Though medical practices have a high burden of proof to claim their bonus--the Department of Health and Human Services is still in the process of fully
defining just what constitutes 'meaningful use'--there is now conclusive evidence that the carrots are working. Recent data demonstrates that solo and two-doctor offices, which still comprise over half
of all medical practices in the U.S., have seen the biggest jump in EHR adoption over the last six months. These small shops are reaching the conclusion
that they must participate, as they risk being left behind technologically and financially.
Lawmakers, too, seem to agree that the digital advancements are both vitally necessary and long overdue. What remains to be addressed is how the total
adoption of EHRs in medical practice will impact patients.
Digitization of medical care makes intuitive sense: Medicine is a complex set of processes prone to error. Relying on fallible human memory or illegible
handwriting seems downright shoddy in an era of "Watson" and personalized gene sequencing. And for the most part, patients view the transition positively,
as medicine is following a path blazed by nearly every other customer-oriented business.
In fact, it's become an article of faith that the huge upfront costs for computerized systems in medicine are recouped in time saved and errors avoided.
Yet medical computing has given rise to a growing class of apostates.
As a practicing primary care doctor, I feel I am slowly being pulled into the apostate camp. Our apostasy is not about EHRs; that game is all but over.
Rather, there's a pervasive sense that our use of technology has become a wedge between doctors and just about everyone else: Nurses. Other doctors. Worst
of all, our patients.
No one describes this more elegantly than doctor and author Abraham Verghese, who has lamented the rise of the "iPatient." For Verghese, the iPatient
symbolizes the adoption of technology to a level that is eroding the foundational elements of the profession, like the physical examination. He decries
trainees spending vastly more time at computer stations looking over their 'virtual' patient [the collection of progress notes plus lab and x-ray data, not
an avatar] than giving face time to the sick person down the hall. Other commentators describe the sloppy habits of " copy and paste" medicine, in which doctors (especially
trainees) perpetuate the same patient histories from one hospital admission to the next without applying fresh thinking. [Human nature is no different
among doctors: Where possible, we take the path of least resistance.]
Further, doctors and nurses are now tethered to computer appliances. To perform any basic hospital function (e.g. admission, lab test, x-ray, pill
delivery, discharge), an order needs to be sent via the computer system. The good in this is that all doctors' orders go through one standardized entry
point: It eliminates issues with poor physician penmanship. However, the technology inhibits doctors and nurses from actually talking to one another.