The pressures of healthcare payment has forced physicians to move patients through the office as quickly as possible, and that is robbing us of high-value services that we can provide, particularly to educate and engage in shared decision making with our patients.
I explored this topic with a new friend and ally, Moyez Jiwa, a physician, educator and publisher based in Melbourne, Australia (which is one of my favorite cities, by the way. Moyez interviewed me on his Health Design Podcast recently, during which we talked about the rise of the electronic health record (EHR) and the barriers that EHRs can create to prevent true participatory medicine.
Why are we using an electronic health record in the first place? First and foremost it should be to improve efficiency, safety, and quality of care that we deliver. When I helped develop an EHR at Beth Israel in Boston in the early 90s (a version of which is still in use today), these were the guiding principles. It was not created as a tool to optimize billing. Further, the EHR it should facilitate, rather than pose a barrier, to clinician-patient interaction. The sad reality is that technology is too often getting in the way and frustrating both clinicians and patients. Thoughtful interactions are giving way to hurried frenzies of mousing and clicking. And as a result, both the patient story and the physician’s thought processes are lost.
During my conversation with Moyez, I noted, “Our (medical) students should be learning one thing, which is to spend the time to get a careful history from your patients, because if you do that, they will do better. You will order fewer tests. You will refer to fewer specialists. Everything’s going to be better!”
In our conversation I also described the origins of SPM (https://participatorymedicine.org/what-is-participatory-medicine/). We have viewed health information technology is an important enabler for participatory medicine so that patient can connect to information, their health care team, and other patients.
I asked Moyez the other day what he took away from our conversation. “It was very interesting that the design of EHRs has become so focused on billing- that has disrupted its potential as a clinical tool,” he said. “The involvement of accountants at the point of care is inappropriate.”
Moyez added, “It is also crucial when designing innovations that those leading the design include clinicians so that the tool doesn’t become a stumbling block in the consultation.”
I invite you to listen to the podcast, https://www.journalofhealthdesign.com/JHD/podcasts/view/428, and I welcome your feedback in the comments section here.
Dr. Danny Sands is a co-founder and the chief advocacy officer of the Society for Participatory Medicine.
It’s frustrating that this has been talked about for over a decade already, over which time a ton of $$$ was spent getting systems installed. What happened?? Meaningful Use was a big mistake, but there was little heard from physicians (except from John Halamka) about it. Why?? There was so much potential to make things better but it’s hard to see that there’s really been any improvement. With more complications from diabetes, along with more people with the diagnosis of diabetes so you can’t just say “they’re sicker”, it’s troubling that we have done little but enrich health IT vendors.