Health IT must make a choice: we can make excuses, or we can make magic. We can blame physicians for their lack of engagement, meaningful use for distracting us from innovation that changing practices is too expensive, and that technology dehumanizes health care. Or we look ourselves in the mirror and admit that we have the technology to make magic, the tools to predict and detect individual suffering and illness. Our patients deserve better than excuses. Moms and dads deserve better than needing dialysis because our population health efforts failed to help them control their diabetes. Grandmas and grandpas deserve better than presenting to an emergency department with pneumonia and leaving the hospital with a bed sore that may never heal. We all deserve better than dying from an infection that could have been prevented.
"I don’t believe that technology will ever replace clinicians. But I believe it will help clinicians give the best care in history"
As a physician on the frontlines of an underserved population, I see these problems every day. As a health IT executive, I know we have solutions. Solutions we are slow to implement and even slower to adopt. Solutions that seem to do the impossible. Solutions that are… magical.
At this moment, we can magically predict who is most likely to get an infection while in the hospital, who are most likely to return to the hospital after discharge, and who will have a significant decline in their health or even suffer a heart attack. We can magically read and analyze all the documents in an electronic health record and sort out who needs preventive services, who isn’t responding to medication, or who might have an undiagnosed condition. We can magically alert physicians to these high risk patients, any place and any time, through computers that fit in their hands.
But we are scared to use magic to help patients, because as an industry we are in denial that the technology actually works. As long as we continue to doubt the technology, these solutions will be nothing more than magic. So how can we relieve these fears? It’s simple, we learn.
In 1942, Leigh Brackett wrote "Witchcraft to the ignorant, ... simple science to the learned.” Knowledge combats fear. We owe it to our patients to learn. We owe it to them to spend time learning that this isn’t magic- its science. The predictions aren’t magic- they are the result of math. The same math that brings you ads on Facebook. Math that lets you find the perfect result from a Google search. Math that tells you when a snow storm is coming, and how many inches of snow will fall. But instead of shopping, searches, and snow, math can be applied to clinical transactions, social and economic elements of health, and demographic factors.
But we aren’t. We aren’t using everyday math to help patients. We aren’t taking those predictions and helping moms and dads avoid dialysis, helping nurses prevent bed sores for grandma and grandpa, helping the doctors to ensure that all of us live healthy, long lives. We need to learn enough about the predictions that we understand how to use them effectively.
An electronic health record represents hundreds and hundreds of pages of medical records for hundreds of thousands of patients. We expect that clinicians will be able to read and process all of it to glean the information needed to treat a patient. Why does it seem magical that a computer could process that same wealth of information and infer clinical context? They can. It isn’t magic.
Just like it isn’t magical when the NSA sifts through millions of emails and phone calls looking for threats. Or when Facebook determines the social context of your posts. It’s not magical when your bank calls to investigate a purchase made on your credit card in Moscow. Or when the National Weather Service predicts that your town will be at high risk for tornados or flash flooding and an alert is pushed to your phone through the Wireless Emergency Alert system. However, suggest that a physician could receive an alert on his phone before a patient goes into distress at a hospital? Magic! This technology is used every day, but we don’t trust it to identify patients that need a blood vessel repair or a follow up call from a care coordinator. We are so immersed in the technology that we don’t even see it. It is just part of our daily lives and seems out of place- magical-in healthcare.
I don’t believe that technology will ever replace clinicians. But I believe it will help clinicians give the best care in history. We need to help them. We need to become the myth-busters, the learned, the illuminated. We need to know what is and isn’t magic. And then we need to teach our clinicians. We need to help them push past the excuses and successfully adopt the technology that will drive improved care. We will know we are on the right path when patients think it is magic that their physician knew to order a test which caught a tumor early, but the physicians know that it’s not magic- it is simply the best technology being used in the best possible way.