Are We There Yet?
Nearly a decade after the advent of the Meaningful Use program that brought EHR systems into virtually every U.S. hospital and physician practice, information technology (IT) still is more of a hindrance than a help to physicians. As a hospitalist, I‘ve experienced first-hand how the IT currently in place is not just frustrating but is downright disrespectful to providers. Consider this:
- When hospitals installed computerized physician order entry (CPOE), they re-tasked the order clerk and created an additional clerical job for the physician. The industry appropriately devised CPOE to improve healthcare, but due to complex workflows and subsequent workarounds, results were suboptimal. Instead, healthcare has gone the opposite way of every other industry on the planet: we added technology and reduced the productivity of our most precious human resources. And the kicker is adding technology didn’t result in lower overhead, and facility costs to treat each patient, on average, have risen.
- The clinical note has expanded to encompass many pages that regurgitate information contained in the EHR instead of being a concise, curated document that highlights the critical aspects of a patient’s care and the clinician’s thought process. Research has shown that U.S. physicians’ notes are four times as long as those of physicians overseas. Accordingly, notes are soaking up a lot more of physicians’ clinical time than before. This is not the way it was supposed to work.
So no, we are not there yet. The potential for health IT, however, is immense. All the patient data in EHRs, if accessible and actionable to providers at the bedside, could be a boon to care. And I think about the additional time I could spend with my patients if I wasn’t devoting the second half of my day to feeding the EHR.
In my opinion, physicians should have one foundational system that they interact with; all other applications should simply co-exist within that environment. Envision an electronic environment where dashboards can be configured for various specialties – hospitalist, intensivist, and OB – and patient conditions, such as diabetes, sepsis or post-partum care. Where dashboards are completely customizable based on role, specialty, or even user, and may have different information, layouts, and available options, depending on what is important for the clinician to see and access in order to care for their patients. Where dashboards can adapt to workflows, such as pre-rounding vs. discharge, to show different types of information most important for the situation. Where condition-specific dashboards contain curated information about the patient’s condition, enabling a physician to see everything that is relevant in one place without having to search through reams of data.
That is an example of how IT can begin to respect physicians, their skills and their professional mission – and to become a valued resource to help providers be a little sharper, more efficient, and better able to interact more frequently with patients.
[This blog post was adapted from a commentary written by Dr. Maiona that appears in the November-December 2018 issue of For the Record magazine.]