If the cheerleaders – including the one in the Oval Office – are right, President Obama evoked the promise of new technology: This will cut waste, eliminate red tape and reduce the need to repeat expensive medical tests,” he said, and he has proposed investing $50 billion over the next five years to help make it happen.will save us all: save jobs, save money, reduce errors, and transform health care as we know it. In a January speech,
By Scot Haig
Any doctor will tell you the advantages of having lots of patient data on computers: it helps us avoid redundant tests, gather huge amounts of data for research, screen automatically for drug interactions, all with no problems with our famously illegible handwriting. I would be happy if every patient could hand me a digital file of everything about him; it could really save time on first visits. But against our government’s push to get all patients’ records computerized we must keep in mind there will be a cost to this – far beyond the billions to be spent setting it up. Many of us in medicine are concerned that the greatest cost will be in the quality of medicine that we practice. (Read “The Year in Medicine 2008: From A to Z”)
American doctors have not been enemies of the digital revolution. Looking up lab results and x-rays on our computer screens beat out carbon copies and sheet film in an instant. We like e-mail; we shop, take tests and read our journals on line. But the romance, for most of us, began to sour with Computerized Physician Order Entry [CPOE]: entering patients’ hospital orders on the computer. This is when we first confronted the downside to uploading our every medical judgment.
The majority of us are forced to use computerized orders or risk losing our hospital privileges. But most of us have found that CPOE is a lot harder than writing out orders on paper, takes far more time and in too many ways is just not as good. We’re never quite sure that what we’ve typed is going to be seen by a real, live, analog nurse, that it isn’t just going to disappear. (It does.) We can’t order certain things with those buttons and pull-down menus that we could in writing – things like “patient may wear her own flannel nightgown and underwear” or “please, please get the x-ray I ordered for yesterday”, or “prop up patient’s legs with pillows like this” followed by a little stick-figure drawing. (See pictures from an X-Ray studio.)