Physical Medicine and Rehabilitation: A Missing Link Between Clinical Care and Healthcare Technology?

By Mohammad Agha, MD, MHA, assistant professor of Clinical Physical Medicine & Rehabilitation and assistant professor of Clinical Orthopedic Surgery; a HIMSS Champion of Health

Mohammad Agha, MD, MHA

Technology has made a tremendous impact on healthcare especially in the last decade or so. Innovations like telehealth along with the implementation of electronic health records have driven technology to the center of care delivery. However, physicians have raised concerns about how the physician-patient relationship is affected by these innovations.

The technological changes that have been forced on physicians with minimal input is one of many factors fueling physician burnout. A lack of physician buy-in not only burns out physicians, it slows adoption of innovative approaches to reshaping care delivery and inadvertently keeps a fragmented system in place. Physicians who champion coordinated care, have credibility with their peers and work well in a team setting will be critical to adopting technology for patient care. What if there was a medical specialty which already possessed these traits?

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Understanding Physical Medicine and Rehabilitation

Physical medicine and rehabilitation (PM&R) – its practitioners are known as physiatrists – is a medical specialty created in the 1940s to aid combat veterans coming back home after World War II who suffered from functional deficits. For decades the field was strictly focused on helping those with functional deficits from spinal cord injuries, strokes, brain injuries, amputations and burns, along with children with functional deficits from medical conditions such as cerebral palsy and geriatric patients.

The goal of a physiatrist is to increase a person’s functional capacity to maximize their quality of life. In the 1980s the field expanded to the outpatient setting to take care of those with musculoskeletal complaints causing functional deficits. Over the last three decades there has been a significant expansion into the arenas of sports medicine, spine care and pain management.

In PM&R residency training, the resident physician is the team leader working with physical, occupational and speech therapists, nurses, social workers and other administrators to help set goals for patients to discharge from inpatient rehabilitation back home with appropriate outpatient follow-up. In the outpatient setting, physiatrists provide non-operative musculoskeletal care including sports medicine, pain management and spine care. We work alongside specialists in orthopedics, neurology and rheumatology to care for patients with musculoskeletal complaints.

Shifting Our Patient Care Focus

In the last few decades the fee-for-service structure in medicine put PM&R on the backburner. Specialties owning an organ and performing more interventions were rewarded at the expense of prevention and care coordination (as primary care physicians can attest). However, the Affordable Care Act has re-shifted healthcare’s priorities to care coordination and proving how patients actually benefit from care. I would posit this is synonymous with improving function and quality of life.

PM&R involvement has demonstrated clinical benefits in various settings, from the intensive care unit (ICU) to outpatient spine clinics. In one paper, physiatrists at New York University implemented an early mobilization protocol in the ICU. Compared to the control group, patients who underwent the protocol decreased their length of stay (LOS) in the ICU almost 20 percent, decreased their LOS on the main floor by more than 40 percent (from the ICU to a floor for more stable patients) and demonstrated an “annualized net cost savings of $1.5 million.” In the outpatient setting, utilizing physiatrists as the initial physicians to evaluate someone with neck or back pain reduced spine surgeries by 25 percent along with decreasing costs and maintaining patient satisfaction.

In the realm of utilizing healthcare technology, a review paper demonstrated multiple studies showing the promise of using technology in rehabilitation populations. Utilizing video-teleconferencing in the burn-patient population saved more than $100,000 in transportation costs by eliminating 146 ambulance transports.

This study also demonstrated saving 80 inpatient hospital days and an average of 2.5 days in patient travel (with 100 percent patient satisfaction). Patients with Parkinson’s disease saved three hours of time and 100 miles of traveling by using videoconferencing. In the chronic pain population, using telephone consultation with a nurse increased use of non-opioid medicines. Other areas of use are in telestroke, spinal cord injury and sports medicine/outpatient musculoskeletal medicine.

My recommendation is to find physiatrists in your organization who have clinical credibility. Their training in systems-based thinking, focus on functional outcomes and ability to work in teams across different specialties make physiatrists an ideal physician partner to deploy technology keeping multiple end-users in mind. Physiatrists practicing across disciplines should be integrated into technology initiatives to drive increased satisfaction among physicians and reduce resistance long term.

The views and opinions expressed in this blog or by commenters are those of the author and do not necessarily reflect the official policy or position of HIMSS or its affiliates.


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