Physicians have terrible technology, but they refuse to recognize high-tech as a medical specialty. They must integrate technology as they do laboratory science.
Physicians are certainly suffering from poorly-designed electronic medical records (EHR), but they are also guilty of wilful blindness in abdicating responsibility for technology in medicine. This must change.
Physicians have a higher suicide rate than post-combat troops in the military. A lot of this is due to widespread burnout from poorly designed EHRs. Yes, it sucks, but who is really at fault?
What if this problem was a consequence of a professional stance medicine can choose to reverse? What if it won’t go away until we do?
How physicians are getting their asses kicked
The constant stimulation of stressful popups with little-to-no clinical significance and lack of relevant data prioritization has led clinicians passionate about bedside medicine and concerned about medical errors to become highly critical of EHR.
Many physicians feel moral injury from their increasing inability to influence the quality of the cognitive environment they are forced to work in.
Simultaneously, physicians’ core clinical roles are being overrun. AI at Stanford predicts patient death and dispatches palliative care docs to the bedside. The U.S. military is developing robots to perform remote surgery on soldiers on the battlefield. Small startups vie to build hand-held diagnostic mini-laboratories which can be sold directly to consumers.
These technologies are not being designed by doctors; they are being designed by computer scientists, electrical engineers and college kids at hackathons. Why? Because doctors have decided that technology is something they use, not something they make.
Hospital software is commissioned improperly.
First, no reputable software designer would excuse the interfaces and circuitous pathways of modern EHRs. EHRs are not only bad medicine, but they are also lousy technology.
A quick glance at any hospital interface on the clinical market makes human-computer-interface (HCI) specialists wince in pain. Watching even the most adept user navigate an ordering system makes interaction designers cry. It’s undeniably, unbearably, unethically terrible software. And the rest of the technology clinicians get is pretty shit too.
But the problem with medical technology lies in its design, development, procurement and implementation. Because clinicians have no little-to-no involvement in that pipeline, the people who do — hospitals, insurance companies, and payors — have no incentive to make clinical care more efficient. In fact, it’s quite the reverse.
Unlike children’s computer games, there is simply no free market for medical software. Currently, the EHR end-user is not utilized until they use the software to order life-saving treatments for patients. And by then, it’s much less useful and more time-consuming than a paper prescription pad.
Simply put, your 8-year-old child has more autonomy and input in the usability of Plants vs. Zombies than your surgeon does on his laparoscopic equipment.
What doctors don’t understand about technology
Doctors are also narcissistic about their specialty as a market. The truth is, despite all the money floating around in health care — EHR was a $29 billion industry in 2020 — most early-stage software developers avoid med-tech.
Doctors and health care systems are perceived as combative buyers without disposable cash, who avoid collaborative development and cannot implement technology rapidly enough for in situ development. Even worse, the user isn’t the buyer, and buyers and users have competing interests, so startups face a double bind — you literally can’t build software that will make your user happy. If you do, you can’t sell it.
Most doctors hate technologists because they believe technology development should be useful out of the box and should be able to design software by giving orders for its design — instead of becoming lab rats in its development, or heaven-forbid, learn how to build it themselves.
The truth is technology is just like laboratory science. It’s a different discipline, with different rules and parameters for success. And doctors know f*ck-all about it.
Physicians can do much, much better.
Drea Burbank is a physician-entrepreneur.
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