Blog | Monday, June 19, 2017

The Greek tragedy of electronic medical records

I've spent a lot of time writing on this blog about the suboptimal nature of electronic medical records and what we need to be doing better. At their best, health care information technology systems can make finding patient medical data unbelievably quick and easy. However, at their worst, they take up an unacceptable amount of physicians' time and also dumb down medicine, reducing our patients' stories to rows of meaningless tick boxes.

If you were to ask any doctor (or nurse) what one of their biggest daily frustrations is, health care IT would be at or near top of the list. The problem isn't with technology itself, which very much represents the future in all aspects of our lives, but rather the fact that the current crop of IT solutions are not properly reconciled with frontline clinical workflow. For more about why these systems were rushed out in response to federal incentives, please watch my video explanation here. Basically, they take far too much time to navigate and turn doctors into “type and click bots.” Medicine is a social and personable professional that will always require a healthy dose of human touch. With statistics suggesting that physicians are now spending only a fraction of their day in direct patient care (sometimes shockingly as low as 10%), there's more need than ever to remember this.

A recent physicians' meeting I attended, served to reinforce my feelings on this subject. A former practicing physician who had read my blog reached out to me to gain my thoughts on the current state of health care and the practice of medicine. She then told me that there was a local area meeting as part of a book launch (focusing on physician job satisfaction) and asked if I'd be interested in going. So there I found myself one day in April in a room with the some of the most interesting and talented physicians I could ever hope to sit down with. All sorts of specialties and a diverse age range, from early career to approaching retirement. As we went around the room and talked about our own experiences, there it was again: The headache of the new world of health care IT. It kept coming up again and again as one of these doctors' biggest reasons for job dissatisfaction and burnout. The endless click boxes, inbox and alert headaches, the extreme lack of time with patients as a result. It was all very familiar.

As I heard these stories one after another, I wondered yet again: How did the medical professional allow this to happen? The group that I was sitting with that evening were such a dedicated and capable group of doctors—yet how they practiced medicine and their visions of what being a doctor would be like, had been shattered. When you take a highly skilled profession and drastically change the notion of what working in it involves, such disappointment is natural and understandable.

My question is, do the world of administrators and IT crowd really comprehend what's happened? Do they understand that doctors don't want to spend over 80% of their day stuck behind a screen? Do they understand that patients dislike it when doctors keep looking at their computer instead of at them?

Another recent article summed up this issue well, by stating that the general public would be shocked and saddened if they saw what the life of a modern-day physician now looks like. How far away this is from the perception of the hero frontline doctor that is portrayed in TV shows, and was the ideal that the current generation of doctors looked up to when they first applied to medical school. Oh, world of regulators and IT professionals, you have got so much to answer for!

So what's the solution to all this mess? Well, for a start, let's realize that going back to pen and paper is not the answer, just like going back to horse and cart was not the solution when the first automobiles flunked. The only answer lies with the world of administrators acknowledging that this is a huge problem, frontline physicians collaborating closely with IT developers, and for major health care technology vendors to have an incentive to improve rather than behave like a typical monopoly once they have a foothold in an organization.

I, myself, have devised my own techniques for getting away from that computer screen and trying to stay true to the ideals of good and thorough bedside medicine—but it's no easy task, and relies more on just accepting that what we have is so cumbersome, and therefore arranging my work routine around that.

A very wise old-school physician I worked with, who recently took early retirement (much to the disappointment of his loyal patients) told me that he felt like practicing medicine had become ”death by a thousand clicks”. That's an analogy any doctor can relate to, and also happened to be the title of another recently released article on the subject.

Until those “dream” IT solutions are developed—that are fast, seamless and integrated with frontline workflow—this Greek Tragedy of what happens when doctors lose control, continues.

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.