Back to Basics

By  Howard M. Landa, MD.                                                                                             Sep 08, 2014

 

Medical informaticists realized long ago the importance of information technology in improving the quality and safety of healthcare and were working on this long before the Institute of Medicine’s 1999 report “To Err is Human.”

We spent decades struggling to integrate IT into clinical practice to derive these benefits, making small but significant advancements. Then six years ago the game changed. Meaningful Use (MU) supercharged health IT and incented implementation at an unprecedented pace. We evolved from pushing organizations into adoption to ensuring the juggernaut that was MU did not become a patient safety cause célèbre. But have we delivered on the benefits we worked so hard for?

In 2002, Secretary of the Dept. of Health & Human Services Tommy Thompson famously groused “grocery stores have better technology than our hospitals and clinics.” Even today, if grocery stores’ barcode scanners worked as poorly as those in most hospitals, there would be riots at the checkout stands!

In 2003, the “Ten Commandments of Clinical Decision Support”1 was published. If we apply those “commandments” to health IT today, we have to admit that:

We do NOT adequately anticipate users’ needs and deliver them into the workflow (Commandments #2 and #3).

We interrupt clinicians in their processes, asking them for information we have already collected and require non-value-add activities (#5, #6, and #8).

We create complex, Rube Goldberg-esque systems and processes, and then when the complaints start rolling in we are often too busy addressing the next project/requirement/crisis to optimize the tools and reengineer the work processes (#4, #7, #9).

Worst of all, we slow clinicians down at a time when more and more is being asked of them (#1).

It is time for us to get back to the basics. Yes, we have to partner with all aspects of our organizations to qualify for MU incentives, improve our documentation to support ICD-10 and facilitate required reporting. But within each regulatory milestone (millstone?) lies the potential to derive real benefit.

We have observed that the implementation and propagation of EHRs has paralleled rising physician dissatisfaction. While not the only reason for this, in many cases there is a causal link. It is within our power to address this and this is a hill to die on. We can drive quality and safety ROIs from our work, instead of just counting MU incentive payments. And we can integrate technology into clinical workflows in simple and supportive ways to satisfy regulations while delivering a better user experience.

We began our careers being responsible for the care of individual patients. We have evolved to being the technology “providers” for our organizations, being responsible for the tools our fellow clinicians use. All the work we do is under the auspices of our core identity as physicians. It is an accountability we can never forget. And one to always be proud of.

Source: J Am Med Inform Assoc. 2003 Nov-Dec; 10(6): 523–530.

1. Ten Commandments for Effective Clinical Decision Support: Making the Practice of Evidence-based Medicine a Reality