The digital age, as we have heard over and over, has heralded in modern-day miracles. The smart phone has become ubiquitous, the portable pad (unheard of five years ago) a must-have accessory, and the laptop — once portability’s peak — a large, clunky dinosaur. Our work and personal lives have been transformed by the switch from analog communication (paper, chalkboards, record albums, etc.) to digital (screens).
In some areas, this has caused major disruption, and probably for the better. The music industry, for the most part, has been brought to its knees by the elimination of the industry’s monopoly on recording and distribution. These days, a musician can make a record on a laptop or iPhone, and distribute it on YouTube. Unless you’re actually in the music industry, this can probably be seen as a good thing.
But digital disruption has not yet become the blessing it promised in other areas, most notably in the medical field. A story in the Contra Costa Times outlines the serious struggles the county health system is having with its new electronic medical record. Doctors, nurses and other providers are not happy with the way the system has been designed – it seems to cause more problems and delays, giving them even less time to be with patients. And the patients are feeling the pain as well, with increased wait times for appointments and a staff that is overly stressed from trying to deal with a new computer system that is unfriendly and anything but intuitive.
Because it is the county system, the public can hear about the struggles. County physicians and providers do not have to keep quiet about it. But rest assured that most if not all major health care organizations are facing the very same dilemma. They just can’t talk about it publicly. Electronic medical records are supposed to be the next cool thing, and a selling point for potential customers. Saying how miserable the new system makes your doctor is not a marketing strategy.
Why is this such a hard transition for the medical field? After all, these are extremely bright people, many of whom already have a love affair with programming and data compilation.
When it comes to things like digital imaging and robotic surgeries, it seems as though physicians and technicians are right at home. It’s the record-keeping part of the electronic medical record that is so daunting. Every time your physician sees you for something, it needs to be recorded as part of your medical record. The entire transaction needs to be recorded and stored in such a way that it is available to any other physician in the system (and someday to those even out of the system), so that you can get what is known as a good continuum of care. That’s the dream, and the vision.
The reality is quite different, however. The people who are charged with designing these record-keeping systems are not physicians – they are designers of systems. They have a nearly-impossible task: make a program that a doctor, nurse, radiologist, therapist, receptionist, etc., can all use to input patient information into, have it stored in a format that can be called up instantly and interpreted easily. That requires programming skills nearly equal to that of a physician.
But again, the designer is not a physician. And, while those who design these things do try and get input from physicians about what the program should look like, still, they have never sat down with a feverish five-year-old, or a terminally-ill young wife, or a lawyer with glaucoma, or a grandfather facing less than six months to enjoy his grandchildren.
Physicians need to spend time with their patients, which is why they became physicians. But now, more often than not, they’re spending inordinate amounts of time trying to check off boxes on a screen, so that the patient’s insurance company can change the appropriate amount for the appropriate diagnosis. They are, many of them, learning to type so the appointment can be recorded as part of the patient’s record. As most of us know, computers are not always the friendliest of devices, and can freeze, or do unexpected things, or simply refuse to do anything. When this happens to me, sitting alone in my office, I get furious and crazy.
Now imagine you’re a physician trying to deal with a sick patient, and your computer decides to freeze.
Health care is a science and an art. You can design things to capture the science, certainly, but as any recording artist who remembers the warmth and depth of analog tape will tell you, there is something about digital that just doesn’t quite want to accept the art.
Those in health care are finding this out the hard way. Let’s hope, for all our sakes, that this is just a speed bump on the road to progress.
Have you noticed any changes in your health care? Tell us in the comments.