Tales from the Bleeding Edge: A Series of Discussions Centered on the Emergence of Information Technology (IT) in Healthcare
Over the next several months, we are going to explore medical IT in detail. Why? Because whether we like it or not, IT is going to figure into our practices in a huge way. The big question is not whether we will use some forms of information technology, but rather whether it is by choice or by mandate. We’ll look into the reasons that previous IT solutions have failed as well as what we can expect to see in the next few months to years.
“They say we hate technology”: Why Information Technology (IT) has failed to stir our imagination.
If you ask most business experts in medical IT they will tell you, almost without exception, that the reason that IT has failed to penetrate the market in a big way is because doctors don’t like technology. They say that we won’t ever use it. They point to the disappointing financial performance of Web based information services and electronic medical record (EMR) vendors as positive proof of our techno-aversion. Is there any truth to it? Are we technical Neanderthals or is this just an example of blaming the customer for bad or poorly implemented products?
Considering that you are more likely to see a physician carrying a laptop or keying information into a PDA, than you are to see them carrying a black bag it seems unlikely that we have a serious aversion to technology.
Ask any hospital administrator about physician views on technology and I suspect that they also would have a different perspective from their business colleagues. Doctors are constantly pressuring their hospitals to purchase and implement all kinds of technologies – sometimes when there is little science to back up the vendor’s claims. We LOVE technology. We love our toys. So what gives? Is IT different?
The answer is yes – and no.
First, what is IT? That’s the first problem. IT is not one thing. It runs the gambit from simple scheduling programs, and office billing systems, through electronic record keeping, all of the way to Knowledge management systems that border on artificial intelligence. We physicians already have invested heavily in the scheduling and billing portions of the IT industry. We have largely rejected the EMR and haven’t a clue about what to think of the other stuff.
There are some real differences between IT and other technologies commonly used in healthcare. Some of those differences create problems. What are these differences?
1) Fragmentation: If you buy a surgical instrument from one vendor you can usually assume that you can use one from another vendor during the same operation. They don’t blow up if they come into contact. Likewise, a CT scan from a Phillips Scanner can coexist in the patient record with a scan taken on a GE system. Not so with IT. IT is supposed to make communication and flow easier. Then why can’t many of these systems talk to one another? Rather than improve communication, IT has created a medical “tower of Babel” where one system is incompatible with another and exchanging information between systems requires a PhD in computer science. MD’s don’t want to have to buy 7 systems to cover the needs of their practice. If the pitch used to sell these systems is improved office efficiency, it doesn’t help that the physician has to pay people to enter data from one system into another one. Until there is seamless connection between office systems that, in combination, cover all of the needs of the office-based practitioner, forget it. Integrated solutions are what we need. Or at least one system has to interface with the others.
2) Information: “what doctors need is more information” We’ve all seen that slogan on a dozen Web sites. WRONG! We have more information than we know what to do with, as it is. . A common misconception is that the mere act of placing information on the Web is a major advance. Yes and no. First, that information didn’t spontaneously generate out of the ether – it came from some existing source (unless someone made it up which is another danger of the Web). Good information came from some reputable source and was subjected to some form of editorial review. That isn’t necessarily true of all information on the Net. Second, looking up information on the Web is not a whole lot better than looking it up in a book (books tend to crash less as well). It is fine to be able to look up everything known about a disease on the Web – problem is that to benefit from this ability you have to make the diagnosis first. It is about like that annoying aspect common to the use of a dictionary – You have to know how to spell the word to look it up! What we need is access to reliable, relevant information, in a timely manner that expands the fund of knowledge that we bring to bear on behalf of our patients. Ideally, this access must be automated. And we need to feel confident in the quality of the information that we access.
3) Missing the forest for the trees: EMR –It sounds great on paper. Market penetration is not that great. Works great in the hospital but why not in the office? EMR is not struggling because the products don’t perform as designed, but rather they weren’t designed with the real needs of physicians in mind. The job of a physician is not to collect records for the winter like some white-coat clad squirrel. Physicians are charged with diagnosing and treating illness. Record keeping is important but secondary. EMR’s have a hard time proving that all the trouble to which you have go to enter data into the system is making us better doctors. It certainly doesn’t take less time. This might change if EMR’s helped doc’s really use all of that stored information on behalf of the patient. That would serve a compelling need. Until that happens, that old paper record is hard to beat.
4) “The fault lies not in our stars, but in ourselves” Old Will Shakespeare could really turn a phrase. This one is particularly important to those of us in the medical profession. I’ve beaten up on the industry a bit so it is only fair that we give ourselves some attention. We have often been our own worst enemies. The promise of the newer Knowledge management programs is a case in point. We carp about how primitive or limited that they are, but the real problem is they strike a little too close to home. Tools that know something we may not, make us nervous. We have to remember one basic truth – In our training, we learned only a portion of what was known in medicine. We retain only a portion of what we have learned. We access only part of what we retain each time we see a patient. Any tool that improves the fund of knowledge we bring to bear on the patient’s behalf is a godsend. We need to remember that these programs are just tools. And any tool that allows us to avoid even a single error is not a trivial thing. If we are serious about the quality of care that we provide we must use any tool that helps.
In short, there is great promise in IT once we get over our insecurities and the vendors build some products that fit our needs. In the coming months we will delve into this subject in far greater detail. Until next time…