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Monday, October 17, 2011

HealthIT Gets my Story

I see my doctor about once every 2-4 months (lately while we have been working through some issues).  In between each visit my doctor sees a couple thousand other patients. I don't expect him to remember my story in between each visit.  But I do expect him to keep good track of what's going on with me, and to refresh his memory before each of my visits.  He does, and he uses an EHR to do it.  I also expect him to be able to share my story with other providers that he refers me to.  Because he has an EHR, he has the records he needs to do it, and can easily extract the relevant data he needs to communicate to others.

My doc has learned how to use the technology to facilitate his work.  But other doctors still don't get it.  Yes, the EHR doesn't capture the whole story by itself.  The EHR cannot look a patient into the eye, read their body language, or empathize with them.  But it does serve to remind physicians of their story, and if  implemented it right, it can put the information they gather through those means into the EHR.  Please don't try to tell me that a physician is expected to remember what is happening with thousands of patients.  Unless they happen to be one of those fortunate few with perfect memories, I simply won't believe it.

And as for what Groopman has to say about "Clinical Algorithms" in How Doctor's Think (which is definitely worth reading):
... but they quickly fall apart when doctors need to think outside their boxes, when symptoms are vague, or multiple and confusing, or when test results are inexact.
It's true that Clinical Decision Support designed to deal with the routine will not do well outside of routine care.  Remember, if you use the right tool for the wrong job, it won't work so well.  Hammers don't work so well on screws.  There are other clinical algorithms that enable physicians to search the immense volumes of information published (medline is headed towards 1M articles indexed a year), which can help clinicians think outside of the box.

Interestingly enough, Groopman also has this to say about the human errors made by physicians.  It would seem that there is a place for clinical decision support that can deal with the routine as well.

An EHR is great at recording data and helping clinicians remember it between visits.  It's not designed to look patient's in the eye and figure out their body language.  That's up to the clinician, who can then record what they learned in the EHR for later recall.  It's also pretty good at remembering the routine so that when they get hooked on the three A's (see the Groopman post at the ACP Internist site), they can fix it.

Physicians have to be willing to learn how to use EHRs to help.  On the good news side, it seems that our incoming crop of physicians expects to.


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