A Change is Coming (In fact its already here!)  / by Micah Brown

Change can be a tough pill to swallow. Im not talking about changing your outfit or changing which brunch spot you’re going to hit up with your girls on a Sunday (even though this can be a big ordeal) Im talking about change that forces you to suck it up, step out of your comfort zone, and produce results. One of the biggest changes that I am going through is not particularly about me, but my job. In the Spring, the dermatology practice that I work for transitioned from paper to electronic. Now I understand, some people will think, ‘no big deal’ but this change is a big deal in that it changes the way we see patients on a day to day basis. To put it into perspective, the practice has 6 providers. One of those providers sees upwards of 60 patients a day. Now multiply that a couple times, carry the one, add a couple patients here and there…and you get a number a little under a million. JK Im not sure of the total number of patients that come to our practice, but as you can imagine, theres a lot of patients which means a lot of paper charts. This may seem like a lot but for a year of me working as a medical assistant, this was the norm. Fast forward a couple months, not only are we trying to scan charts while seeing patients but we have to learn a whole new system.

Instead of walking around with a chart, pad of blank prescriptions, and pens, I now have a iPad and stylus in hand.

This change and even situational chaos got me thinking about something that has become evident. The world is becoming more and more electronic! As my dad says (and I’m sure everyones parents say) “everybody’s in their phone, no one is talking”. But because this is Medically Micah.. we’re going to talk from a medical stand point. Now is this change a good or bad thing..its depends on who you talk to. Luckily for y’all, I talked to 4 medical professionals that are addressing technology in medicine. I brought out the big guns for this blog post! 

@rishimd

@rishimd

Rishi Kumar, MD 

So on the topic of technology in medicine, here’s what I have to say:

I’ll be subspecializing in critical care medicine and cardiothoracic anesthesiology, and in both fields, technology is continuing to revolutionize our ability to more effectively diagnose and treat life threatening medical conditions in a quicker and safer manner for our patients. For example, point-of-care ultrasound allows us to perform noninvasive cardiopulmonary exams looking at a patient’s volume status, cardiac contractility, valvular integrity, signs of ischemia, lung pathologies, etc. In the operating room, new advances in technology have substantially improved perioperative monitoring for beat-to-beat hemodynamics changes and to guide surgery with modalities like three dimensional transesophageal echocardiography (3D TEE).

Although I’m just embarking on my fellowship training, I’m excited to utilize my love of medical technology to better integrate advances into providing better and safer care for my patients.

 

@thekatieduke

@thekatieduke

Katie Duke, MSN, RN, NP

How does technology affect...

Patient Interaction & Treatment

Pros: quick access to records, results, orders, and resources like medication and treatment research (upToDate app), providing patients with information, and even translation services- a huge deal in NYC! 

Cons: spending so much time writing notes, it's time consuming and can take away from time that could be spent with patients (but- so did paper charting) 

The Medical Professionals Day

Pros: makes my job easier, which in turn, makes my day flow a lot better than when we had paper charts,  no internet and no smart phone apps 

Cons: can't think of any to be honest!

Teaching

Pros: Discussion groups, online communities offering support and knowledge sharing and resources, ease of access to information and current research and trends, online education and certification, access to data from global perspectives, with all that's at your hands- you can literally learn anything at any time of day.

Cons: More and more people are leaving the traditional brick and mortar programs for online education and I personally feel that you just get more of an educational experience from the traditional methods

Shari Marchbein, MD  

@drsharimarchbein

@drsharimarchbein

When I was in medical school, there were only paper charts and then when I started residency nearly 14 years ago, the transition to electronic records started but the majority of record keeping other than labs were in paper charts. After graduation, I joined a private practice and they were completely electronic. It took me weeks to get up to speed and I quickly realized that I loved not having to write out prescriptions anymore, but I did not like having a computer in the Patient exam room. It felt impersonal. So I decided to leave my computer by my desk and I have never looked back. I don't bring one into the exam room so I am able to keep excellent eye contact, interpersonal skills, really get to know my patients outside of what their chart says. Doing notes was much quicker before the governmental regulations but I love that I can escribe all medications, it is quick and easy and my patients seem to love it. Electronic records also give you the ability to Template your notes. So I have templates for anything from skin checks to acne visits to eczema visits, and of course I am able to personalize them for each patient, but it makes the process much easier. So although the initial learning curve is steep, ultimately I could not even imagine going back to paper charts. I think it's a balance. We have to keep in mind that although we are mandated to be electronic, there is a real life patient in front of us that deserves our attention, respect And care. And I think that's how we make the system work for us.

Aaliya Yaqub, MD

@clearskindoc

@clearskindoc

I really believe that the future of medicine has to be tech-enabled. We live in an on-demand society where people are accustomed to ordering food or a car via an app on their mobile phone. Why isn't our healthcare accessible in the same way with the same speed and efficiency? In order to improve patient outcomes and make the focus on health more preventative, people need to have better, more timely access to their physicians and healthcare providers. For instance, if someone can get their medication refilled via an app or get evaluated via telemedicine, they can get the intervention or guidance they need. They are much less likely to have a progression or worsening of their symptoms and also much less likely to need urgent care or ER assistance. Opening up access with better technology, can reduce healthcare spend and keep people healthier over time. The flipside is that physicians are already burdened by excessive charting and paperwork so increasing access might create more work. However, if we can change insurance reimbursement patterns, physicians can see less patients in person and do more telemedicine. Overall, the workload would be more balanced. Lots of work needs to be done to bring medicine up to speed with appropriate technology, but we will start to see early indications of these changes in the years to come. 

So clearly, electronic is the way to go in many aspects!

 At first I was hesitant to go electronic. Not going to lie. Im very old fashioned when it comes to things like this. I still use a notebook planner and #2 pencils. A doctors visit that I had once was stuck in my mind… me talking to a doctor buried in his iPad for 10 minutes. I was afraid that it was going to get in the way of what matters most, PATIENT CARE! But as the months have gone on and Ive gotten the chance to practice using the electronic database..im definitely starting to see how this is significantly beneficial to the practice and medicine in general. Being able to share, educate, and document at the touch of a finger makes patient care more efficient and quick. Eventhough I will miss writing out patient notes (not kidding, I enjoy writing) this change is for the better! 

Special thanks to Nurse Katie Duke, Dr. Kumar, Dr.Yaqub and Dr. Marchbein for giving me their input on this topic. These #boss medical professionals are inspiring and make it a priority to make the patient their priority. Feel free to comment on this post. What do you think about technology in medicine? Do you have cons that you’ve experienced? Do you love old fashioned books more than iPads and PDFs? I’d love to hear from you guys.