Brave New World

Remember how computers were going to eliminate paper in the workplace? Doesn't seem to have happened does it? It seems like they should have at least cut down on paper, but that hasn't happened either.

So, with computerized medical records the bold candidate told you how it would streamline care, and save money. And the people went "Ahhhh," and shielded their eyes against the brilliant glow. "Yes, of course it will work. It seems like that would work, no?"

Well, maybe no. Electronic medical information systems are already out there, and one of them almost killed Joe Bugajski:

Medical personnel at urgent care and the hospital who interacted with me all used a version of the same electronic health information system (the “system”). It became clear that everyone was fighting that system. Indeed, they wasted between 40% and 60% of their time making the system do something useful for them. The system kept everyone from fulfilling their duties - the health information system did not help medical professionals perform their duties.

Since my hospital stay, I confirmed that electronic health information systems are mostly broken. I interviewed medical professionals, healthcare IT experts, and my allergist. They confirmed my sickbed analysis. Indeed, several experts said that they longed for handwritten charts once more hanging from the foot of every patient’s bed.

He links to this op-ed from a pediatrician:

In short, the computer depersonalizes medicine. It ignores nuances that we do not measure but clearly influence care. In the past, I could pick up a chart and flip through it easily. Looking at a note, I could picture the visit and recall the story. Now a chart is a generic outline, screens filled with clicked boxes. Room is provided for text, but in the computer’s font, important points often get lost. I have half-joked with residents that they could type “child has no head” in the middle of a computer record — and it might be missed.

A box clicked unintentionally is as detrimental as an order written illegibly — maybe worse because it looks official. It takes more effort and thought to write a prescription than to pull up a menu of medications and click a box. I have seen how choosing the wrong box can lead to the wrong drug being prescribed.

So before we embrace the inevitable, there should be more discussion and study of electronic records, or at a minimum acknowledgment of the downside. A hybrid may be the answer — perhaps electronic records should be kept only on tablet computers, allowing the provider to write or draw, and to face the patient.

I hate to think that these billions and billions of dollars are building a system that is worse than what we've got now.