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 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
panelists, 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 recognized 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 panelist Dr.
Jessica Mega, who leads the healthcare team at Verily, formerly
Google Life.
Nonetheless, 69 percent 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 panelists 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 U.S. 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 U.S. 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 panelists, 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.
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“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 Center 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.”
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