Healthcare 2007: The paper blizzard persists

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Earlier this week I had the pleasure of undergoing an outpatient medical procedure in one of Seattle’s most highly regarded medical centers. Without getting into unpleasant details, let’s just say it was one of those screening exams we’re all supposed to do every 5 to 10 years beyond a certain age and that it involves threading a very long tube (scope) where the sun doesn’t shine. Fortunately, the procedure is usually done with the patient under conscious sedation. What that means is that I don’t really remember a thing about it and that’s just fine with me. However, I do have perfect recollection of everything that transpired up until the time I felt the warmth of those sedating medications shoot through my IV. That’s what I want to share with my readers.

As I said, this took place in one of Seattle’s premier medical centers. They have an enterprise information system and an electronic medical record for their hospital and clinics. However, most of the physicians (especially those in the medical center’s satellite clinics) complain bitterly that the system is too hard to use, too inflexible, and doesn’t meet the needs of physician work-flow; despite the fact that the medical group has invested tens of millions of dollars in this solution.

As I sat in my hospital gown being interviewed and prepped by the IV sedation nurse, I was struck by how many pieces of paper I spotted. There must have been 10 or 15 forms scattered across the room. There were forms for my medical history, allergies, medications, consent, discharge, operative report, anesthesia, and a whole bunch more. “Why”, I asked, “were there so many pieces of paper in an institution that was supposed to have gone electronic?” My IV nurse replied that the systems in place were too hard to use, often unreliable, and that many of the physicians trusted their paper forms more than they did putting vital patient information into the computer.

Dr. Michael Wilkes who writes for the Sacramento Bee may have hit the nail on the head in a recent column entitled “Inside Medicine: So far, electronic records don’t help patients much”. But the point he’s really making is that so far electronic medical records aren’t helping patients or doctors very much. He writes, “Today, a flat-screen computer sits between the doctor and the patient -- just as a fence divides two neighbors. My students and residents -- like doctors around the country -- are slaves to the computer and electronic medical records. If you've not had the experience of sitting across from your doctor as she or he types your medical history into the computer, then just wait”.

Dr. Wilkes also takes a well deserved pot shot at systems that are too expensive, proprietary, and don’t talk to one another. He goes on to say that many of the systems in use today rely on templates for data entry. While this speeds work-flow and helps validate billing codes it also has “a potential for electronic forgery and dishonesty that allows for increased billing, and quick note production, but may do nothing to improve patient care. In fact, it may hinder care and could lead to major problems”.

But before we place blame on physicians for being old fashioned or technophobic, let’s look at the root cause of this push-back on electronic records. How many times have I pointed out that physicians meet the very definition of information worker? They are the ultimate information workers. Have I not repeatedly stated that they deserve the very best tools and technologies our industry can deliver? They must have solutions that are entirely intuitive and require very little training. These solutions must offer every means of data input; from digital ink and voice, to “point and click”, to audio and video capture, and more. These solutions must extend across an entire range of devices to provide information at the point of care and everywhere in between. They absolutely, positively must be mobile. They have to be interoperable, and they should cost a whole lot less than most of the solutions on the market today.

We have the technologies necessary to meet these work-flow requirements. Why aren’t we seeing better solutions on the market? I implore all industry solution vendors to work together to figure this out. If we don’t, some government bureaucracy will do it for us and I guarantee that not one of us, technologists or clinicians, will be very happy with what we get.

What do you think? We’d love to hear from you.

Bill Crounse, MD        Healthcare Industry Director       Microsoft

The Discussion

  • User profile image
    Dengin

    I have also undergone the procedure you mentioned, despite my youthful age, and I remember saying I was doing just fine after the procedure was over and walking straight into an electricity closet instead of the exit. That's why they say you should have someone drive you.

    Anyway, I think in order for technology to permeate more fully throughout the healthcare industry, it should be spoon-fed into the newest generations of doctors. When they learn their profession using the new tools, they are equipped to practice with the new tools. That, of course, does not address the existing practices and procedures, and that's a tough nut to crack. Hospitals are generally not well-funded, so an investment into technology must first and foremost show a cost savings aspect. I do believe there is a huge opportunity and incentive for hardware and software vendors to work together to create a standard solution for healthcare. This is, after all, affecting human lives directly.

  • User profile image
    Dengin

    I have also undergone the procedure you mentioned, despite my youthful age, and I remember saying I was doing just fine after the procedure was over and walking straight into an electricity closet instead of the exit. That's why they say you should have someone drive you.

    Anyway, I think in order for technology to permeate more fully throughout the healthcare industry, it should be spoon-fed into the newest generations of doctors. When they learn their profession using the new tools, they are equipped to practice with the new tools. That, of course, does not address the existing practices and procedures, and that's a tough nut to crack. Hospitals are generally not well-funded, so an investment into technology must first and foremost show a cost savings aspect. I do believe there is a huge opportunity and incentive for hardware and software vendors to work together to create a standard solution for healthcare. This is, after all, affecting human lives directly.

  • User profile image
    Bill Crounse, MD

    Thanks for your comments.  Unfortunately, many of today's medical students and residents are not being exposed to the most contemporary IT solutions during their training years despite the fact that nearly all of them grew up with computers. Sometimes this is because of funding deficiencies in our academic healthcare institutions, but often it is due to medical school deans and faculty so entrenched in "tradition" and doing things the way they've always been done that they inhibit the introduction of new information technologies in patient care.

    After the passage of more than 20 years, I visited my own medical school not long ago thinking that I would observe vast changes in the technologies being used by young clinicians in training.  Yes, I saw laptops in the lecture halls for note-taking or research on the Internet.  There were also computerized kiosks for certain administrative functions. Some students had even designed their own specialized Pocket PC or Palm applications to assist in work on the wards.  But up on the patient care floors it was pretty much business as usual; lots of paper forms and antiquated work-flow processes.  It really hadn't changed that much.

    We can and must do better to improve the quality and safety of patient care and the satisfaction of those who provide and receive that care.  And, we absolutely, positively must do better to train the next generation of clinicians using the most contemporary information technologies and devices available.

    Bill Crounse, MD      Healthcare Industry Director           Microsoft 

  • User profile image
    Bill Crounse, MD

    Thanks for your comments.  Unfortunately, many of today's medical students and residents are not being exposed to the most contemporary IT solutions during their training years despite the fact that nearly all of them grew up with computers. Sometimes this is because of funding deficiencies in our academic healthcare institutions, but often it is due to medical school deans and faculty so entrenched in "tradition" and doing things the way they've always been done that they inhibit the introduction of new information technologies in patient care.

    After the passage of more than 20 years, I visited my own medical school not long ago thinking that I would observe vast changes in the technologies being used by young clinicians in training.  Yes, I saw laptops in the lecture halls for note-taking or research on the Internet.  There were also computerized kiosks for certain administrative functions. Some students had even designed their own specialized Pocket PC or Palm applications to assist in work on the wards.  But up on the patient care floors it was pretty much business as usual; lots of paper forms and antiquated work-flow processes.  It really hadn't changed that much.

    We can and must do better to improve the quality and safety of patient care and the satisfaction of those who provide and receive that care.  And, we absolutely, positively must do better to train the next generation of clinicians using the most contemporary information technologies and devices available.

    Bill Crounse, MD      Healthcare Industry Director           Microsoft 

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