December 5, 2008

Doctors feel vulnerable, less efficient without technology

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Kevin Johnson, M.D.

Doctors feel vulnerable, less efficient without technology

Doctors who receive training in a technology-rich environment, but transition away to less modern facilities to practice after graduation say they feel less able to provide safe and efficient care, a new Vanderbilt Medical Center study shows.

Nearly 80 percent of the 328 Vanderbilt graduates who responded to the survey had transitioned to environments with less health information technology (HIT) and reported “feeling less able to practice safe patient care, to utilize evidence at the point of care, to work efficiently, to share and communicate information, and to work effectively within the local system,” according to the study in Academic Medicine.

“Going from being a medical student where somebody is always watching after you, to a role where you could potentially make a mistake that could actually harm a patient, is already hard enough,” said the study's lead author Kevin Johnson, M.D., associate professor and vice chair of the Department of Biomedical Informatics.

“But when you get there and realize that the systems they have are less functional and less pervasive than the systems with which you are familiar, there is an entirely new set of challenges you have to master.”

Technologies known to improve quality through safety and efficiency in health hospital systems include computerized physician order entry (CPOE), electronic medical records (EMR), and lab results reporting systems.

Johnson said his study illustrates why the transition plan from medical school should include assessing residents' abilities to use conventional technologies in the absence of electronic health records and CPOE.

“These results support greater adoption of HIT and underscore the need for formal, system-specific education for new trainees, faculty, and staff transitioning to a new system of care,” he said.

Johnson said the survey responses in his study pointed to the fact that “you never get so good that you don't need a net.”

“We were very surprised to get answers this polarized when asking about perceptions of a person's own level of 'safety,'” he said. “And you could make the case that efficiency translates into safety as well.”

“When people start saying that they feel less efficient, what you have to worry about is not that they are working until 10 o'clock. You have to be concerned about the behaviors they are adopting so that they can get out by 10 o'clock. Are they watching out for drug interactions? Are they as careful about reviewing a patient's medical history?

“That work is more difficult in environments without order entry systems or electronic medical records,” Johnson said.