San Francisco Medicine devoted an entire issue to “Computers & Medicine.” Robert J. Lull, MD, editor, reviews the various applications of computers in the diagnostic and therapeutic arena, including radiology (CT, MRI, SPECT, and PET scans), radiation oncology, nuclear medicine, cardiac catheterization, etc. But Dr Lull feels that the root of physician resistance to computers lies in a concern that computers threaten their intellectual expertise as the prime purveyors of medical knowledge. When Lull was a student and visited a research library, the medical books and journals were in a room that was off limits to everyone except doctors. Now online research is available to all. Not infrequently, physicians experience patients who have done extensive research on specific disease, have copies of all the latest diagnostic and treatment approaches, and are more knowledgeable than their physicians about their specific disease. They frequently ask questions that the physician cannot answer. Lull feels this is just the beginning of a paradigm shift in medicine. Unless we get serious about computers in medicine, he feels physicians will be left in the dust.
Ella G. Faktorovich, MD, discusses Electronic Medical Records (EMR) and gives anecdotal information as to their continuous value. For instance, your patient arrives in the ER as your are enjoying your Sunday afternoon. You receive the page on your Palm Pilot with the ER message that your patient is unconscious. You access your electronic medical records via your Palm Pilot within seconds, bring up the patients records, including all medications that the patient is taking, and forward the information electronically to the emergency room. Immediate information is available to assist in a focused workup for diagnosis and treatment. This same procedure can used while you are traveling.
Electronics in your office is a different scenario. After completing your first patients, you use a touch pen to enter your findings and diagnosis on the computer in the exam room. The computer software processes the information instantaneously, assigns appropriate ICD-9 and CPT codes and within seconds submits the claim electronically to the appropriate insurance provider. You can enter the treatment plan and order lab tests and the request is then instantly forward to the lab. Your prescription automatically prints out for your signature. The letter to the referring physician is automatically generated. . . . Sound simple? Dr Faktorovich then discusses the expense, frustrations, and pitfalls.
Fabio Almeida, MD, discusses overcoming barriers to physician adoption and use of computers. He feels the benefits of the computerized patient record (CPR) (can we be consistent and call this the EMR also?) have been universally recognized. Handwritten charts are often difficult to read, data from different health care sources are difficult to coordinate into a clear picture of the patient’s status, and charts take time to retrieve. Physicians spend 33 per cent of their time writing on charts, producing 50-70 one-page reports daily. Yet 40 percent of the time the diagnosis is not recorded in the patient’s record. Data collection is often repeated when a record is unavailable. The CPR allows the record to be searched for specific information. Physicians hold the key to the data collection problem; yet the CPR (EMR?) has not been embraced by physicians. Physicians are typically ill equipped to perform the tasks of collecting and managing complex clinical and financial data, yet more than 80 percent of the health care dollar is spent when the physician writes patient orders.
Fabio also discusses the speech recognition programs that allow physicians to speak directly into their computers to record the consultation. The technical barriers for parsing “granular medical terms” has recently been improved with the Linguistic User Interface (LUI) which not only works with the speech recognition software and a large and growing medical vocabulary, but also functions very much like a live medical assistant. It retrieves information requested by the user and provides decision support advice, such as adverse drug information or practice guideline recommendations.
Victor A Prieto, MD, orthopedic surgeon, talks about his experience with the Dragon Naturally Speaking voice recognition system that saves him $2500 a month in transcription costs. . . . Vail Reese, MD, describes a number of their medical society members’ Web sites. He feels the most effective Web sites not only provide medical information, but also give a sense of the personality and perspective of the health providers themselves.
I understand that computer problems have precipitated a new line of cybersympathy cards: Sorry to hear your hard disk died; I hope you get over your virus invasion; I can sympathize with forgetting to back up your data; Don’t feel bad that you can’t reach technical support, I haven’t ever reached them and I have had my computer for seven months; Too bad you bought an obsolete PC. (After WSJ)