Last month, I found myself cursing at the television while watching the network evening news with my wife. There was a story running about the “atypical presentations” of women and heart disease. Everything from fatigue, to nausea, to dizziness…… “may be signs of a heart attack”.
“Oh boy,” I said to my wife, “this is going to be a painful shift tomorrow.”
The rapid expansion of medical information and technology into our practice in 2012 is a mixed blessing. The information available to patients in the Internet era is truly limitless in its scope and accessibility. I have heard reports of regular folks performing simple medical procedures in their homes based on YouTube videos. Will a nursemaid’s elbow reduction become a home remedy in twenty years? Lord, I hope not!
That being said, for the most part I find it easier to do my job when dealing with a well-read and educated patient who has a specific concern about a new symptom. The word doctor is derived from the Latin word for teacher – and really, doesn’t this make up the majority of what we do in the emergency department? We like to think of ourselves as diagnosticians and “resuscitationists,” but much of our work is educating patients and families about the natural history of disease.
But there is growing sentiment, especially among physicians, that the advantages of information technology are being applied indiscriminately across medicine by various stakeholders… often to the detriment of patient care.
What are we as physicians to do about it? In some ways, we’ve already let ourselves become victimized. We find ourselves working in clinical environments with systems designed by others. How many clicks should it take to order an aspirin? What ever happened to vital signs being “vital,” out front and in the open aspects of the medical record?
At a dinner at the recent ACEP Scientific Assembly in Denver, a fellow doctor raised eyebrows when he started a sentence with, “one of the things I like about our electronic medical record.”…. We all agreed that this was the first time in history these words has been muttered by an emergency physician. Turns out his EMR had actually been designed by an Emergency Physician.
One of our physicians, while in residency, actually studied the impact of an EMR on patient flow. Dr. Neil Roy examined the long-arching impact of computer provider order entry (CPOE) on patient length of stay, “door to doctor time”, patients per hour, and other real-world metrics. Unfortunately his data suggested what most ER docs already know: things got slower.
At my company, we have figured out ways around some of these issues. We use scribes at all our Maryland campuses to help with medical documentation and allow our physicians to be…well, clinicians. But the challenges still exist. Who among us will step up and take the lead in the design and implementation of health care information systems, designed to improve physician efficiency and patient safety? Because there is a growing awareness that when it comes to healthcare, simply adding information technology for its own sake won’t cut it.