biggest challenges Primary Care Physicians and Hospitalists faced were:
Difficulty reaching out other clinicians
Lack of information feedback loops
Lack of general information like clarity on test results, history, and medications, etc.
Insufficient access to discharge information of patients
Working towards a solution
Besides these, a lot of problems arise when patients miss out on medications, follow-up visits or any other requirements. Thus, there is a need to create a process where neither do PCPs miss out on critical information nor does the patient stay unaware of the care plans. For this PCPs had identified the most successful care coordination components:
Better coordinated care for at-risk patients
Enhanced direct contact with patients through phone calls
Advanced use of EHRs for better health information exchange
Developing better interpersonal relationships
Health coaches connecting care
The most important aspect of healthcare is that when a care process is nearing its end, the patient should be in a better state. A patient-centric approach is must to make sure a patient gets the best treatment. Health Coaches ensure that the patients get what they need. They make sure that the
Patient doesn’t miss out on his medications
Patient attends follow-up visits,
Patient has no transportation barrier while visiting a hospital
Inform family/caregiver about the care plans and the patient
Track and make sure adherence of care plans
Review discharge instructions
The Three Pieces of Care Coordination
More often than not care coordinators miss out on the essential information about the patients. In worst cases, they have no discharge information of patients creating gaps in care and indirectly increases the cost of care. Ideally, the three pieces of care coordination together can bring dramatic improvements in patient-centric care. The three pieces are:
When we talk about technology disrupting healthcare, we aren’t just referring to changes in the accuracy of health records or the convenience of mobile care; the real disruption comes in the form of fundamental challenges to traditional scopes of practice.
What Should We Do?
Scope of practice, broadly, is determined by a combination of liability and capability. Lead physicians carry greater liability than the bedside nurses assisting in patient care, because the care plan is directed by the lead physician. Likewise, the extra years of education and practice are assumed to increase the capacity of physicians to lead their care teams, make decisions about how the team will go about its work, and parse all of the information provided by the patient, nurses, and other specialists involved with each case.
In every other industry, productivity increases come from technology enhancing the ability of individuals and teams to perform work. Email saves time and money by improving communication; industrial robotics standardize manufacturing and raise the scale and quality of output. Every device, app, and system allows individuals to scale their contribution, to do more and add more value. Word processing and voice-to-text enable executives to do work that might otherwise have been performed by a secretary or typist. Travel websites allow consumers to find cheap tickets and travel packages that would previously have required a travel agent to acquire.
In healthcare, technology is changing the capacity of the individual caregiver, expanding what can be done, and often how well it can be done. These improvements, along with a growing need for healthcare professionals and services, are challenging traditional notions of scope of practice–for good and bad.
Some of the changes to scope of practice are positive, necessary, and constructive. For example, technological literacy is necessary at every point in the care continuum, because interoperable EHRs and the vulnerability of digital information means that everyone must contribute to cyber security. In a sense, caregivers at every level must expand their scope of practice to incorporate an awareness of privacy, security, and data management considerations.
By extension, all caregivers are participating as never before in the advancement of clinical research, population health monitoring, and patient empowerment simply by working more closely with digital data and computers. As EHR technology iterates its way toward fulfilling its potential, caregivers and administrators are being forced to have difficult conversations about priorities, values, goals, and the nature of the relationship between patient, provider, system, and technology. It is overdue, and foundational to the future of healthcare.
Is There A Nurse in the House?
The trend in healthcare toward prevention and balancing patient-centered care with awareness of population health issues puts primary care in a place of greater importance than ever. This, in turn, is driving a shift in the education of nurses to promote more training, higher levels of certification, and greater specialization to justify relying on nurses to fulfill more primary care roles. They are becoming better generalists and specialists, capable of bolstering teams as well as leading them.
The advancement of diagnostic technologies and understanding of the nature of disease, illness, and genetics has also thrust the clinical laboratory into the center of healthcare. It doesn’t necessarily change the scope of practice for the laboratory scientist, but does elevate the demand and scale of operations for these professionals must fulfill. Once again, the broadening demand has dovetailed with an effort to broaden the scope of practice for other clinical roles, particularly nurses.
Whether it is appropriate or practical for nurses–already understaffed and overextended–into all these critical blended roles is open for debate.
Man, Machine and Medicine
While cross-training is valuable for improving collaboration and breaking down siloes–both critically important to the future of healthcare–it blurring the scope of practice or between roles that comprise very different skills and responsibilities. Technology is expanding the capability of every clinical and non-clinical role, but is it not entirely clear whether it is keeping up with our expectations and demand for the people in these roles.
In addition to answering these questions about scope of practice, we need to look carefully at how technology can change the scope of accountability for patients. Technology may be a platform for engagement, but getting real patient participation requires a better foundation of health literacy–just as caregivers must develop a more robust technological literacy to take advantage of EHRs.
About two decades ago who would’ve thought of the invention of Nano robots that are able to carry drugs all the way to the human bloodstream?
It’s happening. Technology is revolutionizing the conventional ‘human country doctor’ health care and there’s not much to be surprised of. With modern machines and software taking over the healthcare industry, one often wonders, “What good is technology doing to it?”
Health information technology (HIT – is information technology applied to health and health care. It supports health information management across computerized systems and the secure exchange of health information between consumers, providers, payers, and quality monitors) is the burgeoning specialized combination of information technology, communications, and healthcare and it is altering the course of patient care for the better. Here’s how:
Practicing medicine is a lifelong learning. Doctors need to be on their toes all the time to acquire the knowledge of the latest developments in their field. Not updating themselves can make their practice stagnant – nobody would want to consult a doctor like that. Health IT brings the knowledge about everything, be it patients, therapies, diseases or medicines at their easy disposal. This knowledge can be easily shared between consultants, patients, and can even be updated when needed. That’s a whole new world of medical science for the doctors and patients to explore.
The world is swiftly moving towards specialization. Healthcare is no different. A single hospital stay could mean being under the observation of several different specialists at the same time. These specialists are required to coordinate with each other on every case they deal with. The way forward is paved by health IT. Health IT helps bring everything related to your condition from nutrition to neural complications in tandem with each other. The specialists know which condition can make regular course of treatment difficult for you or which medicine would trigger your skin allergies. The result? There are fewer chances of problems arising in your healthcare.
The most significant way IT is transforming the healthcare industry is in the form of better outcomes. Automation streamlines the operations of a medical facility, making them more effective and efficient. It is easier for different doctors and nurses to coordinate and diagnose a particular case. There are less chances of human error which ultimately leads to higher quality and safer care. With less time wasted in going through physical files and other manual work, doctors and nurses have more time on their hands to spend with patients.