Blog | Monday, July 8, 2019

Code Blue technology: Why is nobody listening?

Since I started my blog about 5 years ago, one of the topics I've been writing about from the beginning—which concerned me most about the health care frontlines—was the suboptimal technology being implemented across the country (click here for an early article I wrote). I was one of the first physicians in the blogosphere to identify this as a serious issue. I already knew there was an enormous problem brewing because I had worked in an administrative capacity too, during the implementation of new computerized health systems—and had experienced several hospitals up and down the country. I encourage every physician out there, or anyone else who's interested in the history of this topic, to familiarize themselves with Meaningful Use and how this all started with the economic crash of 2008 and the federal stimulus package signed by President Obama.

Fast forward half a decade, and the problem of suboptimal, clunky and inefficient technology for doctors and nurses, is almost daily news. It is the number one driver of physician job dissatisfaction and has caused so much misery for physicians all over America. It takes an unacceptable time away from what physicians were trained to do (in no other profession would you spend 5X the amount of time documenting what you just did, compared to X amount of time actually doing it). I would also suggest listening to the amazing monologue by celebrity doctor Zubin Damania (also known as ZDoggMD). This is probably one of the most brilliant short speeches I have heard on what's happening at the frontlines of health care, and a call to action (video here has been viewed almost half a million times). Health care information technology unsurprisingly makes it into his talk a number of times.

To give anyone non-medical reading this, an idea of what's happened. Firstly, it may sound like when doctors complain about computer systems, they are being “anti-technology”. Far from it. Physicians (including myself) want to embrace technology as much as the next intelligent person. But we want good and seamless technology that works for us and makes us more efficient. Ten years ago, when I was still doing my residency, the workflow used to go something like this: See a patient and then spend 5 quick minutes writing a note and placing orders if necessary (using a computer to go over results and retrieve other information). Now with electronic medical records: see patient and spend 20 minutes plus, with the computer doing the same thing. Multiply this by all our patients, and not only does the workload increase exponentially—but patients bear the brunt of squeezed time slots with the onus on your doctor to “get back to the computer” as soon as possible. It's quite ridiculous that health care in America is the only industry where computers have dramatically decreased frontline efficiency and made it more difficult for professionals to do what they were trained to do.

My question though is this. I have worked in numerous institutions, given talks all over the country and met thousands of physicians, administrators and IT professionals. Why is this issue completely falling on deaf ears? Doctors everywhere keep identifying poor health care information technology as the number one reason for job dissatisfaction and “burnout”, with the massive mind-numbing data entry and administrative requirements that are attached to screen staring. It's not a secret. Yet I haven't heard any high-level administrator or health care leader really take it seriously. It's infuriating how this is just like water off a duck's back. The cynical side of me wonders, these are intelligent people with advanced degrees and real world experience. Is it deliberate? Are they embarrassed and lost themselves? Do they hope that by staying deafeningly silently on this top reason for so much unhappiness, it will eventually just go away? What exactly is going on?

So here's a suggestion for every health care organization. Instead of creating silly “wellness programs” or hiring for BS positions at yet more cost—like “Wellness Officers”—do this one simple thing that may help: Put sincere effort into, and hire someone if necessary, to lead “IT improvement and physician workflow”. This person should go out there and help modify your electronic medical record and be relentless about making it better. Improve interfaces, reduce clicks, and do whatever else is necessary to decrease screen time for physicians and encourage them to spend more face-to-face time with patients. Cut back on excessive bureaucratic requirements for physicians and support them administratively with tasks that they shouldn't be doing. Not only will this make physicians happier, but also more productive too (and because you are so revenue focused, it will almost certainly result in more patients being seen). While this won't magically solve all the problems we have in frontline health care, it could certainly result in a big first step in improving physician and nurse morale.

They say the key to solving any problem, is initially accurately identifying it. I'm not sure what more I can do. I have written blogs, made videos, sent emails, given talks around the country—and I have seen precisely zero genuine interest from administrators. That doesn't mean I stop (it only makes me more determined on my mission). But boy, do we need them to listen. I'm not holding my breath, but the battle continues. And I hope all physicians out there give a loud and clear message: Healthcare information technology is unacceptable right now and needs to get better STAT. As ZDogg suggests in his video, the time for sweet talking is well and truly over.


Here are just three of the many articles I've written about this over the years. How much progress or interest have we seen from high-level administrators? Precisely zero.

Frontline IT struggles, and 3 unique reasons why health care IT is so bad for physicians

Why health IT is such a tragedy

5 ways poorly designed health care IT can worsen patient safety

Suneel Dhand is an internal medicine physician, author and speaker. He is the founder of DocSpeak Communications and co-founder at DocsDox. He blogs at his self-titled site, where this post first appeared.