Thursday, June 26, 2014
My 87-year-old father broke his hip this past weekend. He was in Michigan for a party for his 101-year-old sister, and fell as he tried to put away her wheelchair. The good news is that he’s otherwise pretty healthy, so he should do fine. Still, getting old sucks.
During the whole situation around his injury, surgery, and upcoming recovery, one thing became very clear: technology can really make things much easier:
• I communicated with all of my siblings about what was going on and gave my “doctor’s perspective” to them via e-mail.
• I updated friends and other family members via Facebook.
• I have used social media to communicate cousins about what is going to happen after he’s discharged from the hospital and coordinate our plans.
All in all, tech has really made things much easier.
This reality is in stark contrast to the recent headline I read on Medscape: “Doctors are Talking: EHRs Destroy the Patient Encounter.” The article talks about the use of scribes (a clerical person in the exam room, not a pal of the Pharisee) to compensate for the inefficiencies of the computer in the exam room. Physician reaction is predictable: most see electronic records as an intrusion of “big brother” into the exam room. To me, the suggestion to use a scribe (increasing overhead by one full-time equivalent employee) to make the system profitable is ample evidence of EMR being anti-efficient.
Despite this, I continue to beat the drum for the use of technology as a positive force for health care improvement. In fact, I think that an increased use of tech is needed to truly make care better. Why do I do so, in face of the mounting frustrations of physicians with computerized records? Am I wrong, or are they?
Neither. The problem with electronic records is not with the tech itself, it is with the purpose of the medical record. Records are not for patient care or communication, they are the goods doctors give to the payors in exchange for money. They are the end-product of patient care, the product we sell. Doctors aren’t paid to give care, they are paid to document it. Electronic records simply make it so doctors can produce more documents in less time, complying with ever-increasingly complex rules for documentation.
When I say we need more tech, I am not saying we need more computerization so we can produce a higher volume of medically irrelevant word garbage. I am not saying we need to gather more points of data that can measure physicians and “reward” them if they input data well enough. The tech I am referring to is like that I used regarding my father. I want technology that does two things: connects and organizes. I want to be able to coordinate care with specialists and to reach out to my patients. I want my patients to be able to reach me when they need my help. Technology can do this; it sure did for my dad.
Yet people are incredibly reluctant to adopt this. They fear that using technology will inevitably make things less personal. I have patients who are still reluctant to use computers for this reason, and I definitely see this in my colleagues, who reject my pleas to communicate with me electronically.
My main communication tool, Twistle, allows me to communicate quickly and securely with my patients. Using it has greatly improved the efficiency of care and makes my patients feel more connected with me. Here are some examples:
• Patients routinely send me pictures of rashes/lesions. Sometimes I end up bringing them in to the office to get a personal view of them, but often I can give care based on the computer. One mother was out of state with her child and I could successfully diagnose and treat a yeast diaper rash. She was thrilled.
• I send actual copies of lab, X-ray, and procedure reports to the patients along with my explanation of their significance. Now the patient has a copy with them at all times (as long as they have a smartphone) and so can share the reports with any specialists they visit.
• One patient was having bad problems with an intestinal infection and was in the ER for the third time in a week. The ER doc was not taking her seriously and so she sent me a Twistle message asking for help. I replied with a run-down of what had been done and the reasons I felt she needed to be admitted for a work-up. She showed it to the doctor in the ER who grinned, nodded, and admitted her without any more questions.
• I often have a back-and-forth conversation using Twistle regarding symptoms and/or concerns a patient is having. This sometimes resolves the problem, but sometimes it results in an office visit. These visits, however, usually take less than 10 minutes of the patient’s time (from when they come in to when they leave) because I’ve already gotten the history on Twistle. This is normal in my practice, but is almost unheard of in the “real world.”
There are other examples, but clearly my patients who use this tool think it makes their care better. But what about those who are still reluctant? What about those who worry that this will push their care toward impersonal electronic communication? I finally figured out an answer to this: my daughter.
My daughter is in college in upstate New York (where I grew up, and where my parents live). She loves it up there (although has realized why few people retire and move up north), but the distance has been hard on us. We don’t get to see her nearly enough. The one thing that has helped us deal with this long distance has been technology. We use text messages, e-mail, FaceTime, and other technology to stay close to her. Does the technology replace seeing her in person? Absolutely not. But it does enhance our communication and connects us when we couldn’t otherwise do it.
This is what technology should do: it should enhance connection and improve relationship. Technology doesn’t have to add a layer of complexity or push people apart, in can simplify and connect. Technology doesn’t bring my dad or my daughter down to Georgia, but it can make the distance feel much shorter.
So I roll my eyes when people suggest paper medical records. Really?? I wouldn’t give up the ways in which tech has improved my communication and has brought me closer to the people who really matter. I think most of my patients would agree.
After taking a year-long hiatus from blogging, Rob Lamberts, MD, ACP Member, returned with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind), where this post originally appeared.
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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.
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Suneel Dhand, MD, ACP Member
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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.
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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.
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