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Monday, October 10, 2011

More on HIT's impact on Dr.-patient interaction

We've had some issues including Dr. Mike's response on Health Information Technology's impact on Doctor-patient interactions, so we've reproduced the response below with our own comments in blue - do let us know what you think about this area of informatics...:

Thanks for including me in your conversation. I take it that in the UK your HIT is non proprietary and Government property? Some might wish it were so! but this is not the case in the UK which is awash with 'solutions providers'; in fact many a US vendor has found their way into some of our NHS Trusts - Cerner, for example, have a number of products on the go here [Cerner and iSoft were the EHR subcontractors of prime contractors BT and Computer Sciences Corp (CSC)] - debate rages daily on the e-zine eHealth Insider over the failures and successes (for the sake of balance) of various providers on the UK scene.

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 ... We've often thought that rather than lamenting the dearth of clinical informaticians in the UK, some of our agencies ought to be encouraging their development from with the NHS by supporting NHS organisations to develop their own (standardised) IT solutions - as, in fact, many do...

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. There's a lot of discussion around the use of Open Source over here right now... will post links soon

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. Yup, surely we should be able to develop interfaces of sufficient sophistication that our clinicians do not also have to be trained and engaged informaticians!

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 interface 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

1 comment:

  1. Happy Monday! I will try to post on your blog and will go to my blog as well.

    Thanks again for including me in your conversion(s). It is good to know that some are thinking (actually thinking) about doing the right thing in regard to HIT.


    Regrettably, as with all things medical over the last couple of decades, there are many (THIRD PARTIES) out there who would be happy to take some $$$ out of this pot ... without regard to impact on patients and patient care. In other words, most (if not all) of these systems are a great source of income for the vendor and I venture that ALL would FAIL the scrutiny of cost benefit analysis, if they were in the mix of new products and services being examined. DON'T give them the money! Make them prove that it is worth it!

    But, everyone has (without good reason) jumped on the HIT train ... and it is being pushed full speed ahead ... before the tracks are laid. Sure, I like the data to play with, but is it worth compromising patient care to get it? And, the prices you are paying are a RIP OFF!

    My advice? If you don't want to waste money on HIT, 1. Don't buy anything before you test it! 2. Better yet, make it yourself and run pilots before you spread it around like fertilizer ... cough ... cough ... sputter. 3. Don't waste your time negotiating with 3rd party HIT vendors. Make them prove their systems by loaning trial hardware and software for testing on site!

    Seems as if Governments are in a good position to help develop a SECURE INTERNET that runs parallel to, but separate from the existing hardware and software. Over this INTERNATIONAL HEALTH NET, Personal Health Information could be shared (Standardized Data on OPEN SOURCE SOFTWARE that each patient and provider has) between providers and patients anywhere in the world. Open source, Non Profit COOPERATIVE makes the most sense, because NOBODY should profit (over and above a reasonable wage) from Healthcare. Like ($$$) banks, the information would be held by each patient and provider, but not in central data banks.

    Just my opinion:)
    To be continued ...
    Dr. Mike
    Michael F. Mascia, MD, MPH