Death by a thousand clicks

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By Michael Woodhead, 6minutes editor

I just heard a senior member of an e-health agency start a presentation by saying "health is a knowledge-based industry". Err, no it isn't.

Health is a people-based industry. People get sick, doctor cures them. That is how it is supposed to work. Knowledge helps, but so does a box of tissues and a height-adjustable bed.

And this is a bit of a problem with a lot of e-health ventures - they assume that information is everything, and that doctors and other healthcare providers must change their practice to fit in with the new efficient systems that they deliver.

The presenter at an Australian health congress in Sydney this week poured scorn on a medical centre where the desks and computers were strewn with post-it notes to help staff remember things.

"Clearly not good enough" was the verdict. On the contrary, you might describe this as a "fully-functioning user-initiated cost-effective data enhancement program".

In other words, a simple and flexible reminder system devised by those at the coalface. Unlike a certain electronic medical record system that is being introduced into hospitals in one state at the moment.

In contrast to the Post-It notes, this multi-million dollar system was bought 'off the shelf' by the state health department and imposed on doctors from above. The feedback from those who have to use it is not good. Among them is the complaint that a lot more clicks are needed to enter information, and this means more time for each consult and less time spent treating patients.

I've heard similar complaints for GP desktop software, which grows more complex and needs more attention with each upgrade. So again the doctor spends more time facing the screen clicking the mouse and less time looking at the patient.

E-health is something of a mirage. To the weary traveler tramping though the e-desert of modern healthcare, there always appear to be wonderful benefits on the horizon.

But despite the hundreds of millions poured into e-health, the benefits - and implementation dates - always recede just as you approach them. The speaker at the conference was asked when we might expect to have a fully functioning national system of electronic medical records.

"I can't answer that," was the reply.

This is after spending nearly $400 million. You could have bought 20 million USB sticks for that.

Comments

I would hope that Nehta will inform itself fully on the practical issues involved in bring these tools into the time poor workplace of general practice.
Posted by Dr Lesley Stainkey GP Liaison Consultan on Wednesday, 14 October 2009

Dear Australian general practitioners,
Griffith University is undertaking a nationwide survey in an attempt to explore Australian general practitioners' World Wide Web, Internet and Social Media / Web 2.0 usage to deliver health care in the early 21st century. This survey is the first Australia wide study into general practitioners usage trends and impact associated with such modern communication applications and health care delivery.
Specifically this study will,

(1) Ascertain the degree to which Australian GPs use the World Wide Web and the Internet (Web 1.0) for health care delivery,
(2) Determine to what degree Social Media (Web 2.0) applications play in the delivery of health care by Australian GPs,
(3) Investigate why Australian GPs recommend certain health websites over others and
(4) Determine the level of influence pharmaceutical companies have on health website recommendations and drug prescribing made by Australian GPs to the health consumer.

Your involvement in this 15 minute survey is sought and your comments would be greatly appreciated. Please use the below web link for direct access to the online survey. This web link can be placed into the address bar and accessed. This survey will be active from 29.9.09 until 30.11.09.

http://prodsurvey.rcs.griffith.edu.au/AustGP/survey

Again, your input is greatly appreciated.
Dr Wayne Usher & Assoc/Prof James Skinner
Correspondence: w.usher@griffith.edu.au

The researchers have no affiliations with any pharmaceutical company, government department or marketing corporation

Ethical approval for this study was obtained through the Griffith University Human Research Ethics Committee - GU Ref No: EPS/15/05/HREC. Questions pertaining to any ethical considerations can be directed to: Dr Gary Allen - Manger, Research Ethics - g.allen@griffith.edu.au

Posted by Dr ayne Usher on Friday, 2 October 2009

Medicine is not just about knowledge, it is about the application of that knowledge to specific clinical situations. It is both art and science.
It is also about intuition, 'gut-feeling' and learned experience, all things that can't be electronically packaged.

If all the computers in the world broke down, I am confident I could do my job efficiently, with a pen and paper, my hands and and my good pair of ears.
Posted by mimika on Friday, 2 October 2009

Most GPs use computers.When will specialists start doing the same? 2 days ago I had to stay back at work for 1 1/2 hours, on my half day, to ensure a fax got through to a vascular surgeon.
I needed an urgent appointment for a young patient with complications of a DVT, who had been mismanaged by the local hospital.
I was told an appointment couldn't be considered unless I faxed the referral and results.
We did this 4 times, to be told each time the fax was not coming through correctly. We even faxed it from the pharmacy next door, in case our fax machine was at fault.
The receptionist still refused to give an appointment.
I tried 3 other specialists, only getting through to phone message banks, in the early afternoon.
I finally went home and later rang the specialist when he arrived, and got appropriate advice and an appointment. I then had to call the patient to advise him.

When I told my engineer partner, about this saga, he was amazed that we still had to use fax and not email.
If I could have emailed the information, it could have saved a lot of time and frustration.

As an aside, the new General Practice programme we have just been changed to is much worse than our old one. The screen is too 'busy'. Script writing is tedious and confusing, with a lot more 'clicks' required. It's also easy to lose scripts or letters( there is a confusing 'save' question for letters)and have to start all over again.
Posted by mimika on Friday, 2 October 2009

If you're talking about the Cerner emr rollout in NSW, it's not a bad system but there are certainly some problems with it. They're as much to do with the complete lack of IT support and hardware as the system itself. It lacks some features [such as alerts] that could easily be fixed, but NSW Health went for the cheap version. One of the main problems is getting access - passwords don't work and it takes about three months to get a new one. Oh and cerner is completely incompatible with GP software like MD of course. yet another reason to have hospitals taken over by the Commonwealth! Over to you, Kev.
Posted by IT Guy on Wednesday, 30 September 2009

I have mixed reaction on the issue. The reality is any change causes anxiety in human mind. The transformation of health care delivery system from traditional to technological is inevitable. As a medical fraternity we have to accept this reality. We doctor need to upgrade ourselves beyond the "email savvy" personality.
The more relevant question is how best we can facilitate this change. I agreee with the author that anything that is resource (time, labour, knowledge, money) consuming is not going to work. And it should not. The basic principle in accepting something new is that it has to be user friendly and resource efficient.
Unfortunately, the software developer in most instances do not have adequate understanding of the context, scope and process of healthcare services delivery. Software developers are brilliant in technical aspect of technology but they need to work in co-operation with medico to understand their both physical and emotional (you may laugh, but this is true!) requirement and come up with the best solution to meet the end objective and those are efficiency and effectivity in health care delivery.
Health care system is evolving- there are new generation of doctors who are proficient in management and leading the health care institution. Similarly we need doctors/nurses etc who are proficient in IT. Such doctors/nurses exist in Australia but they are very few and they may be missed in technology development process.
I am confident, Australia will change and our health care delivery system will be laughing so far health care technology is concerned.
Posted by Arun Maji GP/Lavarack Barracks on Wednesday, 30 September 2009

Michael

The most efficient system for medical data management is the "wetware" product where the doctor just remembers everything. There is no need for computers, post it notes (http://ozdoc.mine.nu/wallpaper/postit_p1024.jpg ) or even the 5*8 inch card. It is light, convenient (always on) and not excessively expensive. Admittedly backup and restore is problematic. However, such systems have gone out of favour in the modern shared care environment and an electronic solution has the potential to offer the best, if not the most personable, care.

New technologies require an open mind. One has to adapt to the improved methods and procedures they could provide but it is also good if they can adapt to users' wishes and styles and maybe this is the major problem with the States' health systems.

David

BTW, what do you do with 20 million USB sticks in e-health?

Posted by David Guest on Wednesday, 30 September 2009

Michael,

Thanks for that. I have to say, however, that I do believe that medical practice is actually very knowledge intensive - and to get it right - on behalf of the patient - you need to be an expert in collecting and handling both patient information and clinical evidence. Failure to use both well is not good for either patients or their carers.

e-Health can help. Its not the total answer but used well it can assist in my view.

David
Posted by David More on Wednesday, 30 September 2009

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