Physicians like numbers. Data, double-blind studies, peer-reviewed journal articles, evidence. And they clamor for scientific proof whether the issue is prescribing statins to patients at risk for heart disease or whether the debate at hand is the value of electronic health records systems, the pros and cons of email communication between docs and patients, the benefits of e-prescribing, or the impact of m-health technologies on patient outcomes.
Show me any IT initiative that will affect a physician's workflow, schedule, paycheck, or liability risk and I'll show you a doctor who's calling for evidence that the rewards outweigh the risks.
And since m-health, e-health, connected health, telehealth and data-driven health (et al) are pretty much dead in the water without physician support, researchers are scrambling to deliver it.
The Journal of the American Medical Informatics Association recently published a flurry of such studies, including one that found using an automatic alert system in providers' EHR systems significantly increases the documentation of previously unknown patient problems. Another found that poor EHR implementation can skew quality measures. A third found that some EHRs are lacking in adverse drug event detection. And yet another said they're a good tool for identifying preventative services in order to avoid unnecessary procedures.
But wait, there's more: On any given day you can find a new study that proves this or that about EHRs and other health IT tools. Web-based tools aren't effective for diabetes management. EHRs improve hospital nursing care. EHRs reduce racial disparities. It goes on and on.
You see the problem, here, right? There are thousands--if not hundreds of thousands--of questions about electronic health data and the various tools physicians can use to harness it. By the time researchers finish slicing and dicing data in incremental studies such as these, the EHRs of today will be sitting on a shelf in the Smithsonian ... and we still probably won't be any closer to reaching a consensus about their overall benefits or efficacy.
Research, surveys, and studies are all well and good and I'm not saying that the industry shouldn't keep at it. It's just not enough. What docs really need is practical solutions that they can implement right now.
When physicians raise concerns about how a technology will impact their workflow, they don't need a time-tracking study of random clinicians. They need help solving their specific workflow issues.
When physicians say that learning a new system is too complicated, they don't need a study about alert fatigue--they need reasonably customized alerts and technical support and training.
When physicians fret that sending a patient an email or conducting an e-visit will make them vulnerable to malpractice claims, they don't need a study that tells them whether patients prefer physicians who use email. They need counsel on how to mitigate that risk and they need laws that protect them.
When physicians raise the concern that remote visits will cut their reimbursement rates, they don't need data about how many patients in rural areas lack access to specialists. They need payers to come up with a fair compensation plan.
Maybe if docs had more support from the government, payers, hospitals and health systems, professional associations, and others--whether in the form of money, personnel, or technical expertise--they'd spend more time using clinical HIT tools and less time asking for proof that they work.
Then again, maybe they wouldn't. Hey--maybe someone should do a study on that. - Gienna