Tuesday, May 28, 2013

A Call to Action for HC Innovators: Do the Easy First (and then Google Glass)

At HIMSS in March, I loved hearing Dr. Eric Topol's keynote talk about the Creative Destruction of Medicine, and how future technologies like genomics and nanotechnology will make diagnosis and treatment so much better and easier.  And then last month, I read Travis Good's HISTalk story about "The Power and Hype of Google Glass", and searching online, I found many more:

It got me to thinking that there are so many cool and futuristic things we can (and should) be doing in healthcare.  However, if all the best thinkers are focusing on the "future" - who will be focusing on the present?  By always coming out with new technologies, we seem to have created a "time-shift brain drain", which means we may not be focusing on how to improve or innovate with the stuff we have RIGHT NOW.  It might not be as fun to optimize the slow, clunky "EMR 1.0" we use today, but it is important, and will help free up time for doctors and others to actually take a breath and do what they are good at (e.g. higher order thinking) rather than the rote, repeatable tasks which have to be done every day (e.g. med refills, reviewing every single lab, documenting every single action...)!  And this is especially important as a new study illustrates how "time constraints make it harder for physicians to solve the medical mysteries that confront them".

So it led me to write my May "Innovator at Large" column in Clinical Innovation + Technology, it's called "Do The Easy First"... which is a "Call to Action" for healthcare innovators everywhere to start thinking about both the present and the future... as it will be much easier to evolve our healthcare system if we make sure it does not go extinct first!

Do the Easy First (April 24, 2013)

I love reading about advanced technologies that have the potential to help with our most complex patients. It will be a fantastic future where natural language processing mixed with big data analytics will help diagnose difficult cases and suggest novel management strategies.
A future where Google Glass will help doctors more easily recognize dermatological manifestations of systemic diseases while also providing patients with a video of their visit to the physician. And where a nanotechnology sensor floating in the bloodstream can identify DNA changes related to early cancer or heart disease and send an alert to let patients and their providers know to start intervention quickly.  
However, I am also a pragmatic physician and know that while all of this may eventually happen, I have to live in the here and now of technical and financial limitations. Currently, we still struggle to get reasonably accurate data into EMR systems, doctors are not paid extra to identify anything early and most physicians feel they are running out of steam as they spend half their time doing non-clinical, or certainly non-advanced, duties.  
I believe some innovators need a wake-up call. Instead of focusing all your time trying to figure out the hardest and most complex issues, how about figuring out the easy stuff first? For example, many physicians spend a big chunk of their day documenting what they just did, filling out administrative paperwork, trying to keep everyone up to date on preventive care and disease management protocols, and answering the same questions over and over again.
In other words, physicians are not being used at the highest level of their abilities and, thus, we have created an artificial shortage of doctors. Furthermore, physicians are not great at taking care of all this routine care and administrative paperwork, resulting in decreased quality and patient satisfaction. It’s no wonder our healthcare system is the costliest and not the most effective in the world.

But who says doctors should be doing all this work? State laws on scope of service need to be respected (or at some point reviewed for best practice). But ironically, the current use of IT has often shifted more work onto the physicians than ever before due to poorly created IT systems which were built for a physician-centric setting rather than a team-based setting.  
What if we started applying our innovative technologies and thinking to help streamline the routine and repeatable workflows which clog up a physician’s time? What if we could use automation to cut down on the unglamorous paperwork chores which are slowly strangling our physicians? What if we used HIT to empower a physician’s team to manage a large chunk of their stable patients remotely based on the doctor’s electronic care plan? What if we saved physicians one, two, even four hours a day of this drudgery so they could spend that time focusing on their truly complex patients? What if we could have a future where care could be delivered in a safer, cheaper and more efficient manner and doctors could focus their time on tasks for which their abilities are best matched?
Maybe they’d even have some time to try out that new Google Glass!