Wednesday, March 6, 2013

Attention Technologists, CEOs, And Health Care Consultants

The ICU hummed as the tech guy waltzed in at two in the morning.  A key designer of the EMR himself, the night shift nurses had his mobile and were not afraid to use it.  There was a problem reconciling Mr. Jones med list after his emergency bypass surgery that evening.  Patients first.

The next one in the door was the young CEO of the hospital.  A firebrand, he had pushed the ACO envelope to near completion.  There were still bugs, and no primary team was yet claiming Mr. Jones as their patient.  Some things need to be sorted out in person, even in the middle of the night. 

The chief quality officer was following close behind.  There was a new initiative to interview the patient or family within four hours of admission.  Of course, Mr Jones came in at midnight and was whisked off to surgery immediately.  Some one had to find his wife.  The clock was ticking.

Nowhere, I repeat, nowhere was the surgeon.  After the quickie procedure, he must have been in the middle of a catnap.


As ludicrous as it sounds, I think we often forget what taking care of patients really looks like.  Before we write off physicians for being Luddites for their slow adaption of all that is changing in health care, I think we need to take a closer, harsher look. 

Attention technologists, CEO's, and health care consultants: your decisions can be as dangerous as a nurse with a syringe of overconcentrated heparin, a surgeon with a lack of appropriate sleep, or an internist with the wrong diagnosis.  Yes, your actions can kill!

When EMRs are implemented that take physicians eyes and minds away from the patient without demonstrable improvement in quality of care (and cause excess spending), patients can die.  When four hour pneumonia rules are followed with no scientific evidence, certain patients get C Diff and end up in the ICU unnecessarily.  And when inane unproven giants like ACOs are forced on a population, who knows the untold irreparable harm can be done.

For too long, doctors have been on the front lines taking the responsibility for every aspect of patient well being.  And justifiably, we have become quite cautious.  We don't like following dictates unless a modicum of evidence suggests benefit.  We make decisions based on years of training, reading, and personal experience.  We do not implement new care policy because it "sounds right" or "makes sense".  We have been burned too often by such simpleton principles. 

Yet over and over again, physicians are blamed as slow adaptors and the reason why new policy fails.  If only doctors would fall in line like good soldiers.

Follow me.  Follow me into exam rooms with hobbled patients and hopeful expectations.  Follow me into hospital corridors where families huddle desperately over prayer books and rosary beads.  Look these people in the eyes.  Tell them that you will take responsibility for your actions whether their loved ones live or die.

Then and only then. 

Feel free to criticize me.


elisems said...

Wow. That was powerful. Thanks for sharing.

Ashley said...

Couldn't agree more. Great post!

Craig said...

Those working in Healthcare IT know the potential ramifications of their actions. Any software issue deemed a "patient safety risk" went straight to the CEO of software company, and meant sleepless nights for the developers and software testers until the new code was installed in every customer's system. As a consultant, we had to carry multimillion dollar professional insurance policies in case a software issue caused doctors or nurses to make a mistake in patient care. We too have on-call pagers to respond to patient care concerns 24-7.

The problem with EMR isn't the people working to install it. Most are not ignorant of their responsibility. Most are honest people doing the best they can with what they have. The real problem is the government mandating "meaningful use" of a technology that simply isn't ready yet. The kinks haven't been worked out by the early adopters. The installation timelines are too short, so the software is being customized for the hospital by people who don't really know the software yet, and physicians are being trained by people who were trained just months ago themselves.

Even when IT professionals and consultants know exactly what they're doing, each hospital insists on documenting the same information differently. Even within the same physician group, you'll get three different requests for a data entry screen because each Doc has their own way of doing things. Doc A wants it his way, but Docs B & C get upset. I've seen it dozens of times.

My suggestion to you would be to either become politically active and lobby to change the laws so EMR can be implemented more appropriately, or to be as patient and constructive as possible with those working on your EMR. Given enough time and enough people that really care, all these issues will be resolved.