Dialysis Unplugged- Is Technology the Answer to Improving Dialysis Care?

A recent "DaVita Practice Management Spotlight" looked at the use of technology by nephrologists, especially in the dialysis unit setting. 

Here is a brief excerpt:

“For a variety of reasons — mostly falling into the categories of being too time consuming, expensive, distracting and/or difficult — [nephrologists] have chosen to backburner the adoption of new technology and instead focus on what they excel at: providing the best possible patient care.

The article goes on:

“While these reasons may seem legitimate, many are misconceptions — and physicians are missing tremendous opportunities to improve their practices starting immediately in 2011. Whether considered independently or in aggregate, these opportunities should prompt physicians to not only reassess the potential of new healthcare technology, but embrace it as a means to optimize their care of patients.”

It mentions 5 possible benefits:

• Money by qualifying for up to $44,000 in potential government Medicare electronic health record (EHR) incentives by attesting to “meaningfully using” a certified EHR starting in 2011
• Provide the tools and templates you need to efficiently deliver superior care
• Track, benchmark and improve practice performance.
• Making practice data mobile by connecting to the internet
• Reducing excess paperwork and saving money on the costs associated with paper records and transforming record-storage areas into potentially revenue-generating spaces

In my own practice at the Brigham, I use the EHR extensively as a patient record, for prescription purposes, and for communication with other health care colleagues. However, I draw the line by not using the computer while I am seeing the patient, even though each examination room has one available. Almost always, I print information in advance -- labs, a list of medications, and perhaps educational material -- that I will hand the patient. When I used to round in the dialysis unit, I did not do so with a lap-top. Rather, I wrote notes after seeing the patient. Perhaps, I am the exception or maybe old-fashioned, since the craze for technology continues unabated, but I think talking with the patient without being distracted by technology is important. In other words, technology should be an enabler to more efficient care, not the focus.

A couple of additional cautionary notes: 

• By using the EHR as a tool for protocols there is a tempatation to become enslaved by whatever the protocol or decision support tool says in the EHR and not individualize care for the patient sitting in front of you. Weighing the personalized risk for the patient is where medicine is going, whereas protocols tend to commoditize patient care. 
• Using the EHR runs the risk of interfering with the interaction with the patient and any family members, threatens the quality of the patient-doctor relationship, and makes the visit more robotic. 

In an article in today’s New York Times Matt Richtel discusses this topic:

“Hospitals and doctors’ offices, hoping to curb medical error, have invested heavily to put computers, smartphones and other devices into the hands of medical staff for instant access to patient data, drug information and case studies.

But like many cures, this solution has come with an unintended side effect: doctors and nurses can be focused on the screen and not the patient, even during moments of critical care. And they are not always doing work; examples include a neurosurgeon making personal calls during an operation, a nurse checking airfares during surgery and a poll showing that half of technicians running bypass machines had admitted texting during a procedure.

This phenomenon has set off an intensifying discussion at hospitals and medical schools about a problem perhaps best described as “distracted doctoring.” In response, some hospitals have begun limiting the use of devices in critical settings, while schools have started reminding medical students to focus on patients instead of gadgets, even as the students are being given more devices.”

As Abraham Verghese, a physician at the Stanford University Medical Center says “The iPatient is getting wonderful care across America.. the real patient wonders, ‘Where is everybody?’ ”