The Association of American Medical Colleges (AAMC) projects that the United States will face shortages of between 54,100 and 139,000 physicians by 2033. The major factors contributing to the shortages are the increasing elders’ population (over age 65) and more physicians reaching retirement age.
However, the Federation of State Medical Board (FSMB) reports a net physician increase of 12% between the 2010 and 2016 census. The increase reflects a better physician-to-population ratio from 277 to 295 physicians per 100,000 population (2017). On the same report, FSMB also notes a 44% increase of certified physician assistants. The number of nurse practitioners is also expected to grow from 128,000 in 2018 to 244,000 in 2025.
While FSMB indicates an increase of physicians and clinical staff in the U.S., AAMC has concerns about the shortage of physicians for patient care. We have no doubt about both reports, but a recent Harvard Business Review (https://hbr.org/2020/03/the-problem-with-u-s-health-care-isnt-a-shortage-of-doctors) has brought forward another set of angles to the overall view of physician shortages in the U.S.
The contributing facts are: a. Uneven distribution, b. Incomplete coverage, c. Inconvenient hours, d. Inflexible care models, and d. Inefficiency use of physician labor. All these contributing factors point the lack of care delivery efficiency and care access.
Since the 1990s, other industries have embraced Enterprise Resource Planning (ERP) to address the business process efficiency and the need for process standardization. ERP solutions focus in streamlining the processes and workflows, reflecting accurate information across the business. The shared information flows have enhanced and continuously improved the processes and workflows, resulting to efficiency gain throughout the enterprise.
The Healthcare industry needs health IT solutions supporting the equivalent functions as ERP. The solutions need to be designed for healthcare, focusing on different healthcare processes and workflows to scale up physician bandwidth through process efficiency. Process efficiency must consider staff delegation, care collaboration and leverage new technology such as telehealth.
We refer to this new innovative health IT solutions as Care Resource Planning (CRP).
To understand the need for CRP in healthcare, we outline the business benefits from ERP to identify what would be adopted to healthcare and what would be needed on top of ERP for healthcare. ERP business benefits are aligned on four main areas:
- Catalyst for innovation
- Platform for process efficiency
- Vehicle for process standardization
- IT cost savings
Let go through the above four ERP main areas first, then outline what additional functionalities would be required for CRP:
- Platform for process efficiency: A combination of smart notification and automated workflow for each treatment process would go a long way in process efficiency in healthcare. We can take an example in the Intensive Care Unit (ICU) environment where alert fatigue has been one of the sources for preventive medical errors. It is the efficient process to eliminate alert fatigue as a ‘white noise’, making sure the patient condition gets to the right care provider at the right time. Another example is the Chronic Care Management (CCM) workflow ensuring continued patient engagement from clinical staff and escalation notification to physicians on concerned events. The ability to develop new process and workflow addressing different treatment scenarios and environments critical for healthcare.
- Vehicle for process standardization: Healthcare has standard processes for different treatments and However, without health IT solutions support, these processes are mostly manual. Its efficiency depends on individual providers execution. Consistency is the main challenge in this category. With CRP, the process can all be standardized and supported by health IT solutions. We refer to this functional set as ‘policy enforcement at point of care’.
- Catalyst for innovation: We purposely put this area after process efficiency and standardization. Healthcare innovation has two major components: Innovation for disease treatment and innovation for process efficiency and effectiveness. CRP focuses on process efficiency innovation by supporting data monitoring and analysis for continuous process improvement.
- IT cost savings: ERP has been developed from previous IT solutions. ERP presents the integration, resulting in process efficiency and IT cost savings. Healthcare does not have existing IT solutions besides Electronic Health System (EHR) systems. EHR systems are patient medical recording software. IT cost saving for CRP may not be measured in the context of IT cost savings, but is represented with overall cost containment, derived from patient care quality.
ERP is mostly focused on integration behind the ‘brick and mortar’ boundaries of the business or enterprise. Medical access does not limit to the same boundary as other industries. Patients may need to engage with multiple healthcare systems, facilities and specialists. In healthcare, the integration extends beyond the ‘brick and mortar’ boundary of the healthcare systems. While healthcare has defined ‘Interoperability’ as the required medical data sharing, CRP is required to bring process and workflow beyond the ‘brick and mortar’ boundaries.
Care Resource Planning is critical to address the shortage of providers in U.S. healthcare. It is not about the actual number of physicians in the U.S., but how efficient these providers would interact for patient care.