Blog | Friday, January 30, 2015

If you spend more than 80% of your day on the computer, you are no longer a doctor or nurse


The use of health care information technology has increased exponentially over the last five years, and as a frontline physician I have seen this change at close quarters. In most of the hospitals I've worked in up and down the East Coast, it's been interesting to observe this transformation. The process has usually started with nurses and then moved on to encompass doctors. It's overall a good thing, as I wrote about a couple of weeks ago, because despite the drawbacks, information technology is undoubtedly the way of the future.

Yet at the same time there's so much further to go in designing more optimal systems that are less clunky and cumbersome to use. The problem with having suboptimal IT is that it does not stop at the computer screen or just make life more inefficient for hardworking doctors and nurses. It ultimately affects our patients by taking time away from them and thus has a huge impact on the whole hospital experience. Much was made of a study last year that showed medical interns now spend only approximately 10% of their time in direct patient care. From my own observation of how frontline doctors and nurses are spending their time, this comes as no surprise to me. Sadly for doctors it's the real frontline specialties—such as hospital medicine, emergency medicine and family practice—where our patient interactions matter most, that are most acutely affected by slow health care IT and over-burdensome data entry requirements. As for nurses, glance down any modern day hospital floor and you will see these hard working professionals, who are the very heart of direct patient care, glued to their computer carts, typing and clicking away.

I've learned the golden rule that identifying a problem is the easy part. How do we go about solving it and what realistic solutions can be brought to the table? How can we really improve this situation?

The first most obvious answer lies with the health care IT itself. People who work in information technology who are non-clinical will have no idea how systems impact frontline clinical workflow and take time away from our patients. We need to provide direct feedback, not just to IT departments, but the IT vendors themselves. The best health care IT of the future will be systems that are quick and user-friendly, “seen and not heard”.

The second avenue is to make sure feedback is given to hospital administration and CMIOs directly (chief medical information officers). I personally know many CMIOs, fortunately the better ones. Unfortunately though, some of the others in this field have chosen that route as a way of getting away from clinical medicine. In other words, former physicians who don't practice at the frontlines any more. These are the ones who need the most feedback regarding how current systems can be better optimized.

The third area is to look at mobile IT solutions, such as tablets, that can easily be used “on the go” as you are seeing patients. I would say widespread use of “voice recognition” too, but the current ones I've seen (no company names mentioned) are actually much slower than typing and good old-fashioned transcription services.

There was an interesting article published on the popular online physician social media site KevinMD.com about using medical scribes as a solution to “click overload”. Another article on the same site described how scribes can put humanity back into the practice of medicine. This would be the ultimate solution I suppose, but part of me thinks using them universally would be like admitting defeat on the part of health care IT that better systems cannot be designed. Systems that frontline staff can work with.

Finally, awareness must be raised among physicians and nurses about how their typical workdays are being spent, and how too much of the time involves the computers rather than their patients. I have a great awareness of this myself, and try my absolute best to minimize it so that I spend more time with my patients (doing things such as batching tasks and avoiding sitting down when I need to use the computer quickly).

The simple truth of the matter is that if you spend more than 80% or more of your day staring at a computer screen—typing and clicking away—sorry to be so blunt, but you are absolutely no longer a doctor or nurse. You have become a Data-Entry Bot.

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.