Slashdot Mirror
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.
As someone who works in healthcare IT, I understand where this article is going, and the costs associated with installation of an EMR are certainly feasible. However, this is NOT why doctors hate their computers. They don't want to do the part of their job that is arguably one of the most important. Documentation. They want someone else to do it for them. We constantly get requests for scribes to do that. It's PART OF THEIR JOB. That's like me not installing OS updates, not installing anti-virus. Stuff I'd prefer not to do but it's part of my job. Doctors don't want to do to it so they don't want the system to do it. Bad documentation from scribes leads to increased healthcare cost due to errors, and costs organizations because billing in many cases requires that the documentation be completed by the person who did the procedure.
As someone who spent 9 years working on HMIS systems, I can tell you that doctors hate what everyone hates: poorly designed screens and workflows that do not fit in with the efficient use of their time. One example: a vendor had a system for doing basic Order Entry - where, say, a doctor orders an X-ray. Along with a bunch of other unnecessary data REQUIRED to be entered, the system forced them to manually enter the date and time that the order was entered. No thought of: let's use the actual known current date and time that the order was entered. These types of inefficiencies were rampant and the vendor was truly perplexed why everyone hated the system so much.
The difference between the doctor and the cat is that the cat isn't paying you to fix his problems.
If you think the federal govt will operate in that fashion, of just paying only and not regulating the hell out of it, and making decisions rather than the doctors....you've either not dealt with the Feds much or are just deluded.
The federal govt does not work that way in any fashion to date and never will.
And to that last point, on universal guidelines...that IS a big problem, as that each person is different. Medicine is NOT an exact science and doctors need to have a very broad decision path on deciding your tx.
Part of the problems now with how it is regulated by HMO's and insurance is this same problem that you are advocating happen with federal single payer.
No thanks.
I say, take the bean counters out of it.
Give everyone in the US the capability to EASILY fund their own pre-tax HSA (health savings accounts), these roll over annually and are NOT use it or lose it.
You allow people to use this to pay for routine care, office visits colds, etc. This way, they can more readily shop for doctors.
Make insurance what it used to be, "Major Medical".
It was something only used for emergencies, like a heart attack or getting hit by a bus.
Also, let this insurance be sold across state lines.
These steps would take out a LOT of the waste we have today with middlemen....and allow most of what happens to be directly between the Dr. and the patient, where it should be/
Light travels faster than sound. This is why some people appear bright until you hear them speak.........
LOL, to a doctor, scope creep means that they are still in control!
I used to work in transfusion medicine. My team developed software for tracking the results on people who gave and received transfusions. In the donor hemovigilance system, we had a doctor who had worked with me on prior systems, and he was willing ot live by the requirements that we developed. We took two months writing he requirement, a week of re-reading it (took turns going around the table reading it aloud and addressing any disagreements or inconsistencies), then we shipped it off-shore and received completed software 30 days later.
At the end of the day, we had 1 discrepancy from the original requirement, 2 new features (doctor initially tried to claim it was a discrepancy, but good documentation squashed the complaint. At this point we did a knowledge transfer to internal devs, who continued to work on version so the code, and who where now capable of developing hte next software.
The next software was to track people who received transfusions. Since this part of the process occurred in hospitals (our customers), we did multiple site visits and met with medical directors, laboratory managers, transfusion services nurses and the FDA with compliance issues.
We were nearly complete with the development, when we hired a new doctor and she was assigned to work with us on the software validation. Well, she was eager to help but INSISTED on changing everything about ow the software behaved, eventually. It was nightmarish, but she turned it into a political battle, and with doctors in charge, IT had no say in reigning her in. Eventually the software was rolled out, but the customers refused to use it since it no longer reflected their needs...
TLDR? Doctors are spoiled prats who will shit can any IT project because they are more concerned with playing dominance games than getting work done. This will continue until they are ultimately commoditized like the rest of us.