Keynote presentation at NPSF Lucian Leape Institute Forum & Gala looks at the digitization of medicine.
By Patricia McTiernan, MS
Anyone who trained as a physician 20 years ago probably recalls spending a lot of time on the hospital medical-surgical units, making notes in patients’ charts after rounds. There was one physical chart for each patient, and it lived at the nurses’ station or outside the patient rooms, where interns, residents, and attending physicians spent time—among nurses and other staff—and where team interactions could occur naturally.
Today, with the widespread use of computers in medicine, records can be read or updated from virtually anywhere. Consequently, the chances of running into a colleague in the hall have largely diminished. According to Bob Wachter, MD, the withering of these social interactions is only one downside of the digitization of medicine. In an enlightening (and entertaining) keynote presentation at the 7th Annual NPSF Lucian Leape Institute Forum & Gala in Boston last week, Dr. Wachter made the case for why health professionals and systems need to take a closer look at implementation of electronic records.
Dr. Wachter, who is a professor of medicine at the University of California, San Francisco, is no technology-fearing Luddite. As he proved by displaying his many electronic gadgets (and a selfie he took with his smart phone), he is a proponent of computers. Author of a popular blog (Wachter’s World) and editor of the AHRQ websites PSNet and WebM&M, which together have a million unique visitors every year, he has led the way in the use of digital technology to promote the spread of information. He has even been an advisor to the digital giant, Google.
“We have to do it,” he said of the digitization of medicine, “but so far we are not getting it right.”
Currently visiting professor at the Harvard School of Public Health, Dr. Wachter has spent much of his time recently writing a book about this subject, which will be published in 2015. Extensive interviews with those in the field, as well as his own experience and research, are fueling the project, which formed the basis of his talk at the Leape Institute Gala.
One of the problems with computers in medicine, he said, is that health professionals have approached digitization as a technical issue when, in reality, it is “the mother of all adaptive problems.” Referencing the work of Dr. Ronald Heifetz, he noted that technical problems often have a relatively clear (though not necessarily easy) solution, whereas adaptive problems require people—the users of the technology—to change behaviors and attitudes.
In a step-by-step recap of a medical error that occurred at his own institution, he illustrated how terribly easy it is for computers to enable human missteps. An initial “catch” by a pharmacist led to a dosing error by the resident who tried to correct it. Subsequent alerts were ignored because of confirmation bias and the simple fact that there are too many alerts. And the nurse who administered the medication – a 39-fold overdose of a common antibiotic – was hampered by a barcode scanning system that informed her she was doing the right thing (which in this case involved a 16-year-old taking a cupful of pills).
Some attendees shook their heads in the how-could-this-happen fashion. Yet the overall sentiment in the room seemed to be one of understanding exactly how it could happen—within the setting of a clunky computer interface, busy hospital unit, amidst pressure to get the work done, and reluctance to “bother” other busy people. The nurse who administered the dose was devastated, but there were at least two other points along the way where the error could have been caught.
Fortunately, after experiencing a grand mal seizure, the patient recovered with no lasting effects. But as this example so clearly demonstrates, the urge to listen to the computer at the risk of turning off our own judgment is all too real.
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Patricia McTiernan, MS, is senior director of communications at the National Patient Safety Foundation and editor of the P.S. Blog. Write to her at firstname.lastname@example.org.