For a decade or so, technology has made inroads into hospitals and clinics as a means of enhancing patient safety and efficiency in delivering care. The major development and the most apparent has been electronic medical records (EMR).
The use of electronic records has been mandated by the Affordable Care Act and almost all hospitals — and many clinics — now have almost all patient records in electronic format. The arguments for this are strong ones, but the practice has often been less than desirable. The use of pull-down menus and “check the box” clinical information often means that the nuances of clinical observation are lost. Many clinicians have trouble navigating the computer systems and do not access key information because it is cumbersome to use.
Other technologic tools are also becoming more prevalent. Physicians can now use their smart phones or tablets to access patient records and films and can use diagnostic apps to narrow down the potential diagnoses. Just key in the signs and symptoms, and get a list of possible or likely causes of the condition. Concerned about drug reactions? In the old days, a physician would rely on his/her memory or thumb through the Physicians Desk Reference. Now this information is readily available on hand-devices that can be accessed at the bedside.
A more recent use of technology involves bar codes, the ubiquitous device at the grocery checkout counter or the airline check-in. Bar codes have become common as a means of matching hospital patients with their medications, but the push is on to make them much more widely used in hospitals. Bar code technology can be used to verify the right patient, the right drug, the right dose, the right route, and the right time (sometimes called the five “rights”).
Because bar codes can now be at the bedside, many substances can be labeled with a bar code and verified at that point (examples include blood, stem cells, bone marrow specimens, etc.). This can avoid tragic mistakes, such as when a similar-looking bottle was used but which had a solution that could kill or injure a patient. Just swipe the bottle across the bar code and it is instantly verified as the correct one.
We are probably at the infancy of medical care technology, and the question is whether the technology will actually enhance patient care and safety or whether it will be one more obstacle to the exercise of old-fashioned concepts like listening attentively to the patient and thinking carefully about what the patient really needs. As anyone knows who has been in an examining room and watched the doctor or nurse focus on the computer screen rather than the patient, technology isn’t always the answer.
