The new Art of Medicine campaign is focused on getting physicians back to their original roots – the reason we all stepped over the threshold of medical education and into an honorable profession to serve our community. Its all about the patient but changes in the healthcare system and in particular changes with technology have taken the focus away from our patients and onto the technology in our office. Recent study conducted by Northwestern University highlighted the distraction physicians feel away form their patients by the EMR
As Steve Schiff, MD a practicing cardiologists puts it
As far back as I can remember, there was never a time when I didn’t want to be a physician. It’s a choice in which there is no equivocation: either you want to be a doctor or you don’t.
The campaign includes an e-Guide: The Art of Medicine in A Digital World replete with thoughts, suggestions and concepts to manage the digital world while remaining focused on the most important person in the examination room – the patient. The release was covered in this piece by HIT Consultant and referenced the panel taking place next month in Boston. Many of the thoughts and ideas were captured in the Top 38 lessons from Digital Health CEO’s from Rock Health. I picked a few choice quotes that capture the spirit and intent of the Art of Medicine for me:
“Healthcare is yet to be transformed by technology.” – Joshua Kushner “You need a degree of foolishness to cause disruptive change in healthcare. Dare to dream.” – Vinod Khosla “If you’re going to re-invent healthcare you have to start from scratch.” - Vinod Khosla “The key to good product is invisibility for the user.” “Partnership is going to be absolutely key to taking healthcare to the next transition in evolution.” - Sue Siegel
There will be much discussion at HIMSS14 around the topic and we are looking forward to hosting the panel on Thursday, March 27, 2014, 9:00-11:00 a.m. at Boston’s W Hotel. You can find out more and/or register here or come by our booth 3765 at HIMSS14.
This post originally appeared on HIT Consultant
During a recent and troubling discussion with a physician friend, he described to me a new ailment he’s been experiencing: waking up in the morning, and not looking forward to going to work. The reality is that he is not alone. It’s no secret that physicians across the country, regardless of their specialty or location, are reaching their limit for juggling new requirements, technology upgrades, and policy changes, all while trying to deliver personalized, quality care to their patients. As a result, busy physicians are, quite understandably feeling pressured and pulled away from direct patient care and critical clinical-decision making, and, at the end of the day, that is what matters most to patients and physicians alike. It is easy to imagine the impact overloaded and dissatisfied physicians could have on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, and how these regulatory pressures and so many new healthcare technologies could be linked to the decline of the “art of medicine.” But are we, in fact, misdiagnosing the problem?
A recent study from Johns Hopkins University found that internal medicine interns are lacking proper bedside etiquette, which is not only essential to providing quality care, it directly impacts medical outcomes and patient satisfaction scores. Focusing on five key elements of proper patient-physician decorum, researchers tracked whether or not hospital interns:
- Introduced themselves,
- Explained their role in the patient’s care,
- Touched the patient,
- Asked open-ended questions, or
- Sat down with the patient during the visit.
Results revealed that interns touched their patients (either during a physical exam, handshake or gentle, supportive touch) 65 percent of the time and asked open-ended questions 75 percent of the time, but introduced themselves only 40 percent of the time, explained their role merely 37 percent of the time, and actually sat down during only nine percent of the visits. Such results are disconcerting, at best, and reveal a more pressing truth: These basic and critical communication deficiencies that are essential to providing holistic patient care are not being taught.
The study exposes the reality that the shift away from patient focus and the “art of medicine” isn’t just stemming from increased physician workloads caused by new policies and changing technologies. It is infiltrating our profession through a change in training, as well. While we have reduced junior doctors’ work hours for safety reasons, we have not adjusted the overall length of training they receive. Medical students, our future physicians, are not receiving the holistic education that helps them balance keen scientific skills with compassionate delivery.
But, as they say, “knowledge is power,” and now that we are starting to pinpoint conditions that are tearing at our profession, we can start to heal them. We can’t expect our medical interns to know how to handle difficult and emotional situations unless we show them. We need to teach them how to engage with patients, earn their trust, really listen and understand them. They need to be able to view what their patients say through both a lens of science and medicine, as well as a lens of compassion and caring, in order to help them get and stay well.
And what of the technology challenges that are driving wedges between patients and physicians? While there is no denying that much of health information technology is putting pressure on physicians and forcing them to adapt to new methodologies, these challenges are a necessary to revolutionizing patient care. They are, in essence, the basis of growth and the very nature of science. If it weren’t for boldly trying new approaches, we might still be relying on leeches and blood-letting to cure melancholia. Just as we can’t expect a patient with heart disease to know intrinsically to maintain a low-sodium diet, we can’t expect the healthcare industry to know how to fix everything unless we speak up and advocate for change (especially with the other loud voices of insurers and politicians speaking on “our behalf”).
We must be mindful that as physicians, it is our sworn duty to defend the practice of delivering the best care to our patients from anything that threatens to impinge on that quality. We need to stay engaged and be responsive; and that also means we need to assist with diagnosing major technology pain points and identify when something isn’t working. We have the rare opportunity to shape the future of healthcare infused with technology and I, for one, want to be part of developing a solution that helps the next generation of physicians offer that comforting touch as they deliver an even greater level of care to their patients.
Many years ago I remember an excited friend who worked for one of the vendors of electronic medical records (really this was more of a billing and patient tracking and management system than and Electronic Health record) desperate to show me some of their new applications – in particular a module they had developed to capture clinical data. He pulled out his “laptop” (it was more of a luggable)
Fired up the application, selected a patient and proceeded to enter a blood pressure: click, click, click, click, click, click, click, click…..some 20 clicks later he had entered a blood pressure of 120/80. He was excited and I was not. I am constantly reminded of this as I watch doctors interact with systems and especially with the ongoing focus on blood pressure (Did you know that May is the National High Blood Pressure Education Month) and the video challengefrom ONC
“To create an under 2 minute compelling video sharing how they use health IT or consumer e-health tools to manage high blood pressure”
The winners can be seen here Key to the challenge is having the data for monitoring as emphasized in the Six Sigma techniques of DMAIC
Capturing that data without burdening our clinical staff who should be focused on the patient not on intrusive and distracting tasks of data entry. I made this point a number of years ago “Doctor Please Look at Me not Your EMR” that came from a personal experience in our local practice and as my then 10 year old succinctly put it at the time
“I wish the doctor had spent as much time with me as she did with her PC”
But data is essential and getting this into our medical record is essential to derive the value from these systems. So the study published in Journal of the American Medial Informatics Association (JAMIA): “Method of electronic health record documentation and quality of primary care” who’s conclusion implied that dictating clinical notes “appeared to have worse quality of care than physicians who used structured EHR documentation”.
Digging into the details suggested this was based on old data (2004 – 2008), measured the quality of documentation not the care and that choice in tools is the key to success in EHR implementations and clinicians satisfaction
There are good reasons that dictation as a means of capturing clinical documentation has been so successful for such a long time – it is easy to do, efficient and saves time. But the gap between the narrative text created and the clinical data we need to manage our patients widens with each report created. The JAMIA report highlighted the impact this can have on care, offering some insight into the potential decrease in the quality of care that results in disconnecting the clinician from the interaction and clinical decision support tools and data that is built into the EHR. But the process of entering this data must not intrude into the clinical interaction with patients. All is not lost – Natural Language Processing (NLP) tools are bridging this divide allowing clinicians to use their preferred method to capture the patient’s clinical information in narrative form and extracting out the discreet data that is essential for the EHR systems that need the data to drive the decision support tools and workflow processes.
So clinicians can have their cake and eat it too and best of all it allows them to return to the art of medicine and focus on the patient not the technology.
It can be frustrating to be a clinician in the era of the internet and instantaneous availability of data especially when the reliability and accuracy is variable. But this is the world we live in and there is plenty of data showing that patients are accessing information in ever increasing numbers. The challenge has been helping patients filter the data for both relevance and accuracy.
Vaccination has been at the epicenter of a these challenges for some years – in fact long before the wide spread use of the internet thanks to a piece published in The Lancet in 1998 and unusually retracted. In fact the BMJ published a paper in 2011 declaring the paper fraudulent – as they noted in the discussion the lead author (now stripped of his medical degree and academic credentials) was clearly actively perpetrating the fraud
Who perpetrated this fraud? There is no doubt that it was Wakefield. Is it possible that he was wrong, but not dishonest: that he was so incompetent that he was unable to fairly describe the project, or to report even one of the 12 children’s cases accurately? No. A great deal of thought and effort must have gone into drafting the paper to achieve the results he wanted: the discrepancies all led in one direction; misreporting was gross. Moreover, although the scale of the GMC’s 217 day hearing precluded additional charges focused directly on the fraud, the panel found him guilty of dishonesty concerning the study’s admissions criteria, its funding by the Legal Aid Board, and his statements about it afterwards
Sadly despite repeated studies and investigations. Despite the retraction of the original article by the Lancet. Despite the other authors personally retracting the paper we still hear about a “link”. Sadly some high profile individuals continue to perpetrate the fraud (notably the model Jenny McCarthy and most recently the “reporter” Katie Couric).
I saw the posting by Aaron Carroll MD, MS is a Professor of Pediatrics and Assistant Dean for Research Mentoring at Indiana University School of Medicine (the Incidental Economist) last week when he posted this map of the real effects of this in Vaccine Preventable Outbreaks (click on the map button on the left if necessary)
Add a well known celebrity (or two) and the effects can be powerful, long term and hard to refute.
And ss Dr Carroll notes the impact can be seen in the chart above:
- All of that red, which seems to dominate? It’s measles. It’s even peeking through in the United States, and it’s smothering the United Kingdom.
- If you get rid of the measles, you can start to see mumps. Again, crushing the UK and popping up in the US.
- Both measles and mumps are part of the MMR vaccine.
- Almost all the whooping cough is in the United States.
But the best part of this post is his accompanying video – included below – well worth watching the full 8 minutes
Expertly and accurately put.
Vaccinate your kids….please.
I was reminded of there Jerry Maguire movie clip when I read the latest in a long line of security breach stories – this one emanating from Canada where this group is in hot water over a massive 620,000 patient data breach…taking 4 months to notify authorities. Apparently Canada does not have a national Breach notification rule like the US and the public “Wall of Shame“
Canada does not have a federal health data breach notification requirement. But the Canadian provinces have their own rules, including some that mandate notification. Under Alberta’s Health Information Act, which was enacted in 2001, the reporting of health data breaches is voluntary, privacy experts say.
They might want to change that…
In this latest release Medicentres Family Health Care Clinics, a 27-clinic medical group in Western Canada had an unencryptedclinic laptop stolen from one of the clinic’s IT consultants.
The laptop contained 620,000 patient names, dates of birth, health card numbers, medical diagnoses and billing codes, officials said.
Here in the US the chart of complaints is depressing
How many more data breaches will we see before everyone understands the need to pay close attention to security. Encrypting your hard drives for all machines that contain patient information and demanding all staff and consultants and anyone that has access to patient data encrypts their drive and data would have prevented this.
This is not news for many in the healthcare profession as they face the challenges of billing rules and regulations and the sometimes obscure idiosyncrasy – but as you can see form this piece on NBC for many patients this is a surprise and a costly one at that
Hospitals are told that they “have to” use this status (Under Observation) if the patient doesn’t meet a host of criteria for “Admission” all being driven by a series of guidelines that are publicly available although not well known and much of it in response to the RAC audits All this is set to get worse with the “Two Midnight” rule (you can see some guidance here and some of the issues on this here)
This piece in Wired Natural Language Tech and Medicine: Just What the Doctor Ordered by our very own Joe Petro (SVP of Engineering) as he puts it
Somethings gotta give!
- Simplify Interactions with the EHR
- Balance the Need for Patient Narrative and Structured Data
- Increase Documentation Specificity in Real-Time
Much like NLU has helped drive intelligent, natural interactions between consumers and technology, CLU will help re-humanize healthcare. By enabling physicians to focus on the patient, not the technology, providers can begin to embrace a next-generation approach to healthcare that will drive efficient, intelligent clinical decisions that impact each and every facet of patient care.
It’s an exciting time with CLU and NLP as a critical enabler in helping doctors be more productivity in the new digital era of healthcare and maintain focus on what matters most: patient care.
Nelson (Rolihlahla) Mandela or Mandiba as he was know to many
was an inspiration for many with his incredible strength and especially his compassion and moral courage despite his 25 year incarceration. His strength contributed to the Rainbow Nation. In the words of another early lost talent Bob Marley:
You can take the boy out fo Africa, but you can’t take Africa out of the boy. Today I am proud to call myself an African and stand tall with the people of Africa at this time of sorrow
He managed to bring light into any situation and there are so many tributes across the web – you can read his biography here - hard to pick on any but I liked Richard Branson’s here
and included this great version of the classic song by “Biko” that was performed by
Peter Gabriel performed Biko a cappella at the unveiling of Steve Biko’s statue and the whole crowd sang every word. He said: “I have been living with the words (of the song) for a long time. It is a sense of completion to be here.” You could see tears in Madiba’s eyes – it was one of the most emotive moments of all of our lives.
and Time’s 10 songs to remember Manndiba by
The Nelson Mandela Foundation posted its own message. But it was his words that summed it up for me and I have quoted many times:
My deepest sympathies and condolences to the Mandela Family, the Nation of South Africa, the Continent of Africa and his friends around the world
Hamba kahle Madiba
(Go well/stay well)
You can always rely on Hollywood to take concepts and extend them into the future – sometimes correctly (cloaking, holographic TV, forcefields and eco skeletons with mind control), sometimes incorrectly (aluminum dresses, atmosphere that is completely controlled, suspension bridge apartment housing). We have had speech recognition and Spock’s request:
So it was no surprise to find the latest Hollywood idea is the “Her” – a lonely writer develops a relationship with a newly developed operation system
Intriguing and challenging our current concepts with an exploration of artificial intelligence, voice and natural language technologies. These new styled avatars understand, listen and decipher what we say and something that Nuance has been developing and reinventing the relationship that people and technology can have. We can engage with our devices on our own terms and we have show these concepts in healthcare with our very own Florence – who is getting ready to launch in 2014
Ambitious you say – maybe but imagine the environment with intelligent personal assistants that hear you, understand you, know your likes and preferences – and in our world exist across your doctors office, the phone, surgery, hospital and elderly care and hospice. Cool? Liberating? Impossible?
If you’re Nuance, the idea is not only brilliant – it’s our focus and drive as we reinvent the relationship between people and technology. It is the chance to connect with your devices on human terms and presents infinite possibilities for intuitive interfaces that adapt to you.
Liberating our clinicians to focus on the patient and providing patients with someone they can talk to, interact with and who does have time for them. That future – coming to a doctors office near you:
Patients deserve the same standard and car that doctors receive when they need treatment. But as I have said before (Doctors Die Differently and more recently Treatment Creep in Medicine – sucking Decency out of Patients) we remain challenged especially when it comes to dying.
This piece by Dan Gorenstein, How Doctors Die: Showing Others the Way touched on these issues in a moving a thoughtful way.
Dr. Elizabeth D. McKinley’s battled breast cancer for 17 years but this past spring discovered the cancer had spread to her liver, lungs and brain. Her choice was to undergo more treatment that would have potentially debilitating and mind altering effects on her or change course, accept death and work on getting the best out of what was left of her life…as she put it
..time with her husband, a radiologist, and their two college-age children, and another summer to soak her feet in the Atlantic Ocean…“a little more time being me and not being somebody else.”
And some of her fight was with her own family – the non-medical members
clinging to the promise of medicine as limitless
And the medical members of her family (her husband is a radiologist)
looking at her disease as doctors, who know the limits of medicine
Its not a difference in the effects of disease and death but rather an advantage of knowledge and information that lead to truly informed decisions “doctors have control over their quality of life before they die and this sadly is control that eludes most other members of society” and it would appear especially try here in the USA. More than half of deaths take place in hospital and not at home surrounded by people we love which is the way most say they want to “go”.
So if you do nothing else this Thanksgiving – take the time to talk about the subject with the people you love and create and advance directive or living will. In many respects no better way to be thankful than to set out what is important and let everyone know, now when you are fit and healthy.
Wishing you all a very happy family and friend fill Thanksgiving