In a great expose of the value of the narrative Dr Regina Harrell explores Why A Patient’s Story Matters More Than A Computer Checklist in a journey documenting one elderly patient with knee pain and underlying Dementia
Sadly Dr Harrell spends more time on technology than on the important aspect of patient engagement and clinical care:
At day’s end, I review my meaningful use. I spent more time checking boxes than talking to patients and their familiesThere aren’t enough physicians to see all the homebound patients in my area, so I try to visit as many as I can safely care for. I could see twice as many patients if I could write their notes at the bedside while visiting with them. I would happily do this using paper or an EHR that took the same amount of time, but these are not options.I spend more time talking to the information technology team than I do answering messages from patients.
The underlying problem of technology not fitting the need – in this case demanding a typed note to capture the details could at least be solved with some speech enablement
But I was more troubled by the impact on teaching of our future generations
As a teaching doctor, my feedback to the residents now consists mainly of explaining how to document their visits so that we will all get paid, instead of teaching them how to take care of elders in their homes.
This may fall under the category of Unintended Consequences – but it is a big one…If we are focusing on the documentation at the expense of teaching clinical care then the problems we have today will be amplified dramatically as these new doctors enter the workforce.
Finding the balance between the need for digitizing medical notes and electronic medical records with the time necessary to spent interacting with these systems is still problematic – there are a number of technologies available including Speech Recognition with embedded Clinical Langauge Understanding (CLU) that can help ease this transition form paper to digital. But technology is not always the answer and finding the right balance between the needs to the system and the needs of the patient and their doctor will remain central to successful use and roll out of HealthIT in Healthcare.