Back when I was in medical school – a million years ago – students spent hardly any time in the hospital or working with patients until their third year. My third year began on July 1, and on that date, I found myself rounding on the colorectal surgery service of a huge hospital. Jokes aside, beginning my real medical training with surgery was quite the plunge into healthcare. While I had a ton to learn about surgically related diseases and treatment, understanding what I could and could not touch in the operating room was among the most important lessons to master. After surviving a few days in the OR, I moved onto more essential preparation for a clinical career.
I was taught that one of the most important skills of a surgeon is to know when NOT to operate. While the concept that one shouldn’t operate on patients who don’t require a procedure seems self-evident and obvious, there’s a lot in that statement. Surgeons like to operate (duh!), and consulting doctors often think a patient needs a procedure when they ask for a surgeon to evaluate their patient. The natural inclination is: operate. Yet, the skilled and savvy surgeon knows when to say no. The surgeon who knows when not to operate is the one you want at your bedside.
My regular readers know that I typically write about healthcare IT. So, those readers might be wondering how I plan to take a good surgeon’s ability to say no to an operation and relate it to HIT. Your patience is about to be rewarded! In hospital IT departments all around the country, doctors, nurses, and administrators are pleading with information technology analysts and leaders for tech solutions. “Hey, we’ve got a problem over here, IT people. Can you solve it please?” While the requestor may not specifically state their desire for a tech solution, it’s pretty obvious, right? If you’re calling IT for help, you’re not looking for hand holding or a seminar on team building: you’re looking for technology. Yet… it may not be technology that you need.
Mobile phone applications and EHR modules are not the solution to all problems we face in healthcare. There, I said it. Maybe I’ll lose my membership in the Silicon Valley and Madison Proponents club (SVAMP, as we in the biz like to call it), but so be it. I’m here to speak the truth, people! Just because you have a problem, and even if that problem seems to involve technology, the solution may not be… more technology. I’d like to introduce the concepts of training, agreement on basic ideas of how work is done, and honest-to-goodness, old-fashioned communication.
While many think of training as a dirty word, it need not be. Some software is very complicated, and to use it well, you need training. Surgeons use robots or other assistive devices in operations all the time, but they wouldn’t expect to do so without training. So why is the EHR different? It’s a complicated tool. Should it be less complicated, more intuitive, and support team-based care better? Sure, of course; who would argue with those asks. Yet, often, I hear complaints from doctors about specific parts of the EHR that work well, if only the physician knew how it was intended to be used. I’d love to have the Google interface everyone asks me for, but it’s not a thing. Google looks up information for you; it doesn’t help you write a note or suggest orders (Note: if Google now does these things, I withdraw the previous few sentences and apologize profusely to my software overlords).
Another dirty word in some physician circles is standardization. Doctors rail against “cookbook medicine” which some view as the attempt to have every patient treated exactly the same way, removing the essential art of medicine. Hence, cookbook medicine and standardization become synonymous. Yet, if doctors want to use the same software in very different ways, problems will arise. Some agreement on terms and uses of the EHR are required for success. For example, if physicians disagree on where handoff data and follow-ups are located, no one will be happy. If every doctor wants to release patient results in different ways and at different times, it’s difficult to imagine a successful tech solution.
It’s said that healthcare is a team sport; I’m a believer, but not everyone seems to think that way. I was approached once to “make sure the EHR notifies the pediatrician when the OB is aware of a prenatal result that needs follow-up after birth.” My response was, “Doesn’t the obstetrician speak with the pediatrician to ensure that the proper information is available and that the prenatal plan is carried out now that the baby is born?” That’s how it was when I was still practicing. Very expensive EHRs don’t make the telephone unnecessary. Old-fashioned talking to colleagues sometimes is far superior to the most advanced technology known to man. In medicine, we need to ensure we communicate essential information in a timely fashion, and tech can be horrible at that.
Next time you have a problem with your EHR or other tech, I encourage you to take a step back, breathe deeply once or twice, and ask yourself if it’s really a tech solution that you need.
Craig Joseph, MD, is the Chief Medical Officer for Avaap, an EHR and ERP consulting firm. He is a pediatrician and physician informaticist with experience in both clinical practice and the use of the EHR to improve patient care and physician efficiency. Dr. Joseph also currently serves as the Interim CMIO at El Camino Hospital in Mountain View, California. This piece was originally posted on Avaap’s blog page.