Successful Health IT Must Keep the Doctor-Patient Relationship at the Center

At the CHIME 2017 Fall CIO Forum, Stanford professor Abraham Verghese offers advice on flipping the focus of health IT advancement to patient care instead of tech.

To make a true impact, health IT must progress in a way that not only maintains, but strengthens the doctor-patient relationship. This was the sentiment of Abraham Verghese, author and senior associate chair at the Stanford University School of Medicine, who spoke at the College of Healthcare Information Management Executives (CHIME) 2017 Fall CIO Forum on Nov. 2 in San Antonio, Texas, about keeping the patient at the center of the medical enterprise, especially as medical technology progresses.

The sick patient has to be more than a data point. The sick patient is an individual in need,” said Verghese. “That individual needs care expressed by humans while we juggle all the data coming down the pike, making that happen.”

Many advancements in health IT promise to reduce provider burnout, but previous advancements, such as Electronic Health Records (EHRs), in fact added to the workload and monotony in many ways, which, in turn, triggered patient and provider dissatisfaction.

We are faced with an epidemic of physician burnout,” said Verghese. He added that by some measures 50 percent of physicians are burnt out, which can lead to poorer patient care and emotional wellness.

“If that’s true, this is not an individual problem, it’s a systemic problem,” he said, adding that most people would lay the blame on what’s called a ‘4,000-click-a-day problem,’ which refers to the need of a physician to spend large amounts of time at a computer in order to administer any form of patient care.

For every one hour physicians provide face-to-face time with patients, they spend nearly two additional hours on the electronic health record and one to two hours of personal time each night doing work on the computer,” said Verghese, backing this up with his own experience as an attending physician. “I feel chained to the computer and struggling to get away from it to get to see the patient.”

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Flipping the Script on Health IT Advancement

Even when changes in health IT directly benefit the clinician, such as advances in imaging that can send radiology scans directly to a physicians’ inbox, many times it can inadvertently eliminate important provider interactions.

“Now that I can pick up the image in my office or home, we don’t go down to the radiologist anymore to look at the image with them. We also don’t bump into the surgical folks who have come to see the images. It was an important place for social dialogue,” said Verghese.

While he admitted that he was not eager to return to that era, where charts were often misplaced alongside other mishaps, many of the social interactions that happened around the radiology suite were important “not just for good medicine, but for meaning,” he said.

Putting a Focus on Provider-Patient Relationships

To overcome similar issues as health IT progresses, Verghese urged the industry to work with physicians to find the best way to marry technological innovation with a care model that emphasizes the doctor-patient relationship.

“Much of health IT that we use revolves around billing … and it does that great. It was not really designed for the physician taking care of the patient and that kind of record keeping. Future tools need to recognize that there are multiple functions within [each tool] and make it seamless,” Verghese said. “We need to start looking at things organically from the patient up.”

In fact, Verghese is confident about the progress of health technology and what it can provide, particularly when it comes to artificial intelligence, which he said has the potential to automate the billing process for doctors. Among other possibilities, this could help to streamline a doctor’s workload exponentially.

AI could take the drudgery out of the billing,” Verghese said. “We have cameras catching us doing everything, why not have us bill for what we actually did instead of having us do all this cut and paste and coding.”

Physicians, too, need to ensure they approach technology as a tool and not a cure-all.

“There has to be a two-step process, where the black box makes a recommendation and the physician vets it,” he said.

The hope for advancing medical technology is that it will ultimately streamline and decrease the workload to the point that it will afford the physician more time to interact with each patient.

It could also provide the physician with more time at home, reducing the mental fatigue and burnout that often comes with the medical field.

“I’m looking to you for the most wonderful advances to be coming down the pike in IT and especially in artificial intelligence, to make our lives easier, to allow us to spend more time with the patients, to allow us all collectively to embody this vision, to … [allow] us to truly care for the patients,” said Verghese, speaking to the audience of health IT industry professionals and experts.

We can do better. We need to do better.

Xavier Arnau/Getty Images
Nov 03 2017