EHR Adoption Comes at Expense of Doctor-Patient Relationship
The healthcare system is too focused on technology-based checklists and protocols requiring data entry by physicians, leaving less time for patients and getting in the way of productive doctor-patient relationships.
So argues Douglas Wood, M.D., medical director of the Mayo Clinic’s Center for Innovation. Speaking earlier this week at the HIMSS Connected Health Conference in Washington, D.C., Wood asserted that with the advent of electronic health record systems and the ubiquitous presence of computers in examination rooms something tangible has been lost in the practice of medicine.
“Patients are afraid of the complexity of the system because they’ve learned that oftentimes they’ll tell us their story—sometimes in great detail—but we fail to listen and to synthesize the details of that story into something that we can use to really make them better,” he observed. “Think if we stopped paying for healthcare in terms of office visits, with all of the inputs like ‘did I do all of the bullets of the history and examination’ and really started listening.”
According to Wood, physicians in many respects have been relegated to the role of data entry clerks, focused on meeting the documentation requirements of the electronic patient record.
As John Halamka, M.D., CIO at Boston’s Beth Israel Deaconess Medical Center, puts it: doctors on average have “12 minutes to see a patient, get 140 quality indicators and 200 structured data elements entered, be completely compassionate, and never commit malpractice.” It’s just not possible, says Halamka.
However, at the same time, Wood said that mobile and wearable technology is impacting healthcare in a positive way by empowering patients to take charge of their own care.
“The traditional model that I was taught and, in fact, most medical schools still teach is one of an authoritarian approach that starts with assessment and diagnosis, and then a proscriptive treatment outline by a physician for the patient to follow almost with no questions asked,” he said. “In the future, there’s a participatory model for behavior change that will be critical to medicine and will fundamentally change it. That involves the ability for us to help people with self-analysis and participating in decisions about what they want to do in a self-directed conversation about their health.”
The concept of physicians as healers of illness will ultimately disappear, Wood argued. Quoting the founder of the Mayo Clinic, William Worrall Mayo, he concluded that the ideal of medicine is to eliminate the need for a physician. “We may be on the cusp of that with machine learning but more importantly, as we think about physicians and their role in the future, we need to help become collaborators with patients.”