BY DR. ALAN BROOKSTONE
(Republished from Canadian Healthcare Technology - September 2003)
Despite the hype surrounding technology as an enabling medium and evidence that medical errors could be significantly reduced and health care delivery improved, the number of physicians using computers as an integral part of their practice is still relatively low.
In July 2003, I had the privilege to lead a technology cruise conference to Alaska aboard the Royal Caribbean Radiance of the Seas.With three faculty and 27 participants from the United States and Canada, the conference covered a range of topics, from PDAs to electronic medical records and medical uses of the Internet. The conference also provided an opportunity to reflect on the status of physician computing today. How far have we progressed in terms of the use of electronic medical records, clinical decision support and electronic prescribing? My impressions are as follows.
A presentation on E-mail communication between physicians and patients prompted lively discussion. U.S. physicians are beginning to use e-mail as a professional communication tool, more so than Canadian counterparts. This has some cost-saving advantages, particularly in the managed-care setting, as a mechanism to keep patients out of medical treatment facilities. However, security and privacy concerns are still at the forefront as barriers to more extensive use of e-mail to communicate both with patients and other physicians. Approximately 50 percent of conference participants used PDAs as time management and clinical reference tools. These numbers are growing consistently, indicating a degree of maturity in both the hardware and the range of clinical applications now available for the PDA. The majority of users still use Palm OS products due to ease of use, low cost and the wide range of clinical applications. Has the increased use of PDAs spurred a corresponding use of other forms of technology?
My impression is that physicians overall are far more comfortable with technology than they were two years ago. Because of the low barrier to entry, the PDA has been an enabling technology even for physicians whose overall computer skills are limited. For the majority of physicians, the value proposition to move to an electronic medical records-based practice is still not clear or easily quantifiable in the context of their individual practices. Instability in the EMR vendor market, lack of clinical data interfaces to key sources of information such as labs and imaging, security and the high costs of equipping a practice, were still identified as significant barriers to entry. Although greater numbers of physicians have access to one or more computers in their practices, most are not using computers at the point of care.
In order for computers to be effectively used by physicians as clinical tools, the electronic environment needs to mirror the work environment more effectively. In other words, the environment needs to become richer – more interfaces with outside sources of data, a wider range of clinical decision support tools and secure high speed networks using encrypted e-mail to connect physicians. The sharing of information will not take place until ‘last mile’ connectivity is ubiquitous.
There are some bright lights on the horizon. Tablet PCs have improved since first generation devices were released. Battery life, screen size and resolution and processing power have all improved. In combination with faster wireless networks, computing power is moving closer to the physician’s hand. PDAs and telephones are converging into smart telephones, providing voice and wireless data services such as short messaging, mobile e-mail and Internet access.