Response to “Doctors Raise Doubts on Digital Health Data” S. Lohr NY Times


1410 Cambridge, England.  Minor Canon Thomas Rangle did a final count of the books at Trinity Hall.  He counted 122. Most of the books are biblical in nature or celebratory of our good and righteous benefactor Pope Urban V.  Few have access to these fine artifacts because of their enormous value (costing as much as a farm or vineyard) and the cloistered clergy and Master of the university are unwilling to share their contents.

1448 Mainz, Germany. Goldsmith and known spendthrift Johannes Gutenberg invented the printing press with move-able type.  It is known in town that he has printed school book texts and some indulgences; although, word is out that he is working on a fine bible.  Cost is 30 Florins or the equivalent of three years working wages. 

1450 NEJOM Nether regions somewhere west.  A noted study commissioned by Pope Nicholas the V and carried out by some real smart folks revealed that the offspring of this new invention, what are called books, are a dubious way of disseminating knowledge. The study also concluded that because of the cost, and lack of adoption in the Holy Empire, there was likely no good that would come of them.  A well respected scribe, Penman R. Best, noted that Gutenberg’s press is rather clunky and has many parts that would seem to obstruct further uses and indicate a contraption of vast complexity that might corrupt what it seeks to advance – the minds of the people.

 1950 William Faulkner “The past is not dead, in fact it is not even past.”

 This was the clearest way I know of countering our clinicians (scribes) deep-seated reluctance to change.

Steve McKinney is a President with Advance Decisions LLC. He is based in San Francisco.

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6 replies »

  1. I guess I have to admit that the EMR industry seems to have hit on a really unique marketing angle. “We have a crappy, overpriced product that would make the buyer’s life worse rather than better, but if they don’t want to buy it, it’s only because they have a psychological hang up.” Why wouldn’t that work? Perhaps GM could give it a try too. Of course, while GM’s cars used to suck, they’ve actually worked to make their product better. Now they just have to overcome their bad reputation. The EMR industry, OTOH, still makes a product that sucks.

  2. James
    Thanks for your comments
    We need major redistribution of Docs from wealthy cities and suburbs to underserved areas. We need the return of live house calls. Not more telemedicine.
    Also have you read the voluminous research on the value of touch?
    Dr. Rick Lippin

  3. I have an MS in systems engineering and worked for 10 years as a systems and software engineer. I’ve written 10s if not 100s of thousands of lines of code. I like computers, I type rapidly and fluently, and I was looking forward to finally moving to a “real” EMR. We started using a big-name EMR last August and I’m miserable. I spend hours every night entering useless data. Even though I’m seeing fewer patients, I’m spending an inordinate amount of time trying to interact with the EMR. It’s a disaster.
    I am resistant to change, but the change that I’m resisting is the loss of all my free time.
    Perhaps it’s just the first generation of EMRs (I hope!), but the available tools are badly, badly implemented and don’t provide any tools for improved patient care. The $2M EMR that we use is essentially a crappy, specialized word processor with billing capability. It makes communication between the docs in our practice worse and doesn’t help us communicate outside the practice at all.

  4. How is the doctor listening or touching the patient now when the patient lives in rural Texas and is 250 miles away from the nearest specialist? How is the doctor looking at or touching the patient with heart disease who is discharged from the hospital to their home after yet another hospital stay?
    Patients with chronic diseases don’t live in their doctor’s offices, they ideally live in their homes. How much actual face-to-face interaction does a chronic disease patient have with a physician or medical professional? I have diabetes (well-managed) and my “face-time” with a doctor works out to maybe an hour or two a year. Even a truly sick patient is going to spend the majority of their time not under a doctor’s direct supervision.
    And, of course, if the patient is seeing multiple doctors – the odds are high that each one has big gaps in their knowledge regarding what each of the other doctors have done with that same patient.
    Something has to fill the gaps between the actual one-on-one interactions with a doctor and the ongoing life with a chronic conditions these patients are living.
    I could go on, but the point is that there is ample research to establish the clear clinical effectiveness of new technologies like telemedicine, telehealth, and remote patient monitoring. For example, one may easily find examples of reductions in hospital readmissions through the use of home monitoring technology for cardiac care.
    For example, here is one from the American Heart Association: http://americanheart.mediaroom.com/index.php?s=43&item=405
    Everyone is entitled to their personal opinion, but there is plenty of research on this topic to be had with minimal effort.
    Take a look at the dozens of presentations on the topic of the effectiveness of these new technologies planned for the upcoming American Telemedicine Association annual conference in late April.
    Here is an overview: http://media.americantelemed.org/ATA2009/ATA09%20Prelim%20Program_FINAL.pdf
    Look at the materials from the Center for Connected Health: http://www.connected-health.org/
    Here is a piece from them on the effectiveness of online diabetes management: http://www.healthcareitnews.com/news/online-diabetes-management-may-result-better-care-study-concludes
    Or, there is the work of the AT&T Center at UTMB:
    UTMB, the largest telemedicine provider in the world, handles well over 60,000 patient encounters each year

  5. On April first of this year my hospital turned on the new and improved version of its computer system. Yesterday was my first ED shift with it. That shift was the worst ever in my entire 27 year career. We were not busy, thank God. Now information previosly available to me in the old system is 4 or 5 clicks farther away than before. Plus it takes forever for the screen to change, plus it takes forever for the data to “refresh”. When it finally refreshes the screen is in a different position. Added to that now discharge instructions are intended to be generated from the computer files of instructions with no flexibility and with instructions different that what I have told my patient about what I want them to do. When they turn on the prescription writing piece….
    So what was previously a bad system is now bad on steroids. With the last system our length of stay went from 1hr 50 min to over 3 hr. What it will be now is anybodies guess.
    If the goal is to see more patients, the best way is to use pen and paper.

  6. I agree that resistance to change is a huge problem. But change to what?
    I hope not below-
    “The companies, in a partnership announced on Thursday, plan to spend $250 million jointly in the next five years on research and development of health technologies to let doctors remotely monitor, diagnose and consult with patients in their homes or assisted-living residences”.- says the Times article
    In my opinion this would be a huge setback for American Medicine. One of the biggest mistakes of contemporary US Medicine is putting technology between Doctors and patients.
    Two manifestations of this is that-
    -Doctors have reduced looking at and listening to patients
    -Doctor have reduced touching patients
    A Doctor can do neither effectively through a computer to my knowledge?
    Whoever is advising GE and Intel ought to consider this reality.
    But “the techies” will probably prevail in further ruining the very essence practice of Medicine.
    Dr. Rick Lippin