Every few years I like to speculate about the future of medical technology as well as the future of pediatric practice. Both, you see, are very much intertwined, and in my view the future of pediatric practice looks very good indeed.
One needs to consider that we practice medicine at a time when innovation is progressing at an amazing pace. In the tech sector, experts speak frequently of “disruptive technologies” that create entirely new ways of doing things, or shake up an industry entirely. For example, personal computers replaced the typewriter decades ago, and downloadable media is replacing compact disc media, just as compact discs replaced videocassette tapes and vinyl records. Let’s take a look at some current medical technologies that are “begging” for disruption, and other technologies that may prove to be “game changers” over the next few years.
To help improve pediatric practice, physicians must remain nimble, optimistic, and ever willing to try new things. We also must be innovators ourselves, to challenge the status quo and to aggressively confront government or insurance reforms when they are not in our patients’ best interest or ours. It is important to remember that innovation is not limited to keeping an open mind toward new office technologies. It also involves being creative when it means implementing new models of care or new workflows, and utilizing improved methods of educating parents to keep our patients healthy.
Yep, I have just identified a new medical condition—one that is not yet listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition! Medical documentation stress disorder (MDSD) unfortunately affects many physicians who have been forced by the government to prematurely adopt expensive and inefficient electronic health record (EHR) systems. I discussed improving medical documentation (ie, avoiding “note bloat”), in the January 2016 issue of Contemporary Pediatrics.
If you are unfamiliar with this condition, let me enlighten you. Medical documentation stress disorder is a “click”-related disorder, caused by the inability of providers to expedite completion of office notes, therefore requiring taking an hour or more of one’s personal time to complete notes at home. Symptoms include staring into space or yelling at one’s computer screen, as well as a compulsion to frequently check one’s retirement funds, and chronic pain in one’s dominant hand.
Fortunately, MDSD is a treatable condition. Management modalities include scribes, virtual scribes (see Contemporary Pediatrics, November 2015), and my favorite, voice recognition software (see Contemporary Pediatrics, June 2014). Using new Dragon for Mac Medical software from Nuance Communications (Burlington, Massachusetts), notes that used to take me 10 minutes now take less than 3. I also use Dragon for Mac Medical to navigate from one screen in my EHR to another, using voice-directed macros. I rarely leave work with notes left to be done, and I no longer suffer from MDSD!
There are other innovations yet to be introduced that will assist with our utilization of EHRs and reduce the number of providers succumbing to MDSD. It is one issue to write a note, yet another to quickly review the note to use it as a “handoff” to assist in ongoing care. In my view, one merely needs the ability to press a button that collapses or folds a previous note to reveal just the chief complaint, history of present illness (HPI), assessment, and plan. This would expedite handoffs as it would facilitate chart review. The note, of course, could be expanded just as easily.
Tasks are “to-do” lists that are an extreme annoyance in most EHRs because they are a dumping ground for staff who prefer to message providers to resolve patient concerns. It is not unusual for physicians to have dozens upon dozens of tasks that accumulate every day. Physical forms to be signed, lab orders, and prescriptions to write are examples of items that accumulate on our task lists every day. The solution is straightforward. First, the simplest and lowest tech solution is merely to print out all the tasks and hand them to staff with instructions on how to complete them! If you prefer an electronic solution, redesign the EHR task interface so that a task can be easily reassigned into piles associated with default instructions to staff members.
My last suggested EHR innovation involves correcting a situation that is commonplace. Not infrequently, a patient is seen and tests ordered and the note completed before diagnostics become available. To ensure adequate follow-up, one subsequently needs to enter various sections of the chart (ie, lab, imaging, outside studies, etc) to gather information relating to the original visit. Electronic health records should include the ability to “breadcrumb” all tests, telephone calls, and tasks related to a specific visit or medical problem, and organize and present all information as an “episode of care.” This would improve care coordination tremendously while making EHRs more efficient.