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.
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