Blog | Monday, July 17, 2017

A 5-point immediate action plan for health care IT

Following my latest article on health care information technology (IT), and how tragic the situation has become for physicians, I received a lot of correspondence. As always with articles that express physicians' frustrations with the current batch of IT systems, there's typically a lot of sympathy and agreement (although I believe that just nodding our heads and saying how bad a situation is, doesn't really mean that much).

In amongst all of the amicable correspondence were others slightly more confrontational, and one in particular stuck in my mind. It was from someone who said that it was no good doctors just sitting around and writing articles, and that we should “take action and stop complaining.” That such a comment was directed at me personally made me stop and think, because I don't think I could do any more to try to improve the situation! Through a mixture of my writing and consulting work, along with founding an organization, I (and many other physicians) are doing our very best to make health care IT better.

I learned a long time ago how true the old adage is: “Don't ever bring problems to the table without having a solution”. But it really isn't that easy when it comes to health care IT either. I've reached out to hospital IT departments in places where I've worked, met a bucket load of IT folk and administrators at networking meetings, and even made large presentations on the subject. As much as we as physicians try to engage these people, it frequently feels like we exist in two completely different worlds. Many (if not the majority of the IT sector) think like entrepreneurs, building business plans and focusing on how to sell their product. I'm surprised by many administrators as well, who keep talking in platitudes, discussing themes of “interoperability” and “big data”, seemingly completely detached from the realities of frontline medicine. Nevertheless, collaboration is the key to solving any problem.

Here is my 5-point immediate action plan for health care IT:
1. Acknowledging the problem
The first step for administrators and information technology professionals is to simply acknowledge what's happened over the last decade and why physicians (and nurses) everywhere will typically list health care IT as their number one daily frustration. Understand that medicine is primarily a social and personable profession, and it's unacceptable if doctors are spending only 10% to 20% of their day with patients. It used to be X amount of time with a patient, and then 0.3X time documented the encounter. Now it's X amount of time with the patient and 3X amount of time documenting and performing data entry. In no other profession would you spend so little time practicing your skill, compared to the amount of time documenting what you just did! It's not that doctors don't think that the future is all about technology—it definitely is. But we want fast, seamless and intuitive technology that “gets out of the way” and is “seen and not heard”.

2. Engage your physicians
Reach out to your physicians and identify those who have an understanding of, and are willing to improve, your IT system. These should be physicians who are fully engaged at the frontline and dedicated to high quality patient care. They should be natural leaders, in possession of good communication skills, but also with a keen sense of technology.

3. Perform a comprehensive analysis of your IT system
Through engaging physicians, get unified feedback on how the system and user interfaces can improve. This will include a series of items including a “click analysis” (amount of clicks to perform any given task), feedback on whether the screen interfaces are logical, and whether they conform to physicians' thought processes. No system should “box in” the doctor. This of course needs to be reconciled with the need to capture certain information and reach core measures—but not at the expense of making the doctor into a “data entry bot” and reducing patients' stories to rows of tick boxes. In my own experience of working with almost every single IT system, giving feedback and suggesting improvements, there are always ways to better the interface to make life easier and less cumbersome for the doctor.

4. Comprehensible final output
The final “product” that's generated by most IT systems, whether it be a discharge summary or a set of instructions for the patient—is frequently incomprehensible mish-mash. Reams and reams of data, confusing and meaningless to the typical human being. Add some thoughtfulness to this and make something that's not just “computer speak”. Remember, whether it's a doctor sending a summary to another doctor, or the instructions you give the patient to take home—make everything understandable and sensible, worthy of a great and highly esteemed profession.

5. Constant feedback loop
Before and during implementing any change, be in constant communication with your physicians. Keep on encouraging regular feedback, and make it clear you want the system to get better and will continue to work with them.

Physicians well understand the health care technology train, and how it was accelerated under the Federal Stimulus Package in 2009 (for my video explanation, click here). We also understand your huge lobbying power on Capitol Hill. But work with us to make things better! We can stay true to the ideals of good medicine while simultaneously allowing technology to revolutionize our industry. Furthermore, patients will be much happier as well.

Until those “dream” IT solutions of the future are invented, there is plenty that can be done to improve upon the designs we currently have. Other aspects of technology that also need a thorough work-over include voice recognition capabilities and mobile solutions for rapid order entry. Indeed, lots of work to do. At a time when physician burnout and job dissatisfaction are at an all-time high—with so many physicians listing health care IT as a prime reason—we need things to get better. ASAP.

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.