EMR. Cart. Horse.
Outcomes and quality reporting and meaningful use – cool.
I mean, really, is there a doc out there who doesn’t think improving patient outcomes or obtaining and sharing useful data or using any tool in their arsenal “meaningfully” isn’t just plain, old, common sense, good stuff?
However, all these sound just about as logical to a physician as “you need to eat your vegetables” sounds to a child. Sure, we all want to grow big and strong; we get that. But, if the veggies don’t taste good, if they aren’t presented in an eye-friendly way, if they make a medical practice “gag,” how many docs are going to be enticed to “eat what’s good for them?” Seems a lot like trying to inspire six year olds to eat plain Brussels sprouts.
What started out in with Dr. Larry Weed taking his POMR (Problem-Oriented Medical Record) and SOAP Note brilliance and extending it to digital “data acquisition and retrieval systems” which would extend the brains of physicians helping them make more accurate diagnoses and more effectively deliver “proper care” has gotten completely kerflobbled.
Instead of using computers to do what they do best in helping medical care providers do what they do best, we have skipped right over the logical progression that the good Dr. Weed envisioned some 40 years ago. We wonder why we are now trying to figure out why HIT isn’t being devoured by doctors. We’ve placed a plate of barely warm Brussels sprouts before the healthcare child; now we’re trying to bribe and even threaten punishment if he doesn’t eat.
Instead of keeping the healthcare provider providing healthcare and extending his mental powers onto peripheral brains with tremendous storage and retrieval strengths, we’ve twisted the focus toward turning doctors into mere data input devices. Instead of empowering physicians, we’re eviscerating their strengths and training and minimizing their cognitive clout. Instead of using digitization to maximize our doctors’ capacities, we have seen it used to detract from their mission and delimit their mentations.
In 1997, Larry wrote:
“The meteoric shower of medicine’s scientific achievements can overwhelm a doctor’s mind. A patient has no assurance that his or her doctor is able to take into account all relevant scientific knowledge and integrate it with detailed data about the patient’s own condition. Yet few doctors, patients, or policy makers recognise that modern information tools can become the loom for weaving these two bodies of knowledge into a fabric. In fact, few recognise the dimensions of the problem.”
Recognizing “the dimensions of the problem” and righting the course we now follow won’t be easy, by any means. But, at least for the foreseeable future, computers won’t be able to make the myriad of associations and subtle nuance recognitions required for accurate medical diagnoses on a per patient basis. The brains of our healthcare providers still outshine the petafloppiest supercomputer.
You have a chance of getting a child to eat Caramelized Brussels Sprouts with Pistachios and Red Onions just as you have a real chance of broad EMR adoption if you present something attractive, tasty, and “good for them” if you keep the focus upon enabling doctors’ strengths, not detracting from them.
Before we start reporting, measuring quality, and worrying about outcomes, how about we enable the doctors’ mental machinery and figure out how to make their data capture requirements unrestricting of their abilities to continue to care for us as we go about gathering enough data to meaningfully use?
From the trenches…
“It is the good horse that draws its own cart.” – Irish Proverb
Dr. Gregg Alexander, a grunt in the trenches pediatrician, directs the “Pediatric Office of the Future” exhibit for the American Academy of Pediatrics and is a member of the Professional Advisory Council for ModernMedicine.com. More of his blather…er, writings…can be found at his blog, practice web site or directly from email@example.com.