Fast, easy tech matters to physicians
April 12, 2014 in Medical Technology
For physicians on the combat field, making technology easy to use is nothing short of critical. I am the director of the William Lehman Injury Research Center, where we developed MobileCare, a web-based software that integrates documentation, education and telemedicine. MobileCare was originally designed for Army physicians in the field. We are now applying these lessons to the civilian healthcare sector.
One of the most important things we had to take under consideration when creating MobileCare, which was developed in partnership with the Department of Defense, was the actual design of the app and the related user experience. The biggest lesson I’ve learned as a result of this experience is this: If a certain technology or app is not something physicians like, actually want to use and feel like they can easily integrate into their workflow, they simply won’t use it.
In my opinion, one of the main issues facing all physicians today is the fact that healthcare technology was not designed with ease of use and physician workflow in mind. Put simply, user experience was not a high priority consideration. Instead, many companies put their eggs in one basket aimed at getting only half of the equation right when it came to health IT — and that was collecting data, not enabling doctors to provide high-quality, efficient patient care. And to be fair, it’s no easy feat to balance those two critical needs in a single system, especially when you’re designing it for a highly regulated and risk adverse industry like healthcare.
[See also: Physicians air EHR frustrations.]
In the beginning…
Today’s technology does not mirror the manner by which physicians go about their day-to-day duties. My main concern is that current technologies force physicians to take a before-and-after approach to patient care. Technology is an after-the-fact thought that physicians integrate post-visit, not at the point of care. In essence, technology forces us to break-up our workflow into chunks that don’t fit seamlessly with each other. What’s lost in this approach is the opportunity to engage patients in the complete care process — which includes the capture of their note in the electronic health record — and to also gather all of the patient’s information in real-time so it’s undeniably accurate and not subject to the degradation that happens when a physician has to engage with the EHR, or even worse, has to leave the patient room and make the trek down the hall to document that care.
One of the other major losses when it comes to the advent of technology in healthcare is that systems were only designed to capture data, not make sense of it. An original promise of the EHR was transparency, availability and accessibility of all information needed to inform real-time health decisions. And yet today we are merely storing much of this information. Unfortunately, since it’s not organized or presented in a way that facilitates a physician’s workflow, we must cobble together what we need from bits and pieces of data scat- tered across multiple systems.
EHRs were designed to satisfy specific functions for distinct parts of the care process. Currently, EHRs are all about making sure all the warnings are heeded, and all boxes are checked. It’s not about bringing the information together to make physicians’ jobs easier so they can make faster, more informed patient care decisions.
The problem isn’t solely new regulations and requirements; it’s the fact that we’ve adopted systems optimal for collecting data, not improving care.
All of this leaves us spending more time interacting with technology instead of focusing on patients. As a result, our days are longer, our administrative duties are continually on the rise and our patients are less satisfied. Still, I’m hopeful that through innovation we can start to address some of the patient engagement, physician workflow and data integration issues that have plagued the healthcare industry over the last decade.
[See also: Docs ‘stressed and unhappy’ about EHRs.]
In the future…
The right EHR for physicians captures data without requiring extra physician time to do it, integrates data into a format that’s compliant, synthesizes data for coding and billing, and is so easy to use that everyone involved in the patient care process — including the patients themselves — could look, understand and interact with all of the information created. The ideal EHR is also hands-free and shares information across various platforms and systems. More so, it allows physicians to make smarter decisions faster and enables them to spend more time with patients, and less time on technology.
Let’s consider a not too distant future. A physician enters an exam room, and the EHR immediately begins recording the ensuing patient encounter. Everything the doctor and patient say is captured and collated as needed — unstructured notes for the care team and structured data to satisfy coding and compliance requirements. Based on the physician-patient conversation, the system suggests a diagnosis, recommends and orders appropriate tests, and prints out and emails any post-visit instructions the patient might need.
Truly seamless, beyond intuitive, this is the vision for the smart patient encounter of the future.
Carl Shulman, MD, is director if the William Lehman Injury Research Center; associate professor of clinical surgery; and associate director, surgical residency training program, University of Miami Miller School of Medicine.