Digitization of medical records= Dehumanizing medical care?

US President, Barack Obama claims that modernizing health records by digitization will save lives and billions of dollars.

“To improve the quality of our health care while lowering its cost, we will make the immediate investments necessary to ensure that, within five years, all of America’s medical records are computerized,” Obama said in a speech from George Mason University. “This will cut waste, eliminate red tape and reduce the need to repeat expensive medical tests.”

“But it just won’t save billions of dollars and thousands of jobs; it will save lives by reducing the deadly but preventable medical errors that pervade our health-care system,” he said.

Obama’s plan will cost about $US100 billion, a huge chunk of the stimulus package, but some experts claim it will save two to three times that yearly. Those savings could go toward universal health care or simply flow back into the hospitals for better equipment. However not all doctors agree with this notion.

In a New York Times op-ed piece titled ‘The Computer will see you now’ , Dr. Anne Armstrong-Coben, a Columbia based pediatrician expresses concern that the modernisation of medical records may not be as obviously beneficial as it seems.

FOR 20 years, I practiced pediatric medicine with a “paper chart.” I would sit with my young patients and their families, chart in my lap, making eye contact and listening to their stories. I could take patients’ histories in the order they wanted to tell them or as I wanted to ask. I could draw pictures of birthmarks, rashes or injuries.

Now that I’ve been using a computer to keep patient records — a practice that I once looked forward to — my participation with patients too often consists of keeping them away from the keyboard while I’m working, for fear they’ll push a button that implodes all that I have just documented.

Dr Armstrong-Coben goes on to say that computers are major distractors which affect doctor-patient relationships.

Doctors in every specialty struggle daily to figure out a way to keep the computer from interfering with what should be going on in the exam room — making that crucial connection between doctor and patient. I find myself apologizing often, as I stare at a series of questions and boxes to be clicked on the screen and try to adapt them to the patient sitting before me. I am forced to bring up questions in the order they appear, to ask the parents of a laughing 2-year-old if she is “in pain,” and to restrain my potty mouth when the computer malfunctions or the screen locks up. I advise teenagers to limit computer time as I sit before one myself for hours each day until my own eyes twitch and my neck starts to spasm.

In short, the computer depersonalizes medicine. It ignores nuances that we do not measure but clearly influence care. In the past, I could pick up a chart and flip through it easily. Looking at a note, I could picture the visit and recall the story. Now a chart is a generic outline, screens filled with clicked boxes. Room is provided for text, but in the computer’s font, important points often get lost. I have half-joked with residents that they could type “child has no head” in the middle of a computer record — and it might be missed.

A box clicked unintentionally is as detrimental as an order written illegibly — maybe worse because it looks official. It takes more effort and thought to write a prescription than to pull up a menu of medications and click a box. I have seen how choosing the wrong box can lead to the wrong drug being prescribed.

Older generations of doctors may have trouble adjusting to a totally digital system, and there are bound to be mistakes made by even the computer-savvy before digitisation becomes ubiquitous.

Like everything else in this world, computers have a good side and a bad side. How we manage to use them to our advantage without allowing them to depersonalize medicine is a challenge. But to wish away computers is silly. They are here to stay and how we make the most out of them is up to us and our creativity.