A flawed system

"It's a rotten system,” declares Dr. Lawrence Weed, who at age 89 is the dean of healthcare information technology iconoclasts.

Weed isn't disparaging any particular brand of electronic health-record system. A dismissive “they're inadequate” would fairly well cover a Weed-guided tour of today's EHR systems.

“People don't get the general picture,” he says. “It's broken. It's basically an unsound system.”

By that he means the entire healthcare system, but not because its providers are using faulty information technology, but because they're using IT the wrong way, at least in part.

Weed says the medical education system is at the root of the problem.

“I've taught in five different medical schools,” Weed says. “And over and over again, they kept defending the idea of clinical judgment,” even though, Weed says, the unending and accelerating expansion of clinical knowledge makes it impossible for human minds to keep up—even the high-powered and best-trained minds of physicians.

Still, he says, “In medicine, it's what does the doctor think? It's pathetic.”

“In the 1950s,” he explains, “when computers came along, the engineers and the physicists, they caught on right away. You use the computer to do what the human mind can't do. If you want to go to the moon, you can't have humans doing the calculations.” Computers could do the math, though, allowing us to put men on the moon.

“Whereas the doctors, they didn't say, 'Oh, my God, all these volumes. We can keep track of it now,' ” Weed says. “They didn't do that in the '50s, and I'll tell you why. Clinical judgment had been made sacred.”

“Oscar Wilde said, 'To be intelligible is to be found out,' ” Weed says, hence physicians' many guises. “They knew they couldn't do it so that's why they became specialists. They divided it up.”

To this day, medical schools perpetuate a myth—that the physician brain is up to the task, is able to keep up with the ever-increasing knowledge burden placed upon it—by medical schools and then by the profession, Weed says. “When are they going to wake up and stop moving knowledge through heads and start moving knowledge through tools?”

That would be another Weed solution. In the 1960s, he invented the SOAP (subjective, objective, assessment, plan) format to help physicians think as they kept organized patient records on paper.

In 1984, to help physicians cope, Weed developed a computer-based, diagnostic support system he called the problem-knowledge coupler. The software company he founded, but is no longer with, PKC, now part of Sharecare, still sells the system. Weed still proselytizes with fervor, calling for the use of computers to store, retrieve and apply medical knowledge.

In 2011, Weed and his son, Lincoln, a lawyer, published a book, “Medicine in Denial,” addressing the profession's problems but also providing solutions.

Weed says he started standing up against the system decades ago, “once I saw the root of the problem,” because “we were destroying a lot of very bright young people,” setting them up for frustration as medicine demanded of them things they simply could not do.