24

MARCH, 2019

Wasted resources
Burnout
Uncertain future

The siren song of ‘easy to use’ Electronic Health Records has turned into the furious pounding of endless keyboard clicks.

Doctors have been transformed from diagnosticians into keyboard warriors.

They are now the highest paid data entry staff in the world and they are ‘burning out’ at higher rates than ever before.

A recent of survey of hospital staff asked –

‘If you had the power to change or upgrade one piece of technology what would it be?’

The largest response was Electronic Health Records!

First… some humour…

What went wrong?

What are the practical solutions being used to overcome this problem and what is the long term solution?

With most technology, companies know their very existence depends on the quality of their customers experiences. So they put huge effort into user experience, or UX.

Developers bend over backward to make using their programs easy to use.

Integrating their software with other software is imperative.

Upgrades are frequent, complaints are answered promptly and user suggestions are taken seriously.

Listen to Kai Ryssdal from Marketplace.  “You know that phrase ‘it’s too good to be true? Well, welcome to Electronic Health Records…”

But in healthcare, the paying customer (governments, insurers) is completely disconnected from the clinical users like Doctors.

The result?

Technology companies focus on pleasing bureaucrates and bean counters while Doctors are left with inept, clumsy and uncoordinated software.

“…somehow we’ve reached a point where people in the medical profession actively, viscerally, volubly hate their computers.”
Why Doctors had their Computers – New Yorker November 2018

Multi disciplinary teams sound great – on paper but in reality they can deteriorate to a European style war. 

Like many industries, the health industry is full of people who:

  • Speak a different language
  • Genuinely have different values
  • Developed from different histories and
  • Absolutely believe that they are right in all things

Electronic Health Records need a team of translators who can convert the myriad of patients issues into a user friendly front end for all health staff.

What are the practical solutions being used to overcome this problem?

Physiotherapy services are steaming ahead of medical clinics with their modern clinic software.

This includes:

 

  • Integration with smart monitoring devices
  • Using cloud software to fully utilize the power of Artificial Intelligence
  • Baked in teleconferencing and social media
  • Optical Recognition Software to scan records and identify major issues
  • Segmented mailing lists to provided targeted information
  • integrating medical treatments with video education and suggested lifestyle changes

The rise and rise of scribes

Some American hospitals are now hiring human scribes to follow Doctors on their rounds, just to read out and update electronic medical records. 

It might sound ridiculous but it works.

Doctors spent less time typing into a computer and patients get to actually talk to them directly. 

Some Indian hospitals are using electronic scribes. The Doctor wears a multi directional microphone around his or her neck. The recording is sent securely to a cloud service that transcribes the information, and enters it to the patient’s electronic health records.

Both methods are producing less keyboard time for Doctors and greater job satisfaction.

…”Rather than an electronic ecosystem of information, the nation’s thousands of EHRs largely remain a sprawling, disconnected patchwork. Moreover, the effort has handcuffed health providers to technology they mostly can’t stand and has enriched and empowered the $13-billion-a-year industry that sells it…”
Death by a Thousand Clicks: Where Electronic Health Records Went Wrong – Fortune March 2019

And what is the long term solution?

In my opinion we need to change the funding model of healthcare.

One option is a shift away from private insurers and governments, into ‘pay as you go’ or concierge medicine.

This means:

  • The patient pays for the Doctor’s services direct, with no middle man like interfering governments or bureaucratic insurers
  • The Doctor pays for their technology direct, demands and receives high quality consumer style software

 

Another is a shift towards a single payment system for all healthcare, then adopt European style integration of all electronic health records and associated services.

Both have some problems and some potential rewards but no problem is too difficult to solve.

And we need to be transparent, willing to look at root causes and keep changing until we all get the Electronic Health Records we deserve.

We owe it to the next generation to sort out both the costs and errors in our current health systems.

© Wikihospitals March 2019