Bill CrounseEvery workday morning I spend 30 minutes or so reviewing my Twitter feed.

By following a select group of top healthcare news observers and thought leaders, I find that Twitter works pretty well as a filter for the news events and topics that matter most to me. Over the past couple of days, I’ve been alerted to some articles about nurses and doctors who are, shall we say, quite frustrated with electronic medical records and what they perceive as a decline in the physician-patient relationship.

One of the articles that caught my attention was about a nurses’ union, National Nurses United, that has launched a national campaign to draw attention to what they say is “an unchecked proliferation of unproven medical technology and a sharp erosion of care standards” in today’s hospitals.

Of course, their agenda and real concern seems quite transparent. It is not so much about technology itself as it is a decline in the number of Registered Nurses directly involved in caring for patients at the bedside.

The nurses’ union campaign seems to resonate with another article I came across last week about the lost art of the physical exam. That article from Kaiser Health News and the Washington Post extols some very legitimate concerns about doctors who rely too much on lab tests and medical imaging to arrive at a diagnosis instead of talking to, touching, and examining the patient.

The article provides some great examples of missed diagnoses, patient harm, and undoubtedly increased healthcare costs because doctors caring for these patients either didn’t do, or didn’t know how to do, a good physical exam.

A third article that caught my attention was found on Medscape. Titled, Doctors Are Talking: EHRs Destroy the Patient Encounter, the article reviews reaction to an earlier article about doctors who are employing scribes to enter data into their electronic medical record systems.

As I’ve commented many times before here, I do recognize that data entry remains one of the greatest challenges to overcome for physicians who use most of today’s electronic medical record solutions. Healthcare is a data intensive business. In the past, we just scribbled (mostly illegible) notes on paper, or used a dictation system to record information about patient visits that was later transferred to paper by professional transcriptionists.

Now, there is an expectation that the doctor himself or herself will enter (via mouse and keyboard, or speech recognition) the vast amounts of data that must be captured during a patient examination. Doctors complain that electronic medical records have turned them into (expensive) data entry clerks. Here, they do indeed have a point.

What I find disturbing in all of the above is the knee-jerk response to blame technology for “destroying healthcare”.  For instance, the nurses’ union states that “The American healthcare system already lags behind other industrialized nations in a wide array of essential health barometers from infant mortality to life expectancy. These changing trends in healthcare threaten to make it worse.”

Really? Point in fact; America has been a laggard in the adoption of electronic medical records compared to many of the industrialized countries being cited with those much better essential barometers of good health. Nearly 100 percent of the doctors in many of the European countries to be found on that good health list have being using electronic medical records for a decade or more.

Trust me, it is not electronic records that are contributing to poor health statistics in America any more than it is technology that is contributing to the lost art of the physical exam. Regarding the latter, I believe the decline in physical exam skills among American physicians has more to do with a payment system that increasingly rewards doctors for doing and not so much for thinking.

You won’t get an argument from me that electronic medical record solutions aren’t a part of the problem, or that they couldn’t be made a whole lot better than what many American doctors and nurses are using today. Traveling overseas, I’ve seen solutions that I think are better, and far less costly, than many of the EMRs used in America.

Of course, those overseas solutions are much less focused on billing functionality than the typical American solution. Therefore, they tend to be more elegant in design around actual clinical workflow and the clinical end-user experience.

Technology will continue to improve. Better speech recognition and other data entry modalities, user interface improvements, machine learning, artificial intelligence, analytics,  better mobile devices, better connectivity, and cloud computing—all of these will contribute to technology that works better for the humans who use it.

And in those cases where it doesn’t measure up, I’d say let’s spend more cycles on fixing what’s wrong than on blaming it for destroying healthcare. “It’s the technology, not us” just isn’t a good enough excuse.

Bill Crounse, MD (@MicrosoftMD) is the Senior Director of Worldwide Health at Microsoft. This post originally appeared on the Microsoft HealthBlog

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9 Responses for “Doctors and Nurses in a Twit about Technology Destroying Healthcare”

  1. Granpappy Yokum says:

    Yep, I got it by the second paragraph: this is an MD who doesn’t care for patients and doesn’t use an EMR, but spends 30 minutes a day on Twitter. Worthless drivel.

  2. john irvine says:

    @ Bill

    From my conversations, this is a major issue for many nurses, not just those represented by large and powerful labor unions. I’m not sure this story is quite as black and white as you’re making it out to be. You’re saying – what – nurses are whining?

    @ Granpappy. Nothing wrong with 30 minutes on Twitter. Might do you good.

  3. Perry says:

    I don’t think it’s technology per se that is the problem. We have made great strides with technology as diagnostic tools, so much so that the history and physical exam are becoming obsolete, which is a shame. The other concern I think physicians and nurses have is not the use of EHR in general, but the way it has been set up by vendors and the way they are forced to use it. I don’t use EMR because I don’t have to, but I have read printouts from ERs and other facilities and there is no rhyme or reason to the layout, and much of the information is useless to a provider. My guess would be if nurses and docs felt that what they were doing made their jobs easier and helped provide better patient care they would be all for it.

  4. Granpappy Yokum says:

    @john

    I’ll add a trerapeutic 30 minutes of Twitter to my daily schedule if Dr. Crounse adds 30 minutes of MU busywork to his.

    @Perry

    Of course, the OP has set up a complete strawman: no sensible person is claiming that technology is “destroying healthcare.” Rather, we’re claiming that, just as we predicted, IT is making the problems that were already there much worse, not better.

  5. Dr. Abraham Verghese talks about the 2 virtual I-patient where clinicians are all gathers in a room looking at computer screens to create a “digital picture” of the patient. Meanwhile the patient is in the hospital bed wondering where all his/her caregivers are to answer his/her questions about care. The same analogy applies to the introduction of computers in the office exam room.

    There are big trade offs that need to be made with respect to the introduction of Health IT. Loss of human contact and interpersonal conversation – itself a therapeutic intervention – is lost when the focus becomes the technology and rules (and reimburse) pertaining to HIT.

    I think a healthy discussion about Health IT is a good thing….maybe not for Vendors and their spokes people with financial interests at stake ….but certainly for patients and those in the trenches.

  6. Perry says:

    What I think is lacking is good old fashioned face to face communication here. I had a patient in today for a followup after seeing a specialist to reassure his problem was not going to be a permanent or disabling one. After we discussed the consult, we chatted about 3 or 4 other things that had little or nothing to do with his medical condition. At the end of the visit, I said come back if you have any problems or questions, to which he replied ” I’d come back just for the conversation.”
    On a daily basis, most of the patients I see we spend a little time discussing medical issues and also some personal ones, grandkids, dogs, sports, books, music, etc. It adds to my pleasure in getting to know the patient and vice versa. I can do this because I don’t have to bury my nose in a computer and worry about what I have or haven’t documented that has little or nothing to do with the patient’s health or well-being.
    What is being lost with the inefficiecy of the EMR and computer is the essence of human contact and communication.
    We have an office computer and we are in the process of changing the software to make things better and more efficient, so no, I am not a technophobe. But I will contiue to dictate my notes so I can say what I want, how I want, and get the proper information in to the record that absolutely needs to be there. And I can spend time relating to the patient.

  7. Taylor says:

    Though technology may play a roll in the problem, just because the technology exists does not mean there is a need to be completely dependent on it. It is important to maintain and build your own skills, and come to your own conclusions. However, I believe there are many forms of technology, such a social media, that can be used as a beneficial tool for knowledge sharing. There are even apps that are devoted to benefiting those who are working in the medical field. For example, I have come across the app MyMedicalCV, a free service to organize and store your medical credentials. Tools such as this one aren’t used to replace human workers, or to distract medical professionals, but to benefit those who choose to use it.

  8. PageBurner says:

    Thanks for a snarky post. I could guess which way the opinion would go when I read “30 minutes on Twitter” for newsy McTwits and also by the fact that there is a computer software company name listed before MD in the ‘handle’. Plus it is my personal opinion that the phrase “Thought Leader” is similar to the phrase “Fluffed Ego”. It’s okay. I respect your view but I don’t agree. I mean, let’s be realistic: Who has time to sit around and doodle on Twitter at work? Not many people I know. And who has time to doodle around getting the right apps when your attention is needed on the physical plane for actual real people depending upon you and your schedule? And what guarantees that anyone around you is in the same app or even uses a device compatible to your app? Nurses might be a convenient target to discredit but I can see how technology has proliferated in the workplace and when it is too distracting to resist, especially when it’s Twitter or Facebook calling. In an healthcare environment where there exist different hardware platforms (Mac / PC) and different software programs in versions that are not uniform, add in the constant need to check and update. How much time is spent on tweaking technology rather than interacting with people? Now add in the insurance company’s dictum that every single action for a patient must be documented and authorized and insured and faxed and filed. Result? Complete drain of focus, energy, attention away from what should be the most important relationship of the Healer (MDs, RNs, etc.) to the Patient. I see this underscored around me almost every single day. Technology like this does not bring us together, it separates us. This is the Modern Social Malaise: any look around in public usually will reveal dozens of people staring into their hands or talking with their eyes trained in space, completely disconnected from reality. It happens at work too.

  9. Young Programmer says:

    Everyone complaining about electronic medical records is a member of one of two categories:

    1) a professional with a vested interest in inefficiency
    -Never having to upgrade your skills or suffer transparency is awesome

    2) a Luddite

    The doctors in this thread talking about how you spend a significant portion of a patients’ visit chatting about their dogs and grandchildren makes so irate.

    Just to jar your memories: YOU ARE PAID 200k-400k OF WORKING YOUNG PEOPLE’S MONEY TO TREAT ILLNESS, NOT GAB WITH GRANNY. Treat it, enter the medical records into the database, and move on. With any luck, you have saved their next doctor 20 minutes, the hospital $40 of public money, and maybe even $1k-2k in diagnostic tests.

    -Regards, A 26 year old working professional paying for private health insurance.

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