A recent article in The New Yorker by Atul Gawande titled “Why Doctors Hate Their Computers” examines the mostly failed promises of digitization in healthcare from the perspective of doctors on the frontline of the transformation. According to the article, more than 90% of US hospitals have been computerized in the past decade and nearly half of Americans have their health information in the Epic Electronic Medical Record system.
Digitization’s Impact on Doctors
The promise of Epic and other monolithic health record systems is that they provide one platform for doing almost anything that health professionals need to care for their patients from recording and communicating medical observations, sending prescriptions to the pharmacy, ordering tests and scans, viewing results and handling insurance bills. All paper slips, records, and charts will (eventually) disappear, and the healthcare industry becomes greener, faster and more productive.
But, according to the article, the promised productivity for medical professionals has not panned out as expected:
- A 2016 study found that physicians spend 2 hours of computer work for every hour spent with a patient
- The University of Wisconsin found that the average workday for family physicians has grown to 11 ½ hours
The article posits that one unplanned result of going digital is that there is a growing epidemic of burnout among doctors, with 40% of them screening positive for depression and 7% reporting suicidal thoughts; this is is double the rate of the general working population.
Difficulties with Computers are not Unique to Medicine
The impact of the growing complexity of software is not unique to the field of medicine. An IBM software engineer Frederick Brooks wrote a classic book on software engineering in 1975 called “The Mythical Man-Month” which compares writing software to “a Tar Pit – the more you fight it, the deeper you sink”.
As programs become more ubiquitous and powerful, every small change can produce unforeseen bugs and as the software code grows larger, it becomes more fragile and likely to break or crash. As software systems grow more complex, the more they need to become more bureaucratic and rule-driven. As a result, the Tar Pit scenario has more of us spending more time dealing with the constraints of how we do our jobs and less time simply doing them. The article suggests that our choices are to adapt to the reality or become crushed by it.
Forcing software to cover all scenarios makes it unnecessarily complex and leads to overall sub-optimization.
How Can Healthcare Be Re-imagined
Obviously, there needs to be a better approach to digitization if we want to improve patient care and give healthcare professionals the tools they need to do their jobs better. We ultimately need systems that make the right care simpler for both patients and professionals, not more complicated. And they must do so in ways that strengthen our human connections, instead of weakening them.
Excerpted from “Why Doctors Hate Their Computers” by Atul Gawande, New Yorker Staff Writer
Based on his experience in healthcare technology, Principal Phil Crompton offered his thoughts on the process for re-imagining healthcare and technology:
- Design technologies around workflows, rather than forcing the workflow to bend to the limitations of the technology. Clinical staff are often forced to endure multiple steps in a process that used to be relatively simple, many of which are required because of an inherent limitation in the technology rather than for a clinical purpose.
- Improve integration between systems so that information entered once can be shared between systems rather than having to be re-entered each time. This is a massive time-wasting exercise and increases the opportunity for medical errors to creep into the systems if information is mis-entered.
- Move ownership of the medical record from the institution to the individual. Once we own our records, the incentive for the electronic medical record software manufacturers to move towards a standard format medical record that can be read by multiple software systems will increase as healthcare institutions and their patients demand it.
- Use Internet of (Healthcare) Things devices, Big Data processing power, Artificial Intelligence systems and other technologies to eliminate the ‘low value’ tasks that hospital staff have to perform and allow them to focus on ‘high value’ tasks like working directly with patients and their family members.
How Does Vantage Approach Healthcare Technology Visioning
Vantage has partnered with many healthcare providers to help them develop a comprehensive technology visioning plan as they begin the process for designing and building a new hospital or healthcare facility.
We approach our technology visioning projects by focusing on these three tenets:
Focus on process and workflow rather than technology
Technology is changing all the time and today’s hospitals and medical centers will be around for fifty to one hundred years (or longer). A focus on a specific piece of technology provides a vision that will be too short-sighted to provide much value to the institution.
Involve interdisciplinary teams in developing a vision for technology in a new facility
Doctors, nurses, ancillary staff, IT teams and administration (plus representatives from patients and family members) all have a part to play in determining the future of their organization and how technology can assist (not insist) on how it will function.
Pay attention to the disruptive players entering the industry
Amazon, Apple, Google, etc. – and use ‘technology transfer’ opportunities to revolutionize healthcare by taking the best insights and approaches from other industries.
It can be tempting to write off technological advances as having a negative impact. Self-driving cars have generated significant concern among the general public, but opinions change when the potential savings in lives, dollars and emissions are considered.
Similarly, artificial intelligence systems take away a lot of control but can create huge benefits for our society. Technology saves lives every day in our hospitals and medical centers, with research developing new treatments and procedures, enhanced communication systems ensuring the latest information is provided to the correct staff at the appropriate time, and the latest electronic medical record systems reducing medical errors and improving documentation. As with everything, and especially in health and wellness, we need to find the correct balance on the cost / benefit equation of healthcare technologies. And that’s a challenge we should all willingly accept.