The computer isn't helping...

Computer technology has transformed health care by making information readily available to both providers and patients.  A few times, I have diagnosed problems that I had never previously seen, something that would have never occurred in the days of laboriously poring over exactly the right page in an enormous textbook.  Seeing in the electronic medical record that another provider had already thought of (and tested for) a specific problem for a particular patient after a few clicks of the mouse is enormously beneficial.

At the same time, if one devotes even fifteen minutes reading online about the impact of computers on health care, one cannot help but notice a cacophony of writing about electronic medical records’ negative impacts.  These include diminished performance, diminished job satisfaction, and burnout.  For doctors and mid-level providers alike, simultaneously capturing relevant / needed information and interacting with patients is a tall ask, robbing patients of their providers’ attention and providers of their job satisfaction. The costs of switching one’s attention between the patient and the computer during a clinic visit are very real.  Studies of emergency room physicians shows that interruptions, multitasking and poor sleep are associated with significantly increased rates of prescribing errors (1).  The electronic medical record is a source of all three of these (2,3).

I find my joy talking with patients.  If I spend a few minutes, seated on a stool, facing the patient, out of arm’s length from the computer keyboard before attending to the computer, I can feel myself relax, and I believe the patient can too.  Some things I ask may already be in the electronic medical record, but I ask anyway because finding those things in the electronic medical record distracts me from the patient and is far too time-consuming.  Yet, at the same time, I remain keenly aware of the need to record some of what I’m learning to do right by the person seated in front of me.

I’m not alone in feeling that pressure.  One study found that, per 1.0 full-time equivalent, primary care physicians spent more than half of the 11.4 hour workday interacting with the electronic medical record, including 4.5 hours while at work and 1.4 hours after work (3).  That’s 1.4 hours of time that could have been spent with one’s family.  Since the result is choosing between family and sleep, it’s no wonder so many no longer work full-time or leave medicine altogether.

Surgeon and author Atul Gawande MD wrote a piece called “Why Doctors Hate Their Computers” that was published in the New Yorker magazine (4).  In it, he wrote:

We ultimately need systems that make the right care simpler for both patients and professionals, not more complicated. And they must do so in ways that strengthen our human connections, instead of weakening them.

I’m excited to introduce ChartMedic, an electronic physician and patient assistant which I think makes "the right care simpler."  The idea is not to take away time used for face-to-face communication, but to help physicians maintain focus on patients by minimizing some of the distractions associated with charting.  The idea is to save physician time by automating recording of the history the patient provides.  The idea is to deliver better care.

(Note: the opinions expressed herein are mine, and not those of my current employer.)

References:

1. Westbrook JI, Raban MZ, Walter SR, Douglas H. Task errors by emergency physicians are associated with interruptions, multitasking, fatigue and working memory capacity: a prospective, direct observation study. BMJ Qual Saf. 2018 Aug;27(8):655-663. doi: 10.1136/bmjqs-2017-007333. Epub 2018 Jan 9. PMID: 29317463; PMCID: PMC6204927.
2. Lieu TA, Warton EM, East JA, et al. Evaluation of Attention Switching and Duration of Electronic Inbox Work Among Primary Care Physicians. JAMA Netw Open. 2021;4(1):e2031856. doi:10.1001/jamanetworkopen.2020.31856
3. Arndt BG, Beasley JW, Watkinson MD, Temte JLm Tuan WJ, Sinsky CA, Gilchrist VJ. Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time-Motion Observations.  The Annals of Family Medicine Sep 2017, 15 (5) 419-426; DOI: 10.1370/afm.2121
4. https://www.newyorker.com/magazine/2018/11/12/why-doctors-hate-their-computers