“We’re using our devices, our iPads, our iPhones, our Android devices, to send information to other providers, but that information may not be transparent to other people,” says Dr. Dalal, who heads an SHM technology subcommittee. “But if you have it on a blog, a patient-specific Facebook, or a patient-specific Twitter, than everyone who subscribes to that will have access to the whole discussion.”
Dr. Dalal cautions that the details of legal compliance are important to ensure private patient information is safely transmitted. He anticipates vendors will market products that will balance the need for that privacy with a wider dissemination of information to ensure all involved physicians know what they need to know. One example: He expects the internal-messaging components of EHRs to improve in the next few years.
“It wouldn’t surprise me if these companies start realizing we need to support patient-specific communication in informal dialogues using microblogs and mobile devices,” he adds. “If they don’t do that, they’re probably going to miss the boat.”
The power of technology, large and small, must be balanced with what hospitalist pioneer Robert Wachter, MD, MHM, calls “foundational knowledge.” Dr. Wachter, who counts chair-elect of the American Board of Internal Medicine (ABIM) among his myriad titles, says that hospitalists can’t be slaves to technology. He relates it to a well-known adage in the aviation industry in which planes have become so advanced that some pilots would be incapable of flying them should the technology fail. In one quip, it is said that two people will soon populate cockpits: a pilot and a dog. The pilot’s job is to feed the dog, while the dog’s job is to bite the pilot’s hand if he tries to touch the controls.
“As we move quickly, briskly, appropriately into this new world of computerization, if we aren’t constantly asking ourselves what have we lost in terms of our relationship with patients, we will really screw things up,” Dr. Wachter says. “This is not an argument to be Luddites, it’s not an argument to send back your meaningful use and get rid of the computers. We need them, but we have to be very thoughtful about how we maintain this balance.”
Patrick Conway, MD, MSc, FAAP, SFHM, a pediatric hospitalist and chief medical officer of the Centers for Medicare & Medicaid Services (CMS), says that to tie quality, safety, and technology together, government has to be willing to back therapies, then determine whether their efficacy deserves financial coverage.
One example Dr. Conway cites is the use of intravascular shunts. After backing their use initially for Medicare patients, it was determined that compared with medical management, the therapy had greater risks for death and stroke—and cost about 100 times more. Still, Dr. Conway says, determining how well the shunt works is exactly the process medicine should go through.
“When we have these new technologies that made a promise, we want to get them to market where they might help patients, but we also want to make sure evidence is developed to make sure they truly benefit patients,” he says, later adding, “I think this catalyst for health system transformation is important, and it’s teaching vision coupled with that execution.”
A well-planned blending of quality and technology can lead to improved patient safety, Dr. Arora says. But physicians and HM group leaders have to be proactive. Those with a clinical focus must seek out their IT counterparts and provide guidance on what information users need to access from electronic interfaces. Chief medical information officers and their staffs must seek feedback from providers before creating templates that don’t serve the clinical functions of end users.