Sunday, June 22, 2014

Computer Use to Bring Order Out of Health Care Chaos

The purpose of computers is to bring order out of chaos.


This week I escorted a patient to a surgical ambulatory care center.

Everywhere we stopped or went , there was a computer - at the reception desk, at the vital sign and weigh-in station, at the prep room, at the waiting room for visitors, in the operating room, in the recovery room, at the check-out room, in the parking lot, even after we returned home.

Everything was wired – before, during, after surgery, and even after return home. Everything was anticipated every step of the way. Everything was followed. Everybody seemed comfortable with the computer. I was impressed.

The computer brought order to what could have been chaos. The ambulatory surgical center did 50 procedures that day – everything from parathyroid adenoma removals, to thyroidectomies, to endoscopic cholecystectomies, to exploratory laparotomies, to cystectomies, to ophthmalmogical to urological to orthopedic to cosmetic procedures.

I knew the whole idea behind this widespread computer entry and tracking system was to bring order out of chaos. I knewthe other idea was to broaden the ambulatory care surgical care knowledge base. I knew a third idea was to avoid any mis-identification of patients and to avoid malpractice problems later. I knew you needed a computer to record charges for what was done and by whom.

I knew computers sometimes disrupted work routines, and slowed the pace of work. But I saw none of that. Everybody seemed well trained and at ease with digital technologies.

Computers are here to stay. You can’t live without them. And sometimes, as is the case with endless glitches and with Lois Lerner’s two years of lost emails, and computer hacking and identify-theft, the world knowing everything about you under the sun, and doctors’ time wasted making endless computer entries, it’s hard to live with them.

But all that aside, computers are great for organizing work flow, for accumulating mountains of data, for advancing and broadening your knowledge base, for having improving care by measuring it and having a base to improve upon, for defining patterns of care and outcomes individual can’t, and lately, for manipulating and storing information “in the cloud” in data storage servers outside your personal computer, laptop, or cell phone, or computers at work, and for selling your services on the Internet.

Computers are a mixed blessing. You need them to measure how well you’re doing and to improve upon your work. You need them to find information quickly. You need them to find if a patient is qualified to pay for your services. You need them to track a patient’s vital signs or changes in laboratory or physiological tests. You need them to look up things about a disease or the efficacy of a procedure.

At the same time, if you’re a doctor, computers can be a curse. The money spent to install them in your office and to train your staff drive up overhead. The time required to make data entries is time spend away from patients. . The effort expended to find just the right code is a nuisance Setting aside time to answer all those emails is a pain. Figuring out how to work your way around or through a program obstacle you don’t understand is annoying. Finding just the right electronic health record to fit your particular needs or specialty or type of practice (direct pay practices that are insurance free require much simple systems) takes more time and expertise you may not have.

Someday some aspiring or savvy writer will write a best seller Of Time and the Computer. It won’t be me. I don’t have the time. Still, thank goodness, there will be computer that tracks your royalties.

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