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We have chosen diabetes
and its multitude of complications as an example of disease monitoring
because it affects so many Americans, and because it affects so
many organ systems. Monitoring this disease, and its multiple
facets, is analogous to clinical practice monitoring.
During the last quarter of
the 20th century, the American automobile industry became less competitive
and less profitable as compared to its overseas competitors.
The crisis situation required change, but change for its own sake
would not necessarily improve anything. Improved quality and
efficiency occurred only when monitoring of processes and outcomes
was implemented. By itself, monitoring was not adequate; change
based on the results of monitoring also had to be implemented.
Compare this with the management
of diabetic patients. The diabetic patient has lost monitoring
and control processes, which must be supplemented by artificial
means. The elusive cure of diabetes will occur only when the
automated monitoring and control processes are restored. Until
then, successful treatment involves regular monitoring and intervention
based on ever changing conditions and outcomes.
The same is true in the management
of office based medical practice. The health of the practice
depends on the quality and efficiency of its operations. Most
practitioners sincerely believe that this type of monitoring is
not possible. In fact, most practices are already routinely
monitored by the insurance industry and by the government payers
for health care. These entities review medical records, billing
charges, and levels of delivered care to determine the appropriateness,
effectiveness, and relevance of practitioner efforts.
Most medical offices are managed
with paper charts or electronic document management, separate electronic
billing systems, and further disconnected paper or electronic appointment
scheduling. Relevant monitoring of any aspect of such a practice
is impossible. Comprehensive review of any time-based process
requires that all aspects of that process be subject to review.
Appointments lead to patient visits, which lead to diagnostic
testing and therapeutic intervention, which lead to referrals or
other appointments, which lead to follow up care. Every aspect
of the process must be recorded in the same system and evaluated
regularly to determine the outcome.
There are physicians who insist
on reviewing patient glucose levels, laboratory tests, blood pressure
and multiple parameters of diabetes; they correctly insist on patient
monitoring as a quality issue. The very same physicians neither
monitor nor control any fundamental office processes, such as percentage
of patients who improve or decline, patient time spent in examination
and waiting areas, reimbursement rates based on diagnosis or procedure
codes and insurance payer, or prescriptions and laboratory testing
frequency. Because the Team
Chart Concept is comprehensive by design, the health
care provider can monitor all of the above, and more.
The success or failure of any given practice
is determined by a multitude of factors which change continuously.
Internal control means internal monitoring as the basis of
effective change. Outside monitoring, by pharmaceutical, insurance,
or governmental interests, means outside control. Licensed
practitioners are given the opportunity and the responsibility to
maintain health, to help prevent illness or injury, to intervene
when prevention fails, and to render comfort when all else fails.
As a matter of economics, if current practitioners cannot
perform these tasks, consistent with current scientific knowledge,
they will be replaced.
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Practice Monitoring
With The Team Chart Concept
