Technology is being held back from transforming healthcare

Right now, the technology exists to completely transform healthcare.

A doctor should be able to walk into the room where a patient is waiting for them and get everything they need to make an informed decision about that patient’s care.

Location-based technology should sense the doctor approaching and already know which patient is waiting for them. A computer or a tablet in the room should have access to thousands of data points on that patient (past hospital visits, surgeries, and allergies, the results of recent tests such as x-rays or cultures, the notes of the nurse who just triaged them) and yet be able to synthesize that data in such a way that is useful to the doctor. Relevant assessments of risk, such as the TIMI score of a patient who is complaining of chest pain, should be automatically fed to the screen. Artificial intelligence should make a suggestion to the doctor on a possible diagnosis, while providing them ready access to the information they need to explore other possibilities.

The thing is, information technology in other areas of the economy is already achieving this level of intelligence, interoperability, and ease of use. After all, this is the year that Twitter did a better job than the CDC at predicting the spread of the flu. Each smartphone we carry around in our pocket now has more computing power than Apollo 11 did when it landed on the moon.

And yet, information technology in healthcare is still stuck in the 1980s. As an emergency room physician, I can attest that the technology we do have does more to slow me down than help me deliver better, more efficient care. The past few weeks have seen a number of stories and studies questioning the value of EHRs. As one story from HIT Consultant notes, recent studies have shown EHR implementation “upends organizational structure and often slows down the provision of care,” and tends to exacerbate existing dysfunction rather than alleviate it. Meanwhile, patients don’t appreciate their doctors looking at a screen rather than at them, and doctors don’t appreciate having their practice slowed by data entry that, in the end, doesn’t help them deliver better care.

Make no mistake, though: the potential of information technology will one day transform healthcare for the better. The kind of user-friendly, interoperable, connected system I described will decrease medical errors, dramatically reduce unnecessary care and testing, and help doctors provide more effective patient-centered care. We’re just not there yet.

Dealing with information technology in healthcare today is like operating an automobile just after they were invented. Truth be told, it was still more efficient to ride your horse into town than take your car, just as doctors still reach for their paper and clipboard even when a tablet is available. The first cars broke down all the time, moved too slow, and were too expensive to operate. But eventually they caught up and far surpassed the tools they replaced – and so will healthcare IT.

It’s no secret why we’re stuck in the past. The incentives in healthcare – a healthier population still means less revenue for most hospitals – are more likely to discourage the sort of multi-million dollar investments in technology that could help deliver better patient care. Even so, cost pressures and healthcare reform are starting to shift incentives (New Medicare rules that penalize hospitals for re-admissions is a good example).

As incentives shift, so will investment dollars start flowing into healthcare IT. Forbes recently called this “Healthcare’s Trillion Dollar Disruption.” Reporting on the recent Startup Health Summit, Forbes states that, “the opportunity in healthcare is so big that most startups are thinking too small.”

So to all those doctors on the front lines and healthcare leaders frustrated with the pace of change: don’t give up on it. One day, our EHRs will be so sophisticated that we’ll look back nostalgically on the heady days when we used to grasp for our clipboards rather than deal with a health IT that only goes 10 mph and is less reliable than our horse.

Michael Cetta is an emergency physician who blogs at the EmergencyDocs Blog.

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  • Dr.Azim.j Khan

    Thanks for great info about health….

  • ninguem

    A large multisite group practice nearby, has had their entire electronic health database crash. On more than one occasion.

    Over a thousand physicians, over half a million patients. Thrown into the Stone Age, can’t even pull up the patient’s name and address, let alone health information.

    • Homeless

      So instead of your tricorder in hand, you are going to carry around your paper records. Really?

      “Sorry Jim, he’s dead because I can’t find his chart.”

    • w_km

      I think you meant to say “Temporarily Thrown into the Stone Age.” Modern databases running new hardware have multiple backup and emergency systems readily at hand. I don’t know the details, but it sounds like they skimped out on infrastructure and sub-par IT group. Since you say they were thrown into the stone age, it sounds like they also turned a blind eye to setting up EHR-crash procedures. But hey, lets stay positive, even when the computers fail we still have our brains.

  • Docbart

    EHR is certainly still in its infancy and not really functional to the degree of actually helping patient care in proportion to the time and resources invested in it. This is not for lack of will on the part of hospitals. They have sunk billions into it and inflicted its use on many thousands of their staff. Many medical practices have gone for the incentive dollars and the upcoding opportunities. Money is pouring into that industry.

    Why is it still so primitive? There are many answers to that. Just as the automobile industry had multiple producers and lack of standardization early in its history, that’s where EHR is now.

    Know how to recognize a pioneer? Look for someone with an arrow sticking out of his head.

    I’m happy to leave EHR to others and still use technology that works- pen and paper charts.

  • Bradley Hann

    Great article,

    I’m of the understanding that a big hurdle to IT in healthcare has to do with non-technical aspects of the problem. Who owns the information? What about privacy? What happens to litigation if patients always have a complete history, and can therefore find (and upload to a lawyer) any mistakes or omissions instantly?

    Would you please give your thoughts on these issues?

    • drg

      I can answer some of your questions. The patient owns their own records. If there are mistakes or omissions this is actually common as I have seen in my own records. rather frightening but true.

      Many of us don’t personally look at the notes but I can tell you with so much rushing there are a lot of mistakes. That’s where HIPAA comes in. You can go to the HIPAA privacy dept and request in writing that an addendum be made.
      They will never replace the note. They just leave the note that has the wrong information on it—and then add a note to correct that mistake ADDED to the chart–that will pull up whenever you look at that note. so you will see both.

      Nothing in law or medicine in litigation is fast so having things instantly is of little value that I am aware of.

  • bill10526

    I’m of an age where I had a passbook that bank clerks wrote in to record my deposits and withdrawals. Then came computers. I experienced being in banks when their computers were down, but that has not happened to me in ages. The system at my bank actually reads my checks and deposit/withdrawal slips. It’s amazing and accurate.

    When I was hospitalized in 2010 I kept an eye on how staff associated with the computer system in use. There was no crash while I was there (about 5 days), More importantly, nobody exploded with expletives from frustration with the computers. They liked the fact that the doctors typed instructions were readable. They now use the ubiquitous scanning codes to control their administration of medicines.

    Monetary savings will come when staff other than doctors enter data into the records and patients interact more directly with them.

    As a side issue. The hospital I was in had food dishes that retained heat and overcame the problem of meals going cold from kitchen to bedside. The hospital did a good job with meals. And the staff, to a person, were wonderful.

  • disqus_McUkQK6a8K

    exactly!

  • http://www.facebook.com/ImNtReal Jameson Pugh

    How do you propose the computer in the patient’s room “sense” that the doctor is approaching?

  • olusola creppy

    Is good for a hospital to be highly computerised but will be to expensive for patient at d end of the day and it will also reduce good communication skill such as, greeting and building good relationship, ask and listen, give relevant information, check understanding and discuss the next step of action the patient and family wants to take to try and solve d promblem etc. Without good communication, health personnel cannot gain the trust of the people in d community and information given to patient and families may not be easily understood. Is one thing to be computer literate, is another thing to understand the medical terms.

  • http://www.facebook.com/bubba.punk Bubba Punk

    Sometimes it’s best to let technology grow organically rather than trying to force it on everyone using a top-down approach. The bureaucrats at the top typically don’t have a clue.