Monday, November 2, 2015

If It Takes a Supercomputer...

Many of you may have seen recent announcements that IBMs Watson supercomputer is being recruited by hospital centers and the pharmaceutical industry and to address issues in order-entry, patient compliance, risk, and therapy selection. 

Now, you might wonder, why does medicine, at this moment, need a supercomputer?  The answer is straightforward: The practice of medicine is a complex undertaking.  We all recognize that part.  "But what about the rest of us?", you might further ask, "we who cannot afford the millions i.e. billions for Watsons' help."  Any who can afford such an assistant- as could Alex Trebek & Jeopardy, where Watson walked off with the huge prize- are not like us- everyday docs in a practice.
In truth, advances in Health-care IT , such as access to data, the internet, and an ability to simplify regular repeated procedures, have huge potential in medicine, but it is potential unrealized!  Not only unrealized, but also accompanied, in modern times, with pain.  If you are a practicing physician, no explanation necessary.  Who of you sees patients at a faster rate?  How many complete all charts before the end of shifts?  How many fire up their machines at home each night to "catch-up" on the day's work?  Who among you know for certain what you have documented without reading it over through bleary eyes?  Who doesn't wonder about medico-legalities?  Raise your hands please!

More likely your days of late have been peppered by expletives too extreme for publication here.  And this time, they've not been directed at nurses or patients...but at the machine on your desk.

Here is a simplified list of the operations a well-thought out EHR system should provide.
  1. Easy access, easy navigation to necessary tasks.  Easier than a cell-phone.
  2. Simplified completion of charting/medical-record creation, with very few keystrokes, and preferably with voice activation.
  3. Simplified retrieval of previous work-in-progress even if others have used a terminal in the meantime- with immediate return to the previous place upon which you were working.
  4. Presentation of lab, significant data on any patient being cared for with a minimum of keystrokes or clicks.
  5. Background infrastructure (practice management) that allows the facility in which you work to operate efficiently, for the sake of the patient, and for the sanity of the staff.  Look- Amazon, Wal-Mart and Google do it, so why don't we?
  6. Streamlined billing and collection operations that provide immediate reimbursable data to 3rd party payers, billing agencies, other insurers, and patients.
These are doable; they can be accomplished right now using simplified systems, often boutique systems (i.e. non-Watson wanna be enterprise systems).

Removal of the umbrella of baloney- meaningful use, would be a good step at the moment.  Perhaps when it is shown that medicine can address the interface between man-machine (provider-machine) practically, then the door might be open for the larger pipe dreams: sharing of data between distant facilities via standardized interoperability, and safety conscious clinical decision support and error checking.  But for now, we'd just like to get the job done, easily and correctly.  Right?

Until then, we may have to cast an outsider's eye at Watson doing SCPOE- Supercomputer Provider Order Entry, and get back to taking care of patients.

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