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Friday, October 7, 2011

The Impact of Health IT on Doctor-patient interaction

A recent Twitter conversation put us in mind of the Royal College of Physicians Health Informatics Unit's 10th anniversary celebration at which we observed this: "One not to be named (except perhaps for a fee) attendee drew a picture of a brontosaur on his notepad as the President of the RCP was rounding up and expressing his concerns about clinicians' ability to enter data into computers whilst in the demanding setting of the consultation or ward round"

That the not-to-be named individual was of a younger generation might be guessed as might the fact that they are embedded in DoH IT initiatives - it might be more surprising to discover that they have a background in emergency medical care... without disclosing more, let's just say this guy ought to know what he's talking about so how can his viewpoint be so radically different from our recent Twitter interlocutor from the States whose blog hosts a ten-point list of problems with Healthcare Information Technology.

This analysis comes from someone whose experience also ought to lend them some claim to authority: "based upon more than 40 years experience in patient care, teaching, administration and research. That is ... experience in a cross spectrum of patient care from primary care to tertiary care and quaternary care ... from primary prevention to treatment ... from home to hospital ... treatment of some of the sickest patients in the nation."

So what's the deal here - is it a generational thing? Is it a US vs UK thing (the UK has some advantages in having a single National Health Service)? Is it hope vs experience? Or, as we think is it rather the fact that the observations that our US friend makes hit the right issues but that our UK dino-drawer is more optimistic that we are already addressing and overcoming these problems?

The ten points are as follows - for the real detail on each see the blog - we want to know what you think about each of these, are they US problems, are they non-problems, or are they still hurdles to overcome?:

1. Interface: Too Cumbersome and too much time is used interacting with computers.
2. Data Entry: Too Cumbersome

3. Data Sharing: Too Cumbersome because proprietary systems don't talk to each other.

4. Security: Inadequate & related to #3 above

5. Ease of USE: Non existent

6. Time dedicated to machine: Excessive

7. Redundancy: Inadequate [this relates to back-up in case of power-outage etc.]

8. Reliability: Inadequate

9. Comprehensiveness: Inadequate

10. Flexibility: Minimal

Let us know your thoughts...

1 comment:

  1. Thanks for including me in your conversation. I take it that in the UK your HIT is non proprietary and Government property?
    As a front line provider & proponent who has dabbled in EMR creation and relational data bases for ... how long have they been available? ... I am continually struck by the inadequacy of proprietary EMR products available in the US. And, I can only conclude that the proprietary model is the major barrier to eliminating the flaws ... or is it Ego? Money/Ego? Money vs Ego? Money & Ego ...
    Anyway, no matter what the causes, I strive to set up a Non-Profit Doctor-Patient Health Care Cooperative, and think that the HIT problems can be resolved as a part of the Mission. The objective would be to find a group of IT people who will work together with me to create the ultimate open source HIT platform. I can do it on paper ... I just can't do it electronically.
    It is interesting to note that the HIT people look at me as if I have two heads when I tell them that their product is not good enough, because it gets between us ... between the Doctor and the Patient ... and takes time away from my patient care time. They just don't get it. I should not be surprised, right? HIT people think that interacting with a computer is natural, right? Prove me wrong.
    Well, like it or not, I have watched technology chip away at the Doctor Patient Relationship and nursing time ... bit by bit over the years. Now, it is simply madness ... And, while it may not make a difference ... in certain scenarios where care is irrelevant and people will get better anyway (most clinic patients), it is a serious problem in the ICU, or in the OR to have 25 - 50% of physician time spent on computers. This is foolishness! Especially today ... in an era with availability of such sophisticated technology. Doctors and nurses spending precious patient care time on computers? This is CRAZY, not NORMAL! NOT RIGHT and NOT ACCEPTABLE. If I only had a chance to talk with Steve Jobs ... I am sure he would have seen the value of fixing this problem. Ah, well ... it is what it is.
    Right now, as it stands, we could instantly solve the HIT interphase problem and help reduce unemployment by hiring scribes to serve as the interphase between Doctor and Patient ... one for each patient in the ICU and one for each patient in the OR. (Do what you like in the clinic.) This would work as an instant stop gap measure while we push to bring this monster around to a technology that is friendly to the Doctor - Patient relationship and Nursing care of the patient.
    To be continued ...
    Dr. Mike