SAN FRANCISCO: When an endurance runner with a history of heart failure felt under the weather, he brought his activity tracker data from a workout to his cardiologist.
Dr Michael Blum examined the runner’s heart rate readings. The cardiologist could see when his patient was pushing to climb a hill or to increase his speed, and when he was slowing down.
“I could tell how hard he was working,” said Blum, a professor at the University of California, San Francisco. “I had this amazing data.”
Ultimately, though, he had to inform his worried patient: “This is all really interesting, but I can’t tell you what it means.”
Blum joined three other doctors who spoke last week on the promise – and the reality – of technology in a San Francisco panel discussion sponsored by Medscape and titled “Technology, Patients and the Art of Medicine.”
Technology in the form of diagnostic software helped one of the panellists, Dr Abraham Verghese, conclude that a patient was suffering from neurosarcoidosis – a diagnosis the Stanford University professor didn’t initially consider but one a software program immediately recognised given the patient’s symptoms.
Technology offers doctors a view inside patients’ hearts, brains and bowels. And technology may speed the diagnosis of diabetic retinopathy, the leading cause of blindness, said panellist Dr Jessica Mega, who leads the healthcare team at Verily, formerly Google Life.
Nonetheless, 69% of the 100 doctors in the audience said increased reliance on technology and electronic health records only served to separate them from their patients.
As evidence of the problem, the panellists cited apps that claim to do things they don’t really do, like accurately measure blood pressure.
But the biggest problem stemming from technology for the doctors, and the bane of many doctors’ existence, is the electronic health record, also known as an EHR.
The US government has touted electronic records, initially designed for billing, as a way to dramatically improve patient care and has used financial incentives to speed their adoption. The hope was that the widespread use of EHRs would reduce medical errors, inefficiencies and inappropriate care.
The effort has failed, according to Dr Eric Topol, editor-in-chief of Medscape and the panel moderator.
American doctors continue to make 12 million diagnosis errors a year; one in four patients in US hospitals continue to be harmed; and healthcare costs continue to soar, he said.
Topol called electronic health records “a complete mess.”
“Why do we just put up with pathetic technology?” he asked.
The panellists, as well as the doctors in attendance, bemoaned the time it took them to complete electronic records, time they longed to spend with patients.
Verghese credited electronic records with billing well, with reducing medical errors and with keeping him out of dusty basements in search of patient files. At the same time, he blamed EHRs for tying doctors to their computers and at least partially for his colleagues’ unprecedented suicide rates, depression, burnout and disillusionment.
“I find it pretty incredible,” he said, that with “all the wonderful, sophisticated imaging technology, we still have this dinosaur of an electronic medical record.”
Verghese, a best-selling author, is vice chair for the theory and practice of medicine at Stanford University and has championed the return of what he considers the lost art of the physical exam. He questioned how physicians allowed EHRs to take over medical practices without physician input on how to make them work.
“We allowed this to happen on our watch,” he said. “How did we let this happen?”
“My sense is that the current dysphoria in medicine revolves to a great degree around the electronic medical record but not solely. I think the other piece of it is everything moving much faster, so many more patients, so much more information per patient,” he said.
Blum had nothing good to say about electronic health records. But he refused to blame them for all medicine’s ills.
High rates of physician burnout, depression and suicide predate the government’s relatively recent push for electronic records, he said. He traced the problem back at least 10 years to increased government regulations that turned doctors’ notes into billing documents.
“Then you throw the electronic health record on top of that,” Blum said. “That just took a bad situation and made it horribly worse.”
Blum, who leads the Centre for Digital Health Innovation at the University of California, San Francisco, considers electronic health records separate from technology.
He believes technology has transformed medicine in a positive way and will continue to do so.
“The office visit and the experience of the bonding has clearly been disrupted” by doctors having to type into electronic records, Blum said. On the other hand, he said, “patients can send me a note whenever they want, and within a day, I’ll get back to them.”
As further evidence of technology’s benefits, he cited a study showing that patients expressed more satisfaction following a video visit with their doctors than visits to the office.
“It’s going to explode,” he said, “when we see the next generation of technology.” — Reuters