American College of Physicians: Internal Medicine — Doctors for Adults ®

Monday, March 24, 2014

Two different worlds: HIT vs. real-life, frontline medicine

A couple of weeks ago I attended a health care information technology event in Boston. The event focused on developing new technological ideas for the future. Most of the people in attendance were young, keen, entrepreneurial, and seemed to have a genuine passion for improving health care. There were some great thoughts and ideas put forward, with definite potential for bettering patient care.

I’ve actually been to several similar events and it is encouraging for health care that there’s so much energy and enthusiasm being focused towards our arena. But one thing does concern me a bit when I speak to those who are solely involved in information technology or business development, and don’t have any real world health care experience. As enthusiastic and motivated as they are, when they talk to me about their ideas and aspirations, I’m often left wondering what planet they live on!

While well-intentioned, the way they put forward hospital solutions appears to be based on the assumption that the majority of hospitalized patients are the Facebook generation, technologically savvy with the manual dexterity of a 20-year old. I’ve heard proposed answers to some of our problems in hospital medicine, including how to improve patient satisfaction, provide our patients a good health care experience, better medication reconciliation, and reducing readmissions, that don’t seem to take into account the reality of frontline medical care and the patients we are actually treating in hospital.

For example, the average age of patients admitted to the inpatient medical floor is typically well over retirement age. A majority of them have never even used a smart device, and many are even too sick to turn on the television. If an idea is put forward that utilizes technology and swipe screens for hospitalized patients, facts like this must be taken into account.

We also know that illness disproportionately affects the lower socioeconomic groups, who are less likely to be regular users of technology. And how about the large proportion of patients on any given medical floor that suffer from dementia? Asking them to be fully engaged with technology while lying in a hospital bed would not only be difficult, but also potentially dangerous.

Patient satisfaction and reducing readmissions are further examples of where health care entrepreneurs are increasingly getting involved. Again, lots of them have told me personally how their goal is “ultimate patient satisfaction” and to “transform health care.” That’s all very well and good, but will a computer program or technology device ever really be the main answer to making patients happier in the hospital? It’s a bit of a delusion to think so.

Ask any patient what will make them most satisfied, and the answers will usually be the same. They will be focused more in the human realm, such as wanting more time with caring and compassionate doctors and nurses, a quiet healing environment, and good medicine that will cure them fast. And as for reducing readmissions, when an elderly person who has multiple comorbidities is stuck in the vicious circle of frequent readmissions, very little in the way of technology can help their bodies heal and stop them coming back into the ER when they deteriorate again. Home care and close follow-up may be the only things that will really help them.

There are 2 other common patient complaints which I’ve written about previously: bad hospital food and lack of a good night’s sleep. I heard one idea for an app that can apparently help with making better food. Another one was a technology-based solution that is supposed to help patients sleep by providing background noise. Do we really need to make things so complicated? Surely we don’t need a computer to tell us the difference between good and bad food or how to make a quieter environment!

Sometimes I feel like asking these budding health care entrepreneurs to accompany me on ward rounds one day to actually see the realities of frontline clinical medicine. Most of them are thankfully too young to have barely set foot in a hospital, and I’m sure they would find such an experience insightful to say the least. They will then understand the complexities of delivering health care and how there are some problems that can’t be solved entirely with technology.

They will also realize one other very important thing: Health care is all about human contact and personal relationships. It’s an emotional field to work in. It’s about empathy, compassion and consoling (often just as much as it is about cure). It’s about well-trained doctors and nurses who practice good and thorough clinical medicine.

That isn’t to say that health care information technology, or technology in general, isn’t amazing and transformative for what we do. The benefits brought to us in terms of data access and improving quality are enormous. However, we need to take things to the next level: To bridge the gap between health care technology and frontline clinical medicine. Most physicians, and nurses for that matter, are very jaded right now with their experiences of IT and electronic medical records. Slow and inefficient systems take time away from our patients and actually tend to give them a worse experience as a result.

To really improve health care delivery, what would be good from the technology world? To understand and take into account the realities of frontline medical practice. To recognize that health care is about humanity at its core. To develop all new solutions centered around the principle of doctors spending face-to-face time with their patients, and minimal time with their computers getting in between. If we can utilize a smart device effectively at the bedside for information access, data entry and patient education, that’s ideal. But that should never involve looking more at the screen rather than the patient. Frontline clinicians need to work closely with the technology sector to design and implement optimum systems that promote good medical practice.

There’s a certain political philosophy that the best governments in the world are the ones that get out of the way and let their citizens flourish, while maintaining minimal control and obstructions. No matter what extreme you take this statement and apply it politically, to a certain extent it’s definitely true. Similarly, the best health care IT solutions of the future will be the ones that are seen and heard the least, and quietly do all the right work in the background while the doctors and nurses are enabled to spend maximum time listening to their patients and addressing their needs. When this happens, many of the problems that we face in health care may disappear all on their own, without any additional technology.

Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care. This post originally appeared at his blog.

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Blog log

Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:

Albert Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.

And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.

Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.

Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.

Controversies in Hospital Infection Prevention
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Iowa City, IA, with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).

db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.

Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.

Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.

Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.

Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.

Glass Hospital
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.

Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.

I'm dok
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.

Informatics Professor
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.

David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.

Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.

Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.

MD Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.

Medical Lessons
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.

Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.

More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).

David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

Reflections of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.

The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.

Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.

Peter A. Lipson, MD
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.

Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.

World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.

Other blogs of note:

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by an emergency room physician.

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