The internet has not made everything better. While not a controversial opinion, it tends to bin one in with the Luddites and seems to keep the technocrats (those most needing to hear it) from hearing it. Very rarely in life is an app the answer. Rarely is it even an answer. Digitization does not mean progress. More data does not equal more better.
To wit, the recent investigation by Kaiser Health News and Fortune Magazine indicating that the average physician in America is feeling overburdened by the clicks, clacks, and clatter of the modern electronic health record and that this is leading to direct and quantifiable harms to patients. Though over $36 billion have been spent to bring to fruition that potential of the net-connected health record, it has led to fraud and cover-up, burdens and “by accident” treatment. More than anything, it has changed what the job of a physician is without asking or telling anybody.
I have in mind this single fact, quoting from a 2013 paper from the American Journal of Emergency Medicine: “physicians spend significantly more time entering data into electronic medical records than on any other activity, including direct patient care“. The job of a doctor has gone from “treating patients” to “recording treatments given to patients”. Consider the graph seen below, showing the adoption of electronic health records the moment federal funds became tied to their use.
Ten years ago, twenty years ago, when all these doctors heading out to that “real world” were first thinking about becoming doctors, this was not an aspect of medicine. While documenting cases has always been part and parcel of the profession, the temporal dominance of the activity in practice is only a recent phenomenon. According to the same 2013 study referenced above, an average physician spends approximately 28% of their time directly treating patients, 12% of their time reviewing test results and records, 13% of their time in discussion with colleagues, and 44% on data entry.
What was meant to streamline the process of documentation and to make that documentation more easily accessible to doctors has had the unintended consequence of turning our highly trained medical professionals into data entry specialists. It’s not the job they signed up for and frankly it’s not the job they should be doing. When one learns that the average number of mouse clicks performed by an emergency medicine physician approaches 4,000 during any given day and when one recognizes the fact that almost no one can do something 4,000 times without error (and certainly not those tasked with saving the precarious lives of our most vulnerable patients), then it dawns on us: this isn’t the way it should work.
This goes to the larger discussion of how healthcare centers in our country ought to work. Indeed, how health ought to be preached and practiced in the country as a whole. And if this the sort of discussion you’d like to have, please consider a spot at table for the upcoming Universal Healthcare Group talks. Let’s figure out ways in which data can get to where it needs without human arbitration. Let’s figure out what needs a doctor’s script and what scripts can help out doctors. Let’s figure out how to get patients in front of caretakers, instead of screens in front of each.