Every workday morning I spend 30 minutes or so reviewing my Twitter feed. By following a select group of top healthcare news observers and thought leaders, I find that Twitter works pretty well as a filter for the news events and topics that matter most to me. Over the past couple of days, I’ve been alerted to some articles about nurses and doctors who are, shall we say, quite frustrated with electronic medical records and what they perceive as a decline in the physician-patient relationship.
One of the articles that caught my attention was about a nurses’ union, National Nurses United, that has launched a national campaign to draw attention to what they say is “an unchecked proliferation of unproven medical technology and a sharp erosion of care standards” in today’s hospitals. Of course, their agenda and real concern seems quite transparent. It is not so much about technology itself as it is a decline in the number of Registered Nurses directly involved in caring for patients at the bedside.
The nurses’ union campaign seems to resonate with another article I came across last week about the lost art of the physical exam. That article from Kaiser Health News and the Washington Post extolls some very legitimate concerns about doctors who rely too much on lab tests and medical imaging to arrive at a diagnosis instead of talking to, touching, and examining the patient. The article provides some great examples of missed diagnoses, patient harm, and undoubtedly increased healthcare costs because doctors caring for these patients either didn’t do, or didn’t know how to do, a good physical exam.
A third article that caught my attention was found on Medscape. Titled, Doctors Are Talking: EHRs Destroy the Patient Encounter, the article reviews reaction to an earlier article about doctors who are employing scribes to enter data into their electronic medical record systems. As I’ve commented many times before here on HealthBlog, I do recognize that data entry remains one of the greatest challenges to overcome for physicians who use most of today’s electronic medical record solutions. Healthcare is a data intensive business. In the past, we just scribbled (mostly illegible) notes on paper, or used a dictation system to record information about patient visits that was later transferred to paper by professional transcriptionists. Now, there is an expectation that the doctor himself or herself will enter (via mouse and keyboard, or speech recognition) the vast amounts of data that must be captured during a patient examination. Doctors complain that electronic medical records have turned them into (expensive) data entry clerks. Here, they do indeed have a point.
What I find disturbing in all of the above is the knee-jerk response to blame technology for “destroying healthcare”. For instance, the nurses’ union states that “The American healthcare system already lags behind other industrialized nations in a wide array of essential health barometers from infant mortality to life expectancy. These changing trends in healthcare threaten to make it worse.” Really? Point in fact; America has been a laggard in the adoption of electronic medical records compared to many of the industrialized countries being cited with those much better essential barometers of good health. Nearly 100 percent of the doctors in many of the European countries to be found on that good health list have being using electronic medical records for a decade or more. Trust me, it is not electronic records that are contributing to poor health statistics in America any more than it is technology that is contributing to the lost art of the physical exam. Regarding the latter, I believe the decline in physical exam skills among American physicians has more to do with a payment system that increasingly rewards doctors for doing and not so much for thinking.
You won’t get an argument from me that electronic medical record solutions aren’t a part of the problem, or that they couldn’t be made a whole lot better than what many American doctors and nurses are using today. Traveling overseas, I’ve seen solutions that I think are better, and far less costly, than many of the EMRs used in America. Of course, those overseas solutions are much less focused on billing functionality than the typical American solution. Therefore, they tend to be more elegant in design around actual clinical workflow and the clinical end-user experience.
Technology will continue to improve. Better speech recognition and other data entry modalities, user interface improvements, machine learning, artificial intelligence, analytics, better mobile devices, better connectivity, and cloud computing—all of these will contribute to technology that works better for the humans who use it. And in those cases where it doesn’t measure up, I’d say let’s spend more cycles on fixing what’s wrong than on blaming it for destroying healthcare. “It’s the technology, not us” just isn’t a good enough excuse.
Bill Crounse, MD Senior Director, Worldwide Health Microsoft