Fractured Technology in Healthcare: The Digital Doctor
As I dove into a new side project in the veterinary field, Veterinarian Caleb Frankel, recommended The Digital Doctor to me so I could better understand why human healthcare is in the state that it is in. Although I was working on a project focused in animal healthcare, the book opened my eyes to poor change management and policy that has taken place over the last decade to make our healthcare more effective for medical staff and patients.
While The Digital Doctor focuses on the implementation of technology in the healthcare sector, to me it communicated that, large scale efforts to make industries more 'technical' focus on physical technology rather than the information people consume and how they use it. The U.S. Government's HITECH incentive in the mid 2000's essentially forced human healthcare to find an electronic medical record(EMR) in order to get the $44,000 per doctor (yes, doctor) from the government for their practice or hospital. The result of this incentive is that demand increased for EMR's and there were few quality products that could offer everything that a practice or healthcare system needed to do business.
With the monetary incentive focused on acquiring the technology rather than acquiring the proper information to do business, the healthcare system became fractured among the large amount of EMR's that entered the market. Most EMRs have such a poor design that staff are hindered in their jobs more than ever and mistakes are being made because of them. One story the author regularly recounts is the accidental drug overdose of a 16 year-old patient because of the a combination of poor EMR interface design and alert-fatigue that staff experienced.
It's not about the process, but the policy used to bring healthcare forward with technology. The U.S. Government spent a large sum of money trying to get the physical technology into place. The result is multiple EMR systems that don't talk to each other, poor designs that leave medical staff frustrated, and mistakes being made because users don't know whether to trust their technology or not. Healthcare technology may have better served the industry if more regulation was placed on the technology that was created rather than the people and institutions tasked with using it.
Author Robert Wachter references the regulation of the rail roads in The Digital Doctor. President Abraham Lincoln set a regulation that all tracks be 4 feet and 8.5 inches wide so that no matter what company owned the tracks, all companies could use them. Thanks to this regulation, Amtrak and SEPTA in Philadelphia use the same rail line west of Philadelphia to Lancaster. The approach to teeing up technology to work for the medical staff through regulation may have helped the technology entering the market better meet the needs of the healthcare system. For example, an EMR that promoted the sharing of information between systems, may have prevented healthcare technology companies from charging a ridiculous amount to have records transferred between doctors. This in return, would allow medical staff to be fully aware of a patent's history.
People are still at the core of our society. Technology is an avenue for production to do something. In the same way that a car gets a person from point A to point B, technology allows people to do things. Medical staff are currently the ones being punished because of a failure to regulate the technology entering the market.
We can't design for all users, but society expects technology to enable people to do more with it than they could without it. Healthcare technology is not currently enabling their users to be better doctors, it is a speed bump in the delivery of quality healthcare.