Technology has changed the world—but not all of the environments—in which we practice. As medical students, residents and young physicians, we are primed for electronic health care. Many of us cannot remember an age before ATMs, word processing and electronic journal access, or before “Google” was used ubiquitously as both noun and verb.
Yet every day, we pass by stacks of patient charts in disarray, hoping someone understands how they are organized. Many of us illegibly scribble our SOAP notes and orders. We waste time tracking down charts that seem to have legs. We wait patiently while the consulting specialist monopolizes the patient’s record. We print (oh, do we print), wasting countless sheets of paper in our quest to make patient information portable. We hope that a nurse can decipher our handwriting and avoid associated errors in administering medications.
Paper records and ordering systems not only present logistical nightmares, they limit our efficiency and ingenuity as we care for our patients. We defy you, for example, to stand in the middle of a room of paper charts and motivate yourself to determine the number of diabetics in your practice, whether each patient has had his or her yearly retinal exam, or whose most recent hemoglobin A1C levels were out of range.
This information would be accessible nearly instantly in a health care system with health information technology. The opportunities for quality improvement and population management abound, but regardless of specialty, paper hinders our ability to see how we are doing, strategize how we may improve, and assess progress toward our goals. How many GI patients with polypectomies have received the follow-up colonoscopy indicated by their biopsy results? Was every patient offered appropriate antibiotic and deep vein thrombosis prophylaxes before surgery? Are at-risk pregnant patients actually returning for their scheduled prenatal care appointments, and are they receiving flu and Pneumovax shots on time?
The possibilities for leveraging electronic systems seem endless to young, health information technology aficionados like us. We have studied the opinions of the naysayers and acknowledge their concerns. The systems are expensive; implementation, difficult. Transitioning from paper to electronic records will squeeze even more time from our days and potentially introduce new sources of medical errors while mitigating old ones. Patients and physicians might view the computer screens as a physical barrier between them. And these are only a few.
While important and daunting, these objections and barriers should not prohibit us from doing what we must to bring medicine into the 21st century. And besides, we now have help.
The Obama administration’s Health Information Technology for Economic and Clinical Health (HITECH) Act, a subset of the American Recovery and Reinvestment Act of 2009, is an unprecedented financial and organizational commitment to the advancement of health information technology. Through billions of dollars in financial incentives and, perhaps as importantly, boots-on-the-ground technical assistance, the HITECH Act aims to remove obstacles and bring doctors’ offices and hospitals online.
To qualify for the incentives, physicians must do more than simply plug in computers and install medical records software. Instead, they must become “meaningful users,” who participate in health information exchange and use health IT to inform clinical decision-making at the point of care. They must eventually use health IT to drive improved population and individual health outcomes. If they do, they can qualify for up to $63,750 in incentive payments over six years. The health IT grants and policy programs enabled by the HITECH Act are meant to address some of the remaining barriers to adoption, including those related to privacy and security and the exchange of information between systems and settings of care (see chart at right).
Where do we, the “new physicians,” fit into the picture? We must embrace this considerable impetus to reform our system of care delivery and run with it. New technology is old hat to us; we adopt and adapt to new systems and applications with alacrity. We take the value of technology for granted at a time when we cannot afford to minimize its benefits. We must advocate vocally for health IT, not only for ourselves, but for our patients. We must use our comfort with technology as a strength—and teach our teachers. When we join the ranks of practicing physicians, we must accept that many of our more seasoned mentors were not raised in the same technological age we enjoy, so we must ease their transition from paper to electronic records. These veteran physicians have invested many hours in our medical education, imparting clinical wisdom and passing on the intricate art of medicine. We now have the chance to give back, assisting with health IT training and messaging the value of the technology for our patients.
Our generation must be the one to drive this fundamental reform. Those of us learning or practicing medicine in a setting with electronic health records understand their challenges, but may not have grasped their benefits. Push the envelope. Use the technology in ways beyond simple documentation of patient encounters to provide use cases for your colleagues who cannot. Decide to work only in environments that leverage technology. Ask for electronic health records systems if your hospitals and clinics are not already equipped.
Only together can we effect this fundamental, necessary and long-overdue change for our patients. We must adopt this mission as our own now—the timing has never been better. Health information technology will be our legacy.
Emily Maxson is a fourth-year at Duke University School of Medicine who works as a National Institutes of Health research fellow at the Office of the National Coordinator for Health Information Technology. Dr. Sachin H. Jain took a leave of absence from an internal medicine residency at Brigham and Women’s Hospital to serve as special assistant to the National Coordinator for Health Information Technology. This article solely represents the views of the authors and does not reflect any official positions or policies of the Department of Health and Human Services.