Years ago, when the first computers entered doctors’ offices, hopes related to digitalization were high. PCs were to help doctors and automate many repetitive activities. And so they do, but a fairly common effect has consumed the added value of IT. Where are the long-awaited benefits of digitalization?
Less medicine, more paperwork
Today, statistical physicians are more and more burdened with administrative obligations. During a patient’s visit, they spend long minutes in front of the computer filling in electronic medical records and entering data.
After observing the work of 36 doctors in one of the Swiss hospitals, researchers drew alarming conclusions, then published in the Annals of Internal Medicine. The doctors spent 5.2 hours per shift at the computer, 1.7 hours with the patient, and 13 minutes on both activities simultaneously. Interestingly, another research conducted half a century ago suggests that doctors devoted a similar amount of time to patients like today. Where are the profits of substantial technological progress in health care?
Processors make it easy
Today, digitalization primarily benefits the payer, who receives consistent and full reporting data, and the health care system, meaning its authorities. What about doctors? Why has computerization failed to reduce the time required for paperwork? A computer should make things faster, thanks to templates and easy-to-use standardized databases (ICD, medicines, procedures, etc.), and more convenient. Once entered, data is supposed to be automatically used in various reports and re-used many times. Doctors should save a lot of time typing in the same details. They all are already in the EHR. Hardly anyone believes that this is what happened. Unfortunately, the advantages of technology have been utilized differently than expected by medical staff.
Healthcare has become the victim of the rebound effect, described for the first time by the British economist William Stanley Jevons. A classic example of this phenomenon is electricity. Why does energy consumption, in some cases, not decrease despite the introduction of energy-saving light bulbs? The reason is not that new bulbs are not better than the old ones. It is because users simply leave them on for longer, knowing that… they are energy-efficient.
Nowadays, a similar problem is affecting health care. In the ’80s and ’90s, when a significant number of reports were made on paper, a limited number of documents was required. The payers and healthcare authorities could not demand more, as it would exceed the capabilities of doctors and health centers. Today, insurers, national and local healthcare institutions may impose further requirements, knowing that service providers have the tools (computers) to develop even the most sophisticated reports. The time that was to be saved by the doctors has been absorbed by the rebound effect.
A computer doesn’t do magic
Technologies are improving at a great pace. Algorithms will perform preliminary data analysis, artificial intelligence will help the doctor make therapeutic decisions, voice assistants will convert natural speech into structured medical records without having to tediously type data with the keyboard. Many standard measurements of the patient’s health parameters will be entered into the electronic medical records from devices existing in the patient’s home. Theoretically, the doctor will be able to finally take care of the patient. Will the proportions reverse, and will the doctor be able to talk to patients and focus on their worries instead of staring at a computer? Will health care be, therefore, more human than today?
Not necessarily. This “gift of time” gained through technology can be wasted, which also described Eric Topol in his latest book “Deep Medicine.” An efficient doctor with time reserves will have to see more and more patients, and in this way, everything will remain the same.
Technology alone is not enough to make medicine patient-friendly, which we have already learned in recent years. This should be borne in mind by those responsible for health policy.
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