Atul: Why doctors and computers don’t mix

Another classic article by Atul Gawande, this is much more than a screed against EMRs. It is a philosophical and at times spiritual assessment of the interaction between humans and machines. Too much to easily summarize. But here are a few tantalizing quotes that paint the picture:

More than ninety per cent of American hospitals have been computerized during the past decade, and more than half of Americans have their health information in the Epic system.

A 2016 study found that physicians spent about two hours doing computer work for every hour spent face to face with a patient—whatever the brand of medical software. In the examination room, physicians devoted half of their patient time facing the screen to do electronic tasks. And these tasks were spilling over after hours.

I’ve come to feel that a system that promised to increase my mastery over my work has, instead, increased my work’s mastery over me.

The software ‘has created this massive monster of incomprehensibility,’ she said, her voice rising. Before she even sets eyes upon a patient, she is already squeezed for time. And at each step along the way the complexity mounts.

And yet it’s perfectly possible to envisage a system that makes care ever better for those who receive it and ever more miserable for those who provide it.

Medical scribes are trained assistants who work alongside physicians to take computer-related tasks off their hands. This fix is, admittedly, a little ridiculous. We replaced paper with computers because paper was inefficient. Now computers have become inefficient, so we’re hiring more humans. And it sort of works.

I have been at times dismissive of “physician burnout” attributing more to the selection and grooming of the wrong time of providers. But research now indicates that EMR computer systems are a real and major cause of significant physician burnout. The article also appropriately points out where EMRs have improved the quality of the care and hence the lives of patients in a way that was simply inconceivable in the paper-chart based world of the past. We have seen the same in our practice. We opted to build our own EMR because we suspected that buying Epic (or any other third-party EMR) would mean that we would be forced to adopt the vendor’s workflows.. We were also highly repulsed by the immense number of features that weigh down the current products - features that are rarely used and just add to complexity and create friction, as revealed in the Gawande article. In the end, this article reveals that there is still great room for innovation. Despite the market dominance and success of Epic, its EMR now seems surprisingly fragile and vulnerable. There is room for surprise entrants who take on small segments of the EMR tasks, focus on MVP, and make the EMR more adaptive to and supportive of both patients and providers.

Read: New Yorker, Why doctors hate their Computers

Read: Annals: Physician Burnout in the Electronic Health Record Era: Are We Ignoring the Real Cause?

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