Having a patients entire history at your fingertips collected through their lifetime.
Being able to apply machine learning to their symptoms to find possible obscure issues
Being able to combine data from populations to find new symptoms for illnesses
Being able to identify outbreaks alot faster
Better ability to analyize complex data to prevent drug interaction
And so many more.
No I think primary care and internal medicine physicians are threatened by technology and are resisting it, because 95% of what their job consists of is exactly what computers are really really good at, crunching data to find statistically likely outcomes.
Tech is going to do to medicine what is already happening in Law. Put 90% of physicians out of business by making the few employed physicians infinitely more productive.
In a 20 years we're going to view having a physician diagnose you as primitive as having a physician bleed you with leeches.
It is also annoying when professional “priests” commit what amounts to claiming only they have the mystical gifts to interpret what aren’t “tea leaves,” when it’s usually done out of fears of job security, special power and/or change of a legally-protected professional class.
It's a basic data analysis which is exactly what computers are good at.
No Tea Leaves involved.
This whole pushback by physicians is about status, jobs, wealth, etc.
In a 20 years we're going to view having a physician diagnose you as primitive as having a physician perform bloodletting or trepanation on you.
This has benefits and costs.
https://en.m.wikipedia.org/wiki/VistA
FOSS software suffers from the same problems gaining a foothold in healthcare as it does in most sectors - namely a lack of money to spend on sales, and a malaise of FUD.
My social worker friend already uses a SaaS for his billing and patient management.
I think technology will massively enable solo practitioners.
Our proposal was approved almost unanimously by the student section of the meeting, but was argued extensively by the physician section, not on the proposals actual merit, but on the usefulness or lack thereof of scribes. Some delegates thought that they led to errors in documentation (our proposal was to study this), others thought they would be leapfrogged by newer technologies and thus unnecessary.
Long story short, I have two comments. The first, that having more scribes would be beneficial in letting doctors being doctors, perhaps being a simple solution to the problems demonstrated in the article.
The second is that doctors from all kinds of specialties probably agree on many issues affecting patient care and physicians at large. However, all I see are disagreements.
Not to mention that the notes are pertinent to goals other than patient treatment. A mechanic might replace every known bad part and could handle it himself by just noting the inventory changes but that would be discarding much of the engineering useful data like how the commonly worn out parts were damaged.
Anyway my personal opinion of the medical data systems are that they aren't unnecessary but awkward and poorly designed - perhaps due to having to serve too many disparate goals and having very complex systems to track in the first place.
I could see adaptive data charts and interfaces being useful in that context. A patient with one leg would have now irrelevant fields fields autofilled as "N/A - amputated" or similarly in their relevant contexts.
Regardless, looking at the present, in my opinion having scribes available would provide a simple solution to a problem often bemoaned in medicine.
Maybe people are worried that EHR quality would suffer if people with fewer credentials entered the data. According to the article EHR systems are already full of garbage data entered by physicians. Does it actually get worse if data entry specialists do the entry instead? This appears to be readily testable. You can have them do it in parallel with the physicians who enter their own EHR data now, and compare after a year.
I think it has to do with the fact that the buyers (decision makers) of the system are not the actual users so decisions are made based on everything but usability.
As time goes on people will figure out new ways like you're suggesting of using the technology.
Maybe I'm just relying too much on this article plus a few similar complaints I've read in the past. Maybe most doctors don't spend much time on data entry but I only see the grievances of the few that are forced to.
I love electronic records because I don't have to handwrite anymore, and all the data I need is just a few clicks away. The problem isn't the electronic nature of the records, but rather the reporting and documentation requirements that come with it. Why are there increased amounts of documentation required? Because it is a form of rationing: make patient care so time consuming that fewer patients can be seen, and less can be billed long term. It really is a pernicious way to decrease healthcare expenses, but it comes at the cost of depersonalizing patients, physicians, and nurses.
That, and also legal protections because lawyers exploit any "bad outcome" as negligence, even though no negligence occurred.
Also, I'm only recently learning how pernicious the fear of malpractice suits is, and how this fear makes doctors reluctant to collaborate informally -- if you can't see a patient yourself or get their full chart, the perceived liability risk is high enough to prevent informal collaboration
I didn’t see the computer or data failing in my hastey read through of the piece. It always contained what data the people entered.
It's silly to assert "the computer didn't do anything wrong". The computer has no agency or will. It doesn't matter if we run perfect software against a bad dataset, or if we run perfect data through bad software. The only thing that matters are the results. The computer and the people are all parts of the same system.
Blaming the automation software for this fundamental misalignment is silly. Software is just a tool that optimizes for the needs of the business and the customer. And in American healthcare the patient is not the customer. Insurance companies and the government are the customer.
Yet a significant problem with this article is that it provides no comparison to other professions.
"A clinician will make roughly 4,000 keyboard clicks during a busy 10-hour emergency-room shift" -- I doubt that 4,000 "keyboard clicks" is unusual for any profession at present, even one where attention is moving across interactions with patients, colleagues, machines, and the computer. A page of text is about 3,000 characters.
(Aside: I'm actually not quite sure what is meant by a "keyboard click" is -- maybe the author is talking about mouse clicks or toggling checkboxes; elsewhere in the article the phrase is "4,000-key-clicks-a-day" -- if it's just 4,000 taps to keyboard keys, that's a pretty low number. I don't think that 4,000 checkbox or mouse clicks is even really such a big number. Answers here (https://www.quora.com/What-is-the-avarage-number-of-mouse-cl...) suggest between 5000 and 7000 mouse clicks/day. Another resources says a doc does about 2500 clicks/day -- http://www.healthcareitnews.com/infographic/infographic-one-... -- and that's for a 16 hour shift.)
In any case, is there something distinct about clinician work with regard to the use of computers, compared to what we're all doing? A claim that there is would strike me as special pleading. If there is an argument to be made, it must be made comparatively.
The author also claims that "Even if the E.H.R. is not the sole cause of what ails us, believe me, it has become the symbol of burnout" -- do doctors _really_ suffer from more burnout than other professions? _Doctor-authored_ studies may say so, but we need to have unbiased studies of burnout across the professions, and understand generally how being lassoed to a computer affects morale.
At what point does the hivemind merge with algorithmic ML to form a sort of distributed AI?
My experience (and resulting skepticism) in data collection for business suggests that “the business” side is the driver behind many or most of the inefficiencies.
To the commenters claiming “scribes” can do this. It’s just not that easy. I was involved in developing a scribe system. It worked for a couple doctors. We thought we had the next big thing. The doctors were able to go in and actually talk to and look at the patient while a scribe sat in another room and listened to the conversation and watched a mirror of the doctor’s tablet (all with patients consent). By the time the doctor left the exam room, the progress notes were completed and prescriptions, follow-ups etc. were ready for order. The doctor just had to review and complete. System was great. Doctors were able to go home at a decent hour instead of spending 2 hours in the evening going over each patients encounter. When we tried to expand it failed. In hindsight it was easy to understand why. The scribes we initially used were CAs who had been working with these doctors for years and they could pick up on subtle verbal cues generating complete encounter notes just based on a few comments. In our experiment, it just didn’t work once we brought in scribes who had never worked with or around the doctors. I’m sure there’s a way to make this work and hopefully someone will one day. It would be nice to have a conversation with my doctor again. Anyway, just some thoughts. I see a lot of posts in here discounting the article and claiming the world is ready for computers to replace doctors, and it’s just the greed/ignorance of doctors holding us back. If you’re ready to put your life in the hands of AI and computers, I wish you the best of luck. I just want a system where doctors can actually be doctors again. The greedy people in our health care system don’t wear white coats. They run around with titles like “Hospital Administrator”, “Pharmaceutical Rep”, “Health Care Lobbyist”, “Senator/Congressperson” and “Insurer”.
