Monday, December 21, 2015
Health care IT: I was duped
I was playing golf with some friends. The Boston area had been having a bit of an Indian summer, and we were lucky to still be getting out there (long may it last). The conversation during 1 of the holes turned to health care information technology, when my friend, who is also a physician, told me about his experiences with a (certain famous) new electronic medical record that's just been installed in their hospital. I remember this same friend telling me a few months ago that he was looking forward to the change, anticipating that it would make his and his patients' lives better. He turned around to me after taking his swing and said, “You know what, it's all been a big disappointment.” That was a profound thing to say, as I'm sure it sums up how hundreds of thousands of physicians across the United States feel about their EMRs.
A desperate disappointment indeed. There was so much promise and hype a few years ago and nobody really wants to go back to the bad old days of piles and piles of paper charts. So what went wrong? An excellent recent article published on the social media blog KevinMD, sums it up here, as does a parody video by ZDoggMD. In a nutshell: health care information technology interferes with the doctor-patient relationship and physician workflow in ways that nobody could have imagined. Disaster might be too strong a word, but then again maybe it's not, as statistics show that many physicians now spend an absolute minority (as little as 10%) of their day engaged in direct patient care. Physicians are intelligent on-the-go people and definitely not your average clerk or desk worker. Most of us went into medicine with very noble aims and won't accept our job being changed so much from what it is supposed to be.
This is of course a topic I've written a lot about, and readers may be surprised to hear that I was a huge advocate for health care IT as little as 5 years ago. The story goes something like this. I had been an attending physician for almost 3 years, loved my job, was involved in teaching and above all else saw medicine as a calling. I was approached to take part in a huge new project that the hospital was undertaking: creating a Computerized Physician Order Entry system that would revolutionize the way we put in orders for our patients. In my naivety, I hadn't even heard of Meaningful Use or federal incentives for my hospital. So I put my head down and got right to work.
I helped design and implement the CPOE system that our hospital would be using. At first this consisted of weekly meetings, but quickly became more intense. On a personal level, I met some fantastic folks and befriended people from the world of IT, consulting and hospital administration, enjoying the feeling of broadening my own horizons at the same time. I promoted what was happening to my physician colleagues and even made videos explaining what the new system would entail. It was several more months before we were ready to launch and thanks to intense investment in IT support by my hospital, the process went relatively smoothly. After that, came medication reconciliation and electronic progress notes—but by then I had already moved to another hospital in another state.
On my subsequent travels up and down the country, I've worked with almost every major IT and EMR system, and have unfortunately seen the train wreck unfold. I've witnessed seasoned physicians (and nurses) despair and in some cases almost bang their heads on the table as they struggle to navigate the inefficient and cumbersome systems placed before them. I've seen them spend ever less time with their patients. I've seen them moan about the lost productivity and not being able to see as many patients. I've seen patients complain to me in droves about how their doctor never even looks at them in the eye any more. Oh where oh where did it all go wrong?
Looking back, the warning signs were there from the start. Many of the other physicians leading the charge to expand health care IT had no interest whatsoever in clinical medicine. In fact, many of them were looking at it as their passport out of frontline patient care, and am sure are now sitting comfortably in ivory towers contemplating the wonderful world of “big data,” “connectivity,” and “cloud solutions.” I remember 1 of them openly telling me when I once made a suggestion that a certain method wasn't going to make things faster for the physician, that health care IT “isn't being designed to make things faster and more efficient for doctors.” I remember one of the external consultants proudly telling me that their IT solutions represented the way of the future and that he had seen older (and no doubt popular) physicians in previous hospitals leave their practice altogether because of their new electronic medical record.
Now I look back and remember that promise of a brave new world of health care IT. One that I thought would be seamless, efficient and user-friendly. One that would be as simple and pleasant as using my iPhone to place an order in a few seconds. One where I could spend more time seeing patients and less time writing notes. Oh my, I was so duped.
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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