Friday, December 12, 2014
Health care information technology: new rules
Information technology clearly has a long way to go before it delivers on the immense promise of technology to truly improve health care. Most of the current solutions—quickly rolled out in response to Meaningful Use requirements—are slow, inefficient and cumbersome. Physicians (and nurses) spend far too much time staring at their screen and navigating the system, often to the detriment of patient care time.
A study published last year in the Journal of General Internal Medicine shockingly found that medical interns now spend only 12% of their day in direct patient care and 40% with computers. Statistics like that are a great shame for the practice of medicine. The problem is not so much the idea of increased use of information technology in health care, but that what's available right now is suboptimal and actually takes longer to use than it should. So until those dream systems of the future are released, here are 5 new rules for our interactions with health care IT:
1. Do not let the computer cost you your patient relationship
During any patient encounter, refuse to spend more time looking at a computer screen rather than them. Even if it takes a bit longer and you need to use the computer again later, sit down and spend time engaging in direct conversation. This applies especially to office care, where the worst thing a doctor can do is keep turning their back on the patient every few seconds to start typing away and being a data entry robot
2. Do what's necessary
If free data entry takes too long on your IT system, try to enter the minimum needed in order to be succinct and to the point. Avoid typing long descriptive paragraphs if they are not needed, which can take a lot of time above and beyond what's required
3. Learn the intrinsic quirks of your system
Every IT system has its own quirks and way of getting things done. There will likely be more than one way of placing a certain order or entering data. By getting to know your system well, you can often find a quicker and more efficient way of doing something
4. How you interact with your computer
Many tasks, such as ordering a medication, can be done “on the go”. If you get into the habit of sitting down every time you are in front of the computer, a task that could take 10 seconds can easily turn into 2 or 3 minutes. Whenever you can, stand up and do whatever you need to, and get right back to where you should be—with your patient
5. Give feedback and organize
My experience is that hospital IT departments are usually very responsive to feedback from frontline doctors and do whatever is in their power to make the system work better. It could be changing a menu option, altering a screen appearance or reducing the amount of clicks it takes to perform a given task. If you see something that can be done to improve workflow, pick up the phone or send an email. And on a national level, how about making this problem a bigger issue?
As electronic medical records evolve, the likelihood is that we won't be having this conversation in a few years. The ideal systems of the future will make life better for both doctors and patients—seamless, user-friendly and efficient. They will also be the ones that are “seen and not heard,” allowing direct patient care and maintaining the human relationships in medicine. Until that day comes, let's get to work.
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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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.
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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, 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.
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db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.
Suneel Dhand, MD, ACP Member
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Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.
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Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.
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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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