In response to reader commentary:
Bravo! Dr. David M. Polaner is so right and has written such an insightful comment! Yes, the information technology people and their backers bully us constantly that, as he said, "The clinician should adapt to the software instead of the other way around." This is epitomized by their favorite put-down of clinicians: "It's hard to change, isn't it?" His comments hit the nail right on the head that "The inability to look simultaneously at multivariate, multimodal data in multiple windows to correlate and integrate information reveals an utter lack of understanding as to what physicians actually do when confronted with a clinical problem" and that "poor presentation can easily contribute to missed diagnoses and adverse outcomes. The aviation industry recognized this risk long ago, and spends countless research and development hours optimizing displays in the cockpit for safety."
So why has the medical software industry not done the same? I think it has to do with the fact that the financial force behind foisting an expensive but immature technology on us is the administration—of hospitals, third-party payers, drug companies—and not clinicians themselves. We just don't have the financial clout to demand the building of more clinician-oriented medical software, and so he who pays the piper calls the tune—all medical software engineers care about are, as you point out, "documentation, meeting Joint Commission, Health Insurance Portability and Accountability Act, third-party payer, medico-legal and regulatory stipulations."
All this, on the unproved conjectures that one, no matter what the other ill effects may be, by solving physician handwriting legibility issues, patient safety will be markedly improved. Also, no matter how deleterious the IT is to physician time efficiency, by somehow preventing "duplication of tests," costs will be dramatically lowered.
Thankfully, thus far we've been able to resist installing such bad and dangerous systems in our own offices—physician adoption of electronic health records in their offices is less than 15%. Now that all the politicians of both parties are behind this sexy thing called health IT, however, we'll have to be prepared for having these systems shoved down our throats not only at the hospital, but also in our own offices.
Dennis Y. Fong, M.D.
Walnut Creek, Calif. To submit a letter to the Modern Physician Reader Blog, click here. Please include your name, title, company and hometown. Modern Physician reserves the right to edit all submissions.
