The huge investment in health information technology including EHRs, Drug Information, and a multitude of other systems has taken place over decades, recently accelerating as the promise of a technology-supported healthcare system becomes more of a reality. Incentive and accompanying penalty programs have been enshrined under the HITECH Act as well as through other programs designed to encourage adoption of information technology by clinicians. When these programs started a number of years ago, a limited amount of quantitative evidence existed demonstrating that EHRs and related technologies improved quality of care. As our knowledge base grows, we are beginning to move beyond anecdotal examples to evidence of the benefits of sophisticated technologies such as CPOE or clinical decision support systems (if implemented and used correctly).
However, is there potentially a darker side to the adoption of information technology? Can clinicians maintain the art of medicine in a dominantly technology-based practice setting? Will we lose the the great diagnosticians who honed their skill over decades based on their knowledge but also great powers of observation as we implement EHRs and become dependent on the integrated tools to diagnose for us, make recommendations and warn us of impending clinical problems?
Earlier this week I read a blog article by Dr. Stuart Gitlow, acting president of the American Society of Addiction Medicine. In the article When Brilliance Revolutionizes Treatment, Gitlow explores the impact of Steve Jobs on Apple as a single brilliant brilliant decision maker and states:
“If we look at physicians the same way, and imagine that we all fall on a bell curve, you might think you want guidelines and protocols and teamwork, at least for the bottom half of the curve. But by applying them to everyone, you end up with regression to the mean that rules out brilliance. You’d have no one with terrible outcomes, but you’d have no one with amazing outcomes either. All physicians would be following the recipe, producing equal products of certain and specific quality.”
Whatever the formula, there are the leaders and the followers. However, with information technology completely woven into the fabric of care delivery, will we create an army of adequate, competent physicians, but limit excellence? The culprit may be standardization of processes, templates, clinical decision support applications, and knowledge tools. In the words of Aldous Huxley, “Hell isn’t merely paved with good intentions; it’s walled and roofed with them. Yes, and furnished too.”
What are your thoughts? How do we ensure that quality of care continually improves, and “good enough” does not become the safe but mediocre standard to which we aspire?