I'm glad this finally made it to the front page because it is an important story of how culture and true customers shape software development. Notice that government incentives spurred hospitals to quickly adopt software that physicians (and a whole host of other clinicians and supporting actors) use. Hospitals/Health Systems/etc != Physicians.
Some reactions to the article I sent to my team:
Bulletpoint summary: [1] “The article includes a brilliant comment from WellSpan SVP/CIO Hal Baker, MD: ‘Physicians have to cognitively switch between focusing on the record and focusing on the patient … I have yet to see the CEO who, while running a board meeting, takes minutes, and certainly I’ve never heard of a judge who, during the trial, would also be the court stenographer. But in medicine … we’ve asked the physician to move from writing in pen to [entering a computer] record, and it’s a pretty complicated interface.’”
EPtalk by Dr. Jayne 3/21/19: [2] “The piece hooks the reader by opening with a story that details a patient’s death from a brain aneurysm, with the lack of diagnosis being influenced by failure of the head scan order to be transmitted by her physician’s EClinicalWorks EHR.”
Reader Survey Results: How I Would Change EHRs: [3] “There is no perfect technology. Our ability to acknowledge data integration is key is tantamount.”
Not related, but also interesting: [4] HIStalk Interviews Grahame Grieve, FHIR Architect and Interoperability Consultant: “A lot of doctors I talk to think about this as a technology problem, but it’s not a technology problem. It’s an information problem, and so technology can’t solve it. It needs clinicians to make clinical agreements in order to get clinical interoperability.”
> Physicians have to cognitively switch between focusing on the record and focusing on the patient … I have yet to see the CEO who, while running a board meeting, takes minutes,
Aren't doctors usually assigned an assistant? My GP has one, dentists have one. (I'm in Hungary.)
An assistant to write my notes? Wow, that would be great. I've been practicing for 12 years and haven't had one yet. (Primary care/public health.)
There are certainly scribes out there and some docs use them, but the practice is hardly universal nor is it without cost. And, of course, some are better and more accurate than others.
When I had an accident in Dallas in 2012, the specialist at Baylor general had a foot pedal-activated recorder (one of those micro cassette tape deals), and then sent off his recorded notes to be transcribed. 1970s technology. Seemed pretty effective.
I used to dictate everything when I did hospitalist work. It seemed pretty efficient and notes were in the chart within hours. There's a cost there too, but it might be better borne by tertiary facilities and medical centers. It's the small offices where the expense can only be spread over a couple docs.
Yes and no. There are often lots of medical assistants of various sorts, ranging from someone titled "medical assistant" (who is qualified to take your temp, confirm you are the right person and little else) to "Physicians Assistants" or "Nurse Practitioners" who for a lay person are basically doctors with a lesser title.
An assistant specifically for documentation is known as a "scribe." This person follows a physician and does all the typing into the EHR so the doc can focus on the patient. My children's pediatrician recently recently started using one and it does allow the physician to focus more on the patient. My understanding is that they have to pay for the scribe out of their own pocket.
So the Hungarian healthcare system is in complete shambles, because of lack of funding, drastically severe power imbalances (doctors are scarce so they can do whatever they feel like, and they exploit their privileges, usually they simply ask for money to make up for the aforementioned lack of funds - but then nurses and other staff see almost nothing of these "funds"), and of course enormous lack of efficiency (due to lack of funds, patients wait a lot, travel a lot, and then wait some more, and then the doc doesn't have much time for each patient, so the results/outcomes are not great, many things get overlooked).
GPs get money from our NHS thing (it's called Country Healthcare Treasury), after patient visits and after assigned patients (patients can choose their GP), but they have to bear the fixed costs (leasing an office, scribe, etc). Since the GP system is sort of overloaded, there seems to be enough money for every GP to afford a scribe.
Some reactions to the article I sent to my team:
Bulletpoint summary: [1] “The article includes a brilliant comment from WellSpan SVP/CIO Hal Baker, MD: ‘Physicians have to cognitively switch between focusing on the record and focusing on the patient … I have yet to see the CEO who, while running a board meeting, takes minutes, and certainly I’ve never heard of a judge who, during the trial, would also be the court stenographer. But in medicine … we’ve asked the physician to move from writing in pen to [entering a computer] record, and it’s a pretty complicated interface.’”
EPtalk by Dr. Jayne 3/21/19: [2] “The piece hooks the reader by opening with a story that details a patient’s death from a brain aneurysm, with the lack of diagnosis being influenced by failure of the head scan order to be transmitted by her physician’s EClinicalWorks EHR.”
Reader Survey Results: How I Would Change EHRs: [3] “There is no perfect technology. Our ability to acknowledge data integration is key is tantamount.”
Not related, but also interesting: [4] HIStalk Interviews Grahame Grieve, FHIR Architect and Interoperability Consultant: “A lot of doctors I talk to think about this as a technology problem, but it’s not a technology problem. It’s an information problem, and so technology can’t solve it. It needs clinicians to make clinical agreements in order to get clinical interoperability.”
1. https://histalk2.com/2019/03/19/news-3-20-20/
2. https://histalk2.com/2019/03/21/eptalk-by-dr-jayne-3-21-19/
3. https://histalk2.com/2019/03/24/reader-survey-how-i-would-ch...
4. https://histalk2.com/2019/03/25/histalk-interviews-grahame-g...