Blog | 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.