Put technology in it's proper place

What do I expect from my healthcare providers?  Simple, I want them to use their skills at diagnosing and treating to fix me when I am unwell.  Will technology enable them to do that job better?  That is a complicated question. 

Let’s take a look at diagnosing.  A diagnosis is a ultimately a decision about what is causing a person to be unwell and that decision informs the treatment.  A recent study by Paley, examined the accuracy of diagnoses in an emergency department.  Residents were correct in their diagnosis 80.1% of the time, and senior physicians were right 84.4%.  Inversely 2 people out of 10 were misdiagnosed.  The study went on to validate the contributing factors to a successful diagnosis and confirmed that classic diagnostic tools such as reviewing patient history, physical exams and lab tests are critical.  It was identified that older clinicians rely on the history and physical to a greater degree than younger clinicians.  As a result, many recent graduates can only make cardiac diagnoses by echocardiography, relying more on technology for their decision making. 

This study reminded me of the discussions that emerged following Captain Sullenberger’s successful landing of Flight 1549 into the Hudson River.  The experts identified the primary reason for the successful ditching was the decision making of the flight crew members during the accident.  Captain Sullenberger’s years of experience with multiple aviation systems, including low tech gliders, directly influenced his decision making ability. 

I found it interesting that Captain Sullenberger, a safety expert was a proponent of building a balanced environment of learning and accountability to enhance safety and he even had a copy of A Just Culture in the cockpit.  A Just Culture is an environment where learning and accountability are fairly and constructively balanced and is critical for the creation of a safety culture. Without reporting of failures and problems, without openness and information sharing, a safety culture cannot flourish. 

Technology can be an important enabler to a just culture but it is only one part of a learning environment.  Technology provides skilled practitioners with a tool to do their job more accurately and faster, it does not replace the interpersonal skills and human judgement required to effectively diagnose and treat patients. 

A recent New York Times article The Face of Future Health Care  speaks to the role of technology in helping healthcare providers track patient care.  When Dr. Jennifer Slovis recently saw a patient, she was able to spot that the patient had an abnormal blood test several years ago. By reading through the patient’s medical history, she determined he was now overdue for an M.R.I. to check the status of a growth in his brain. She was able to e-mail his endocrinologist and schedule the necessary tests without the patient having to make an appointment with the specialist or her having to make her own diagnosis. “It saved a lot of starting over,” she said.

In measuring the value of technology in healthcare we need to focus on the practical 

applications not the hype. 

Forbes Magazine reported on the President’s Council of Advisors on Science and Technology who have concluded that “the impact of IT on health care over the past decade has so far been modest.” But, don’t underestimate what’s coming. It is nothing short of an explosion in innovation and creativity, facilitated by open systems and connectivity.  Here is where the real value lies.  Technology allows for a connected system that will help patients take responsibility for their health. Strong teams of physicians, nurses and caregivers will use an intelligent network to make their results better and their jobs easier. 

Sorry Watson, while we anxiously await your contributions to healthcare, you can’t replace the decision making skills of our healthcare professionals that are honed in a continuous learning environment. After all, your decision-making algorithms are informed by those of learned professionals and that learning, is constantly evolving.  Let’s all take a moment and think about the role of technology and how it can be used to build a just culture that encourages learning and rewards accountability in healthcare. 

I want technology to support my healthcare provider’s decisions, not the other way around.  After all, if my health stopped functioning and I needed an emergency landing, I’d put my trust in a medical version of Captain Sully any day of the week to guide me to safety. 

It’s your health.  It’s your health information.  Manage it well.