Quantified health and the great digital divide

Go into any hospital today and notice that between every great nurse and patient sits a computer terminal. The quantified health movement has created the great digital divide, between the patient and everyone else.

The nurse of old used to actually touch the patient. No more. Now, they wheel in a computer console, sit down and record the digital output of the wired up patient, every vital sign, every drug order or scheduled procedure. It’s the same with doctors’ rounds. Groups of doctors place a mobile computer between themselves and the patient and stand around talking about the numbers.

In the central nursing stations, where conversations about the patients used to lead to sharing insights, no one talks. Everyone from the nurses to the visiting doctors are pecking away at the multiple computer consoles.

And it’s not just the patients who are being recorded.  Everyone is being quantified. How many seconds did the nurse take to collect the vital signs? Recorded and graded. How many seconds did it take to draw the blood? Slower or faster than the standard?  How many entries in the patient chart were made?  All recorded, scored and eventually economically credentialed. For the nurses, too slow is too expensive, slow nurses can be replaced by faster ones. For the doctors, too many requests for expensive tests or consultations may lead to a restriction of their admitting privileges or the loss of their hospital-based job.

Talk is not quantifiable, so it’s out with the inefficient chatter and handwritten thoughts and notes.

Old-style medical records, which used to have the thoughts and musings of doctors on the possible diagnoses, exist no more.  It is indeed faster for the doctor to cut and paste the same note each day (patient alive, vitals signs checked, wound dressings dry etc.) but there is no interpretation, no guidance in these standardized notes. There is no patient chart to pick up and thumb through, looking at all the nurses’ notes and consultants’ recommendations.  The patient only exists in bed and in cyberspace.

The sterilized electronic record provides data to the system. The digitization of the American health care system is supposed to wean out inefficiency and improve health care. Eventually, it may become more cost efficient, after the software glitches are all resolved, but it only improves the care of patient from the point of view of those who want to watch data from across the room.  Me, I still love to talk to the patient and even touch them too.

Kevin R. Stone is an orthopedic surgeon and chairman, Stone Research Foundation

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