Technology Tizzy

I have been pulled, kicking and screaming, into the age of information technology.  I didn’t want a ‘car phone’ when mobile phones first became available, but soon gave in because of my profession; as a doctor on call, it was very convenient to have a mobile phone, rather than to look for the nearest pay phone when in transit.  Soon, it became pretty important to have that cell phone, as answering services, other doctors, and patients grew to expect a quick response from their physician on call.  Finally, as pay phones became all but extinct, the cell phone was no longer optional.  Now I have and iPhone, and I am utterly lost without it.  I use it for calls, but I also text, get my email instantly, keep my schedule in it, and use a variety of apps (I even call them apps, not applications- that’s how much I’ve bought in) for personal and professional reasons.  I have Epocrates on my phone, which tells me drug doses, side effects, and even prices.  I can log on to the health system’s computers to get patient labs and X-ray results from my phone.  And I can get Uptodate, which gives me the ability to look up just about any symptom or disease state, and get the most sophisticated information available on diagnosis and treatment.  This from the woman who was not going to have a ‘car phone’, much less a computer.  Now I also have two laptops and a desktop.  I was terrified of email 10 years ago- now I don’t know how to function without 24/7 access to it.  I email, blog, Facebook, text- but as of this writing, I refuse to Tweet.  Still, given my history, that is subject to change at any moment.

And now, the transformation is almost complete.  Though, as a small, private, primary care practice, we resisted the Electronic Health Record (EHR) when lots of other doctors had been using it for years, we are now in the process of implementing an EHR in our office.  And I’m scared.  Really scared.  I don’t make these kind of adjustments easily.  But now, it simply can’t be avoided.  We need to come into the modern era.  Our paper charts are antiquated, and we have to make the change.  Paper piles up and gets disorganized.  The charts get too big and start to shred over time.  Pages go missing.  It’s bad for the environment.  Our handwriting becomes more and more illegible as we age.  While we are not being forced by our health system or by private insurers to use EHR, Medicare is putting pressure on by cutting payments to docs who don’t use computerized records and electronic prescribing.  So we have to do it.

Younger people probably have trouble understanding why a computer program is daunting to me.  My kids can’t believe it when I can’t immediately figure out how to use some new piece of equipment or when I struggle with getting some web app to work.  They’ve grown up in a high-tech world.  I hate to admit how old I am, but my introduction to the computer in college was when the computer was the size of a building.  Yes, we went to the computer center, where we sat at one of maybe ten terminals in a little room connected to the gigantic main-frame computer.  We used punch cards, and programmed in Basic, or once we were in Advanced Computer Science, Fortran.  We wrote our own programs for playing poker or working through a mathematical sequence.  Computers weren’t used on a regular basis for things like word processing then, either.  I typed my papers on a typewriter.  I was lucky, because mine was electric, but it didn’t even have a self-correction ribbon, so I used plenty of white-out.  It’s almost shocking how much our day-t0-day lives have been transformed by all our computerized gadgets now, for better and for worse.  Because back then, things moved slower.  If you wanted to reach someone, you had to call them from your home and hope that they were at their home.  Or you had to wait for a letter to go out in the mail, get to its target, get answered and back to you through the mail.  Mail came once a day.  Not like now, when you can get a phone call or text or email any time of the day or night.  This goes on continuously, with callers and senders expecting instant results.  No wonder we’re all so stressed!

But I digress.  Back to the Electronic Health Record. There are some very positive things that an EHR can do for us.  Our charts will be paperless, neat, and organized.  Data will go directly from the hospital lab and radiology and other testing sites to our patient records.  We can share information with a patient’s other providers within our own health system.  Our patients will have access to their own information. Prescriptions will be sent directly from the doctors to the patient’s pharmacy, saving time and energy.  I could go on and on.

But the fact is, there are also downsides.  That’s why I’m scared.  The biggest one for me is what this will do to patient encounters.  Writing in a chart doesn’t keep me from being personal and human with patients, or from making eye contact.  But having a laptop between me and the patient?  Well, that’s an entirely different story.  Lots of my patients complain about encounters they’ve had with other physicians during which the computer seemed to dominate the visit.  I really don’t want that to happen.  It’s going to be a challenge to keep the technology as a tool and not as the focal point.  I’m also worried about my own ability to utilize the system.  I know at the beginning, there will be a steep learning curve, and it will slow me down a lot in the beginning.  A couple years ago, my husband’s whole health system (one of the major Philadelphia health systems/medical schools) went up on an EHR system, his days were a couple hours longer than usual for a while, and he struggled with the many glitches and limitations of the computer program.  Granted, it got better over time, and he now feels it saves him time, but it took a while.  And he is MUCH more technically savvy and facile than I am.  So I think I have a good reason to worry.

Then there are the realities of technology.  The internet can go down.  Data can be lost.  It can even be stolen.  Computer equipment breaks, and I don’t know how to fix it.  Yes, we have tech support, but my IT guy can’t hold my hand all day.  Most frightening of all, I don’t really understand how acomputer, or the internet for that matter, works!  There’s no mystery to paper and ink.  If my pen breaks, or runs out of ink, I just use a different one.  All this complicated machinery is a different story entirely.

Regardless, we WILL be using the EHR.  I will put on a brave face, and forge ahead.  I have mastered use of my computer and my smart phone.  I suppose I should be able to do this too, even if I do it kicking and screaming.                              -RK


~ by drrozkaplan on February 3, 2012.

2 Responses to “Technology Tizzy”

  1. Brave new world ; )

  2. I used to hook up an external keyboard to my laptop and put the keyboard on my lap so I could type while I talked to my clients- without having the laptop in front of me…

    or, get a tablet style laptop with an electronic pen– you’ll still have the handwriting issues… but that’s part of the fun of medical records!

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