Earlier this week I had the pleasure of undergoing an outpatient medical procedure in one of Seattle’s most highly regarded medical centers. Without getting into unpleasant details, let’s just say it was one of those screening exams we’re all supposed to do every 5 to 10 years beyond a certain age and that it involves threading a very long tube (scope) where the sun doesn’t shine. Fortunately, the procedure is usually done with the patient under conscious sedation. What that means is that I don’t really remember a thing about it and that’s just fine with me. However, I do have perfect recollection of everything that transpired up until the time I felt the warmth of those sedating medications shoot through my IV. That’s what I want to share with my readers.
As I said, this took place in one of Seattle’s premier medical centers. They have an enterprise information system and an electronic medical record for their hospital and clinics. However, most of the physicians (especially those in the medical center’s satellite clinics) complain bitterly that the system is too hard to use, too inflexible, and doesn’t meet the needs of physician work-flow; despite the fact that the medical group has invested tens of millions of dollars in this solution.
As I sat in my hospital gown being interviewed and prepped by the IV sedation nurse, I was struck by how many pieces of paper I spotted. There must have been 10 or 15 forms scattered across the room. There were forms for my medical history, allergies, medications, consent, discharge, operative report, anesthesia, and a whole bunch more. “Why”, I asked, “were there so many pieces of paper in an institution that was supposed to have gone electronic?” My IV nurse replied that the systems in place were too hard to use, often unreliable, and that many of the physicians trusted their paper forms more than they did putting vital patient information into the computer.
Dr. Michael Wilkes who writes for the Sacramento Bee may have hit the nail on the head in a recent column entitled “Inside Medicine: So far, electronic records don’t help patients much”. But the point he’s really making is that so far electronic medical records aren’t helping patients or doctors very much. He writes, “Today, a flat-screen computer sits between the doctor and the patient -- just as a fence divides two neighbors. My students and residents -- like doctors around the country -- are slaves to the computer and electronic medical records. If you've not had the experience of sitting across from your doctor as she or he types your medical history into the computer, then just wait”.
Dr. Wilkes also takes a well deserved pot shot at systems that are too expensive, proprietary, and don’t talk to one another. He goes on to say that many of the systems in use today rely on templates for data entry. While this speeds work-flow and helps validate billing codes it also has “a potential for electronic forgery and dishonesty that allows for increased billing, and quick note production, but may do nothing to improve patient care. In fact, it may hinder care and could lead to major problems”.
But before we place blame on physicians for being old fashioned or technophobic, let’s look at the root cause of this push-back on electronic records. How many times have I pointed out that physicians meet the very definition of information worker? They are the ultimate information workers. Have I not repeatedly stated that they deserve the very best tools and technologies our industry can deliver? They must have solutions that are entirely intuitive and require very little training. These solutions must offer every means of data input; from digital ink and voice, to “point and click”, to audio and video capture, and more. These solutions must extend across an entire range of devices to provide information at the point of care and everywhere in between. They absolutely, positively must be mobile. They have to be interoperable, and they should cost a whole lot less than most of the solutions on the market today.
We have the technologies necessary to meet these work-flow requirements. Why aren’t we seeing better solutions on the market? I implore all industry solution vendors to work together to figure this out. If we don’t, some government bureaucracy will do it for us and I guarantee that not one of us, technologists or clinicians, will be very happy with what we get.
What do you think? We’d love to hear from you.
Bill Crounse, MD Healthcare Industry Director Microsoft