Friday, March 16, 2012

When Programmers Outnumber Doctors

Patience.  You have have to have patience. 

“It’s got to be me,” I tell myself. "I'm a computer guy.  Surely there must be something I’m missing."  "Why would they take away that functionality that we had before?"  "Why so many buttons and choices?" "Seriously?"

Everyone wants something different from our electronic medical records these days. Administrators want numbers, doctors want pictures and meaningful narrative, nurses want every pill given and bed-rail elevated documented and every check-list completed.   The geeks want it mobile.  Our government, administrators, physician leaders and legal system say they need this piece of data or that piece of data and then, please people, give us some more data, will you?

So everything we think, eat, and breathe is entered on a computer. Right now, it's all about the computer.  After all, we’re told the Electronic Medical Record sees everything and will be our salvation.

But now I’m seeing something new.

There’s so much data that we risk doctors becoming lost in it. It is entirely possible that we are in danger of not being able to find our most important clinical signals amongst the noise and clutter of all the data.  Worse: time with patients is disappearing.

Our health care information gold rush has acquired teams of programmers to feverishly implement a myriad of bureaucratic information system requirements in just a few short years. To this end, these programmers have been extremely effective. But almost as incredibly, these same programmers have little perspective of what physicians do or how we interact with patients and THIER data.  As a result, doctors are not only confronted by all of this this information placed before them, but waste preceious time sifting amongst the data and continue to be the fall-guy for data entry. Codes, quality measures, documentation requirements and, oh, yeah, the progress and operative notes, are all being entered by doctors. In return, our screens have become crowded intersections of buttons, flags, options, icons, colors, warning alerts and (if we're lucky) text.  Oh yeah, and a new "upgrade's" coming next week.

Typing, clicking, choosing, clicking. That one? No? Maybe this one? Yeah. But wait, now what?

Entire industries have sprouted to address this problem and provide doctors scribes to enter all this data. But are there cost savings this way? With such a model, aren't we just changing our doctors from data entry to quality assurance personnel? (“Is this what you said?” “Which code should we use, doctor?”)

Few seemed concerned about the data flood and screen crowding that's upon us. In fact, most don’t acknowledge such a problem even exists.

If you're skeptical, just ask a doctor if he spends more time with his computer or his patients now. 

Doctors need better information before us, not more of it. We don't need to know what "type" of order we entered, for instance.  We need more time with our patients and less time with data entry.  We need white space on our screens.  Deciding what information goes and what stays for all caregivers should be a priority we consider going forward.  

But we can never have enough data these days, can we?  Like Play-doh, we play with it, we compile it, we shape it and twist it, then bounce it around. 

But someewhere in there, we also make critical medical decisions with it.

So if Google can understand the value of white space on their front page, why can't we?


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