Contrary to the public’s experience, most doctors do want to make eye contact. They aren’t antisocial. They want to engage. But they can’t. They’re too distracted by one of the worst computer games ever invented—the electronic medical record (EMR).
You may be surprised to see the EMR compared to a computer game, but there are many similarities. Both offer a series of clicks with an often-maddening array of tasks to solve. There are templates to follow, boxes to fill in & scoring. However, unlike most electronic games, the points accrued in the EMR often translate into payment—real dollars for either your doctor or the hospital.
Although these clicks and boxes may be necessary to document your visit, it’s distracting. And your doctor begins to feel more like a librarian cataloguing information rather than, say, a historian capturing your story.
So, why weren’t EMRs designed to wrap around physicians rather than the other way around? Because contrary to what you might expect, EMRs aren’t primarily built to care for people. As hinted at above, they were built as medical accounting software. For example, if you are treated for pneumonia, the doctor will click on a box that triggers a charge for that. However, if you are treated for pneumonia and you also have diabetes, the additional checked box results in a charge that is almost double.
Tracking treatment and the long list of possible associations lends itself to structured data collection, a series of ever-expanding check boxes and blanks to fill in. The problem here is that human conversations—the kind of interaction most of us would prefer when meeting with our doctor—tend to be unstructured.
If you are not happy with the situation, neither is your doctor. Most physicians feel that the electronic medical record is an unwelcome stranger in the exam room. So, what’s the solution?
Things that work well—true solutions—require humans and machines to combine forces effectively. After losing to Big Blue, an IBM super computer, the then-reigning world chess champion, Gary Kasparov, proved this point when he sponsored a unique tournament. The competitors were, respectively, men, machines, or a combination of—get this—lesser man and lesser machines working together. The tournament winner was not the best man nor the best machine but rather a group of amateurs with computer assist.
That outcome makes more sense than you might first assume. Machines have been described as brilliant idiots, masters of repetitive tasks and organizing data, but lacking in creative insight. Humans are relatively poor at repetition, but are superior when creative problem solving is required. Ideally the strengths of humans and machine should be combined to offer a solution.
There is hope for the future. Newer software companies like M*Modal, and Nuance now offer more effective tools. To some extent the software provides real-time prompts based on the data being input, reminding users of key questions to ask. (Think Google where the search bar makes suggestions based on a few typed letters.) Then, after the fact, the transcript of the conversation can be parsed into useful information. In essence such new software gives us the best of both worlds: no confining front end for the doctor and computing power on the back end for analytics.
So, what can you do today and what are the opportunities for tomorrow?
First, when your doctor’s eyes seem glued to the EMR, speak up; engage her. Remind her of the principle of “garbage in; garbage out,” i.e., that the EMR is only as good as the conversation you and she are having in the moment. Second, let your doctor know you are sympathetic to her dilemma, that you understand that a computer game, the EMR, is a necessary but unwelcome guest in what should be, primarily, a human-human experience.
As for the future, EMRs present a real business opportunity for savvy entrepreneurs, especially those that step back to rethink how EMRs could be built from the ground up, emphasizing care while accommodating medical billing.
Bottom line: Medicine should be, above all, a human-to-human experience, supported by information and technology. Only when humans and machines work together will true solutions be available for patients and doctors.