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Why Doctors Hate Their Computers (newyorker.com)
Digitization promises to make medical care easier and more efficient. But are screens coming between doctors and patients? Here's an excerpt by Atul Gawande of The New Yorker, which talks about the deployment of Epic, a new medical software which cost Partners HealthCare a staggering $1.6 billion, panned out: On May 30, 2015, the Phase One Go-Live began. My hospital and clinics reduced the number of admissions and appointment slots for two weeks while the staff navigated the new system. For another two weeks, my department doubled the time allocated for appointments and procedures in order to accommodate our learning curve. This, I discovered, was the real reason the upgrade cost $1.6 billion. The software costs were under a hundred million dollars. The bulk of the expenses came from lost patient revenues and all the tech-support personnel and other people needed during the implementation phase.
In the first five weeks, the I.T. folks logged twenty-seven thousand help-desk tickets -- three for every two users. Most were basic how-to questions; a few involved major technical glitches. Printing problems abounded. Many patient medications and instructions hadn't transferred accurately from our old system. My hospital had to hire hundreds of moonlighting residents and pharmacists to double-check the medication list for every patient while technicians worked to fix the data-transfer problem.
Many of the angriest complaints, however, were due to problems rooted in what Sumit Rana, a senior vice-president at Epic, called "the Revenge of the Ancillaries." In building a given function -- say, an order form for a brain MRI -- the design choices were more political than technical: administrative staff and doctors had different views about what should be included. The doctors were used to having all the votes. But Epic had arranged meetings to try to adjudicate these differences. Now the staff had a say (and sometimes the doctors didn't even show), and they added questions that made their jobs easier but other jobs more time-consuming. Questions that doctors had routinely skipped now stopped them short, with "field required" alerts. A simple request might now involve filling out a detailed form that took away precious minutes of time with patients.
In the first five weeks, the I.T. folks logged twenty-seven thousand help-desk tickets -- three for every two users. Most were basic how-to questions; a few involved major technical glitches. Printing problems abounded. Many patient medications and instructions hadn't transferred accurately from our old system. My hospital had to hire hundreds of moonlighting residents and pharmacists to double-check the medication list for every patient while technicians worked to fix the data-transfer problem.
Many of the angriest complaints, however, were due to problems rooted in what Sumit Rana, a senior vice-president at Epic, called "the Revenge of the Ancillaries." In building a given function -- say, an order form for a brain MRI -- the design choices were more political than technical: administrative staff and doctors had different views about what should be included. The doctors were used to having all the votes. But Epic had arranged meetings to try to adjudicate these differences. Now the staff had a say (and sometimes the doctors didn't even show), and they added questions that made their jobs easier but other jobs more time-consuming. Questions that doctors had routinely skipped now stopped them short, with "field required" alerts. A simple request might now involve filling out a detailed form that took away precious minutes of time with patients.
It wasn't that computers are less efficient than old school / antiquated methods. It was a matter of incompetence. Before the transition all people involved should have been properly trained. They shouldn't have made a mass transition to the new system, but rather should have piloted it with a small group of the best in class as the first users, who would then be in a position to help their colleagues thereby greatly minimizing the need to involve IT. The data imports should have been tested properly. Printing issues should have been resolved in the piloting phase. Basically, everything was done wrong, but at least the Hospital Administrator's nephew got a new job out of the deal! (I don't know about that last point, but I do know non-tech people hire people they know, not people *who* know.
Guns don't kill people; Physics kills people! - John Lithgow as Dick Solomon on Third Rock From The Sun
But should it be their job? Might it be better if the doctor focuses on the patient and a scribe focuses on the data entry? We keep hearing about a shortage of doctors and it's easier and cheaper to train a new scribe than a new doctor.
As for the billing bureaucracy, perhaps an anal stickectomy is in order.
They hate them for the same reasons ALL corporate and centrally-controlled system users hate them - the dump changes on the user, then run away, and leave everyone else to just figure it out on their own.
Yeah, doctors are such villains. Their attempts to cure illness and ease suffering is just a clever ploy.
That's quite the perspective you have. Why wouldn't everyone want to be just as bitter as you?
The only thing worse than electronic health records is staying with paper forever. Let’s implement an EHR system that everyone can live and then force those highly paid prima donnas to use it.
...with private medicine in one phrase:
the expenses came from lost patient revenues
When patients are revenues, who's interested in curing anything?
"Encyclopedia" is to "Wikipedia" what "Library" is to "Some people at a bus stop"
More often than not, the adherence to paperwork and rules CAUSES the care problems that ultimately lead to complications and deaths. Doctors and nurses cannot learn and pay attention to patients' needs. Instead too many have become strict rule-followers, mis-interpreting and mis-applying the guidelines they're given and destroying patients comfort, recovery prospects, and even lives.
My children, and literally everyone else I've visited in the hospital in the last 20 years, have all had this problem. 100% of them.
Most doctors and nurses are actually great at dealing with this. But one single nurse on one shift who can only deal with literals (thus having a strong tendency to mis-apply guidelines and fail to listen to patients) will ruin the prospects for a patient's recovery.