Thursday, September 26, 2013
Here Is A Health IT Debate We Probably Need To Have. What Do You Think?
This appeared a few days ago.
SEP 17, 2013 9:35am ET
A recent study of work hours of medical interns in the new era of duty hour regulations produced an interesting side finding, which is that modern medical interns spend about 40% of their time at a computer . To some, this prompted concern that computers were drawing medical trainees away from patients and their care.
A finding like this certainly warrants attention. However, I wonder whether many expressing concern are asking the wrong question. The proper question is not whether this is too much time at a computer, but rather if this amount of time compromises the interns' care of their patients or of their learning experience.
Implicit among those who raise the question of too much time with computers is the assumption that computers are taking physicians away from patients. It is instructive, however, to consider historic data of how much time physicians spend in direct vs. indirect care of patients. It turns out that physicians have historically spent most of their working time in activities other than in the presence of their patients.
Time studies of hospital [2-6] and emergency  physicians show physicians spend about 15-38% of their time in direct patient care versus 50-67% of their time in indirect patient care, divided among reviewing results, performing documentation, and engaging in communication. Likewise, studies of outpatient physicians find that 14-39% of work takes place outside the exam room [8-9]. In addition, work related to patients when they are not even present at the hospital or office consumes 15-23% of the physician work day [9-11].
Therefore, this new study does not necessarily indicate the computers are drawing physicians away from patients.
By William Hersh, M.D., professor and chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University. Dr. Hersh blogs as the Informatics Professor.
This is quite an interesting issue.
In the past there has been concern about how the use of a computer while providing patient care might interfere with the doctor-patient communication and relationship and some have made some good suggestions about how to minimise the impact.
There is a useful very recent article here:
The use of electronic health records in the exam room need not harm the doctor-patient relationship if physicians use EHRs properly, according to a recent report from the American Medical Association Board of Trustees. But observers raise some serious questions about how EHRs may be changing doctor-patient interaction and about whether physicians are trained well enough to know what they're doing.
William Ventres -- an Oregon family physician who coauthored a Family Practice Management piece on the subject -- said that many physicians are too absorbed in their computers to pay adequate attention to their patients during office visits. A major reason for this, he said, is insufficient training.
"Most people starting out with EHRs get very little training on how to use them in terms of the doctor-patient relationship," he noted. "The computer is put down in front of them and they're told to 'use it.' And there are many different ways of using it, but people don't get that education."
Lots more here:
I think any concerns with all this should be balanced by the benefits received by both clinician and patient if the clinician has access to accurate records and other relevant information (lab results and the like).
Clearly there is also benefit to be had if we ensure the patient can see what is being recorded, correct if necessary, and develop a better understanding of what is happening to them.
There is a useful blog discussing this issue here:
Overall, as long as systems provide good workflow support, I think there is considerable upside and limited downside with computer use. What do others think?
Posted by Dr David G More MB PhD at Thursday, September 26, 2013