What Med Students Really Think About Healthcare IT
By Kenneth Iwuji, RN
Results from the annual Future Physicians of America Survey are in, presenting me with a well-timed opportunity to weigh in on some of the survey’s most interesting findings. This year, 1,026 respondents (75 percent of whom were third and fourth-year medical students) shared their opinions on medical training, preparation for practice, state of patient care, interoperability and how they plan to use digital medicine. Here is my take on what I consider to be the most interesting highlights:
Timely access to patient records needs improvement. Almost all students believe that easily sharing patient records among care teams is critical to improving patient care, yet 44 percent are concerned about the ability to do so within a hospital or practice; 73 percent worry about the ability to share patient information across unaffiliated practices. Other findings show that 96 percent believe improving the ability of EHR systems to access patient data from other systems is important to providing better patient care.
This point especially resonated with me. I’ve been a registered nurse for seven years and still practice while in medical school. I’ve worked for various health systems that use numerous vendors and it’s always been nearly impossible to synchronize patient information; the systems can’t talk to each other. In order to gain critical information about my patients, I still find myself making telephone calls and faxing request for release of medical records, which just doesn’t cut it in emergency situations. It also leads to a lot of waste in the system — we have no choice but to repeat tests and procedures because we cannot gain access to the results when needed. It baffles me that these systems can’t find a way to sync up — every other electronic device in our lives does.
Students are lukewarm on telemedicine, preferring face-to-face visits. When it comes to leveraging digital tools to enhance delivery of care, 41 percent of students turn to a medical app first for clinical answers while only 29 percent would seek advice from a peer first. Almost all would encourage patients to use monitoring devices (97 percent) or email them for treatment advice via a patient portal (74 percent). Yet 98 percent of medical students would prefer to see their future patients face-to-face for the initial visit as opposed to virtually. Even for follow-ups, 89 percent of students favor the traditional face-to-face exam. This may strike some folks as strange, given the surge in telemedicine in the past few years. There are benefits to telemedicine, of course, especially when care isn’t readily accessible to patients, but there is no better substitution for face-to-face visits that allow a physician to perform a thorough examination and form a relationship with the patient. Great physicians do not rely only on technology or laboratory tests and procedures to make diagnoses and formulate treatment plans. Coming up with the most accurate diagnosis or even differential diagnosis involves spending time with the patient and obtaining a detailed history; the best way to do that is face-to-face.
Burdensome documentation is overwhelming. (I can personally attest to this.) Seventy-one percent of third- and fourth-year students report they spend more time documenting encounters than seeing the patients themselves; 80 percent expect they will continue to document more than interact with patients when they become physicians. Again, this feels to be a shortcoming of the technology — instead of being able to spend my time taking care of the patient, I have to stay glued to the screen. EHRs should be more user friendly — simple changes could make a big difference. For example, sometimes I find myself double charting the same information in different screens. After I chart information once, it should carry over to the next needed screen.
Finally, dissatisfaction with practice management training continues. For the fifth year in a row, medical students said they have been inadequately prepared to run a successful healthcare practice: Only eight percent feel equipped to manage a practice and only 4 percent to bill and code. I personally am not especially frustrated by this, though it seems some of my peers are. I view school as the place where we learn; we shouldn’t be expected to become experts until we are in practice.
Despite my frustrations with healthcare technology, I still have faith that it will continue to evolve and will eventually work seamlessly for all providers; the barriers just need to be broken down. There is no reason why information shouldn’t flow freely and securely, providing benefits to patients and allowing doctors to do their work.
Kenneth Iwuji, RN is a fourth-year medical student at Texas Tech University Health Sciences Center School of Medicine.