Stubborn physicians

By Jianggan Li | 2 March 2009 | Permanent link | 0 comments

A month ago, when I was back in China for the Spring Festival (a.k.a. Chinese New Year), I visited the hospital where my mother has been working for over 30 years.

The hospital had recently implemented a computer system. It was developed by a local (and apparently unknown) software company and had lots of flaws. (For example, log in often fails without reason, not much clinical data is recorded). But clinicians and administrators are finally able to quickly locate the medical/billing information they need.

I have vivid memories of my visits to the hospital when I was young, where I always saw a doctor or nurse scratching their head, trying to dig out the right record from a huge pile of paper, which is heavy as each record was attached to a metal holder.

Although the system is far from perfect and falls way behind what Bumungrad has achieved, clinicians in this tiny costal town are using it.

A senior surgeon who heads a major hospital once told me that the thing that made him most proud of their system is that it is used by doctors and clinicians, though there was the odd complaints here and there.

He said this indicated a successful implementation.

In that regard, this ‘primitive’ information system in my mother’s hospital is also a success.

It is known in the industry that physicians are probably the hardest people to work with, especially when you try to implement any changes – it is a problem which is as persistent as their illegible penmanship.

Such stubbornness is a subject that vendors and implementers often complain about. Lots of discussions take place on how to convince doctors.

But in a way it might not be a bad thing that doctors only use a system when they see real value. We have seen too many failures in other industries where a top down approach forces a new system into the workflow, which works like a time bomb.

Many healthcare computerisation projects fail because they fail to improve the way clinicians work. Some are just moving a paper based workflow to electronic, which probably saves a lot of time and energy for nurses but didn’t make much of a difference for doctors; some others are so difficult to use that a clinician has to spend more time dealing with the system rather than the patient.

These are not good systems precisely because they don’t add value to doctors, therefore to clinical decision making, which is absolutely crucial for the patient. By not using them, doctors actually help avoid bigger calamities in the making.

We have to recognise that humans are fallible. The decisions that specialists make are not always correct and in the medical context it is very dangerous to assume that they are. But that is exactly why we need a good system – to help clinicians make better, more informed decisions.

And doctors, as highly trained specialists, are picky. If they don’t see the value, the system probably will not achieve a great deal.

In fact, a keynote speaker of last week’s HIMSS Asia Pacific conference aptly pointed out that “We have put too much emphasis on the system itself, how much more efficiency it can achieve. He says that by doing this, we overlook the human element, which risks making healthcare as a whole less effective as doctors and the system don’t work together.

The system itself can’t make a decision – it is there to help the doctor. Therefore the two must have a seamless, (and human), working relationship.

While a standard set of metrics to measure the value of computerisation is (glad to see that there are a few initiatives to achieve just that), responses from doctors provide a decent measure on the success/failure of any health IT implementation.