Several months agao we published a blog putting forth the premise that the increased availability and utilization of clinical technologies in the diagnostic areas – MRIs, CAT Scans, and Ultrasounds – have significantly diminished the use of inspection, auscultation, percussion, and palpation by health care providers. These four tools , utilizing the eyes, ears, and hands, are taught as part of physical diagnosis courses. They require the physicians, nurse practitioners, and physician extenders to get close to the patient, communicate with the patient, and collect import information which drives the primary and secondary diagnoses, additional studies, and, ultimately, the treatment plans. Without such, many more expensive diagnostic tools are being utilized, often leading to over-treatment and mis-treatment, both resulting in unnecessary costs. This less-than-favorable outcome driven by important clinical technological advances we have termed a “toxic side-effect”.
Unfortunately, the same phenomena are being seen with information technologies which have significantly improved the flow of data between doctors, hospitals, ambulatory surgery centers, and clinics. The recent Ebola cases in a Texas hospital brought forth a significant side effect of the state of the art of these electronic medical record systems. The availability of such has led to what some are now calling “electronic silos” in which individuals having different roles on the healthcare team now communicate via this electronic media rather than face-to-face.
In addition, nurses and physicians often have their own “computer cubicles” where they enter their clinical data. But even when this data is seen as being critical to the patient’s care, the direct personal communications to their team members does not occur. Rather, they each assume the others will see it on their computer screen. Unfortunately, most patients can only have positive outcomes if they are treated by a coordinated team of care givers who share information promptly and freely. In the case of the Ebola patient’s first visit to the emergency department, it appears that although the patient’s travel from Liberia was recorded on the computer, this critical personal communication between the triage nurse and the treating physician did not occur, contributing in part to the poor outcome. Hence, this becomes a significant toxic side effect of information technology.
There is total agreement that the advances made in clinical and information technologies have significantly improved healthcare delivery. But like all technological innovations, they have some potential toxic side effects which can be eliminated of we always remember that ultimately people and teams practice medicine, NOT tectnologies