Physicians today often spend more time looking at their computer screens inputting information into Electronic Health Records (EHRs) than they spend looking at their patients. That is frustrating for doctors and patients alike.
Randall Oates, MD, was a family practice physician in Northwest Arkansas when he became a physician entrepreneur by developing the SOAPware medical practice software that has time-saving solutions for medical records, patient communications, scheduling, billing and payment\coding.
After 26 years in practice, Oates retired from a traditional family practice about 10 years ago and followed his passion to take the electronic paperwork burden off physicians. SOAPware has proven to be so helpful that it is now in use in the U.S., and in 29 other countries.
“I think I am just getting started,” Oates said. “SOAPware is focused on utilities that create connected care, and deliver access and connectivity rather than just EHR documentation. That is exciting to me.”
Oates said the 50 percent burnout rate among physicians is of great concern. It can help make it easier for doctors to be doctors doing what they really care about—taking care of patients—rather than record keeping.
“SOAPware was really kind of a hobby that got out of hand,” he said. “I loved practicing medicine, but I detested the interference that medical records created as a distraction between really giving patients what they need. Back in the early 1980s, I started using a word processor to automate some of the documentation paths. Between patients, I actually wrote a program to automate the repetitive tasks so I could be more focused on the interactions with patients. I shared this with physician friends in the early 1990s and got a whole group of doctors across the country tinkering with it. I had a busy practice and it got to be too big of a burden, doctors calling me between patients asking me what to do. I decided to hire programmers to use my ideas to make a real product. I haven’t written any code since the 1990s, but doing so initially gave me sense of how software works and that has served me well.”
Oates grew up in Morrilton, went to the University of Arkansas Fayetteville for undergraduate work and then to the University of Arkansas for Medical Sciences in Little Rock for medical school. He has always loved science, figuring out how things worked and why.
“We had internet in the 1980s, but it didn’t really take off until we had browser capabilities with the World Wide Web on top of it,” he said. “We take the hyperlink for granted now, but I was probably the first to do that at the point of care back in the late 1980s.”
One of the early purchasers of his product was NASA. That opened some doors as he spent time in Washington, D.C., to share ideas about how to connect and give access to information in ways that hadn’t been done before.
“It is really about connected care, how to link a need for information to information at the point of care when it is needed and how it is needed,” Oates said. “There was a whole group of physicians working together doing this. I was the ringleader in what became a national effort to find a way to get back to taking care of patients rather than charts. Doctors are being turned into shift workers like cogs in a wheel collecting data to make sure documentation meets certain reporting requirements when what doctors really value is connectedness, having a positive impact on people’s lives.”
Since EHRs became standard, the time demands on doctors has greatly accelerated.
“When you go to a doctor or health professional, they are turned more to the screen than to your face,” Oates said. “That is not because they want to, but because the system has been designed to turn them into data entry clerks. The average office visit is 7.5 minutes, and it takes on average 15 minutes doing charting and administrative tasks for every 7.5 minutes with a patient. It is a tragedy that the doctor’s focus in the current system has to be on having the documentation have a good outcome, not the patient outcome. If the documentations doesn’t meet the mandates and regulations, then they don’t get paid and they can’t stay in business. Physicians can feel like they are on a hamster wheel.”
Oates is frequently in demand as a speaker at national conferences to talk about options to prevent physician burnout while delivering better patient care. He also has served as a liaison to payers and to large health systems, and has served as an ambassador to assess patient-centric care in several foreign nations.
Oates said one option for doctors who want more focus on service and excellence is to consider various models having a more direct payment relationship with patients so you don’t have to go through a third party. With Direct Patient Care (DPC) Models, the patient pays a monthly or annual fee or retainer that is usually around $50/month. That way a doctor can afford to have 500 patients rather than 2,000.
“About 40 percent of the revenue of a medical practice is spent just on trying to collect the revenue,” Oates said. “In many areas of the country, there is a big shift with employers offering $50 to $100 per employee per month for medical practices to provide their primary care. They still have insurance to cover catastrophic medical, and are saving 30 to 60 percent on healthcare costs. Practices don’t have to deal with the crazy reporting requirements of health plans and the government, and can focus on patients.”
While most government and private insurance health plans don’t pay for virtual office visits, DPC arrangements allow physicians to be more efficient by allowing patients to ask questions or send in information like blood pressure readings electronically.
“Since it is not necessary to take off work, it decreases absenteeism,” Oates said. “As a company we continue to improve our legacy EHRs. But we have shifted our focus to promoting connected care. In addition, our infrastructure is designed for delegation of administrative tasks and data entry so members of the care team can operate at the top of their license.”
Oates said this is a golden era for that because healthcare in the U.S. is in huge need of innovation.
“I am a believer in incremental evolution instead of sudden, drastic change,” he said. “How do we architect an information system where patients are more than a vessel for codes that shift money around? Our healthcare system has embraced technology because it could improve interactions, but ended up with a system where technology is a controlling, distracting interference. I’m determined to figure out how to use information technology to facilitate rather than interfere with patient care.”
His work to transform health information technology has dovetailed with a personal health transformation, as well. He weighs 100 less than ten years ago, which he attributes in large part to gradually developing new habits. These initially focused on eating, and later was followed by a focus on exercise. A more recent habit has been biking.
“I found we have a wonderful set of bike trails here in Fayetteville,” he said. “Every day I get on the bike and ride for an hour. And I absolutely love it. It is like a Zen meditation. You have to find what works for you as far as exercise. But creating the habit is really the important thing.”
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