ORLANDO — Robert Wah, MD, is like the Thomas Jefferson of health information technology for physicians.
He served as the first deputy national coordinator for health IT when the office was founded within the Department of Health and Human Services in 2004.
Before that, Wah worked as associate chief information officer for military health, which made him the lead physician for health IT for the military. Today, the McLean, Va., resident works as the chief medical officer for CSC, a health IT company in Falls Church, Va.
But as president-elect of the American Medical Association, he is also a respected physician leader.
Wah sat down with MedPage Today‘s David Pittman to talk about physicians’ issues with electronic health records (EHRs) during this week’s Healthcare Information and Management Systems Society (HIMSS) annual conference in Orlando.
David Pittman: Why do so many doctors seem to abhor EHRs?
Robert Wah, MD: I’d liked to redirect that just a little bit. I’m very sensitive to this comment that physicians don’t like technology and don’t like health IT.
I think physicians are very quick to embrace technology that they can quickly see would help them take better care of their patients. We have historically been very, very early adopters of technology.
The example I always give is physicians were one of the first groups of people to carry pagers. Why? Because we recognized very early on that it was a technology that allowed us to move further away from the hospital than to be within earshot of a loudspeaker. We embraced pagers back when pagers were quite, I would say, complicated.
I don’t think it’s a fair statement to say we don’t embrace technology or we abhor technology. I think we don’t like technology that gets in our way or makes our job harder. I will agree with that.
Pittman: Is that because EHRs and health informatics can help improve patient care but the current technology is more of a hindrance than a benefit?
Wah: I think there are a couple of reasons. One is, that, historically in many occasions, the technology was developed without sufficient clinical input.
One of the things that drove me to be very interested in health information technology was, as a practicing physician, I was always frustrated and always looking for more tools to help me take better care of my patients. When it came to health information technology, I was often surprised to find how little clinical input there was in the development of the technology tools that were being distributed.
I got involved because I wanted to have a clinical voice in the room that had some experience taking care of patients. I learned that we need technology development to have a clinical perspective at the very beginning so that it drives the initial development decisions.
We need better input on how the interface works between the machine and the physician. I think most importantly we have to have a better understanding of what the workflow and the business process of delivering patient care is, so that the technology can integrate into that workflow and support that business process.
One of the most frustrating things I hear from physicians is “This thing gets in my way.” The technology should be seamlessly integrated into the workflow. If we did that, physicians would embrace it very quickly.
Pittman: We can’t go back to the beginning and start all over again. What is your advice to doctors out there struggling with this today?
Wah: I think we don’t do the best job thinking about our business process and our workflow to prepare it to take full advantage of the technology. Much of our workflow was assembled in a paper-based world, and paper drives a certain number of workflow steps because it’s very sequential.
For instance, a paper record can only be looked at one person at a time, so most of our clinic flows are very stepwise, like a conveyor belt. An electronic record allows simultaneous access to the same information by multiple people. We ought to think “If we’re freed up of this conveyor-belt requirement, what could we do differently?”
Pittman: One of the arguments against EHRs is that they interfere with doctor-patient communication. The doctor is looking at a computer monitor instead of the patient. How can this be overcome?
Wah: I think there’s going to be future technology, there’s some in development now, that will make that interface better. The interface between a pen and paper is not a great interface. It’s just the interface we’ve known for over 100 years.
I think we can get to the place where we can do the same thing we do with pen and paper. In the meantime, people are working on all kinds of different workarounds — dictation, scribes.
Pittman: What is this technology you’re talking about?
Wah: It’s the concept that we could record information without typing. Whether that’s voice or images and objects that we use. Typing requires a lot of attention, more so than even writing.
Pittman: When will EHRs help really improve patient care?
Wah: It’s my belief that in the future electronic records are just going to become another data source to a layer that’s going to sit above electronic records. That layer is going to be where the real payback for all the effort we’re putting in today. That’s where the analytics will be. That’s where the care coordination will be. That’s where we’ll be able to take much better care of our patients using better information.
At CSC, we’re working on a layer that we’re calling Harmonics. It’s pulling data from multiple sources, including electronic records, and making that information available to help navigate patients through the system to get better care at the right time and the right place. Source
