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Do EHR's Make You LAZY?

April 29, 2009
by Pete Rivera
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I was asked the other day about the impact EHR's will have on provider productivity. Not in terms of improvement, but the loss of skill set. The rationale was that EHR's "spoon feed" information. Therefore, providers will lose some of their analytical skill sets. Was this just an excuse not to use an EHR, or maybe just the comments of a technophobe?
I guess I am just one of the guys waiting for the Star Trek system...just speak to the computer.



great points Mark. Kudos

Laziness is ordering one of every test because it is easier than creating a coherent differential diagnosis. Laziness is ordering a CT scan with a wet reading because it is easier than searching thru old charts to see if one was done before. Laziness it doing something because "that's the way I have always done it." My hope is that the EMR will enable the thoughtful physician to better apply evidence based diagnostics and therapies. The skill will be in making the correct diagnosis. The art will be creating the therapeutic milieu that enables obtaining a truthful history and forms the basis for a healing relationship. CDS could be a crutch for the "lazy", but much more likely it will fulfill its promise of making information available at the point of ordering to a thoughtful and artful generation of practitioners.

It's a little surprising to me how frequently this line of concern shows up, especially in those who think about medical training.

I got into an unfortunate exchange with a physician blogger a while back who was trying to make just this point- that modern clinical systems make doctors lazy and stifle their creativity.

While I don't think systems are smart enough for that to be a real threat, there is a human tendency to take shortcuts that may not always be advisable.

In the end, it's up to training programs to make sure that they are producing professionals with the foundation of knowledge they need.
It's up to practicing professionals to use the tools that are available to them to maximize their effectiveness.
It's up to the professional boards and associations to maintain the highest standards of practice.
And it's up to those of us who are IT professionals to work with the clinical professionals to build systems that perform the repetitive and computational tasks that computers are good at, while making it easier for people to exercise the judgment that we need from them.

I was recently doing a small construction project. I needed to multiple 17 x 18. I knew that I could do it with pencil and paper in 10 to 20 seconds. Or, I could "be lazy" and get the guaranteed correct answer, in less time, with the calculator that was readily available on the computer screen.

Per Dr Bankowitz's brilliant analogy above, 'LAZY' is very SMART.

I think that's crazy. We are so far off from computers doing much, with, for, or to the majority of doctors, I don't think there's much to worry about right now.

Anyway, when it happens, we can just use another stimulus package to get them OFF the technology.

To me, this seems to be an old argument. I remember giving a Grand Rounds on use of clinical protocols sometime around 1990 and the questions then centered around whether or not this was "cook book" medicine. Now the argument, it seems, has shifted, not in substance, but in target - towards the EHR.

Let's consider the question in this way. Imagine you have just taken off on a trans-continental flight, and you hear the following. Should you feel more or less at ease?

"Good evening from the flight deck. We expect a generally smooth flight across the Atlantic tonight. We would like you to know, however, that the First Officer and I have decided that, although known to be highly effective and almost invaluable in these types of flights, the autopilot feature of this aircraft will be disabled. The First Officer and I both agree that this feature interferes with pilot autonomy and we disapprove of what is becoming 'cook book aviation.' You may notice more than the usual "turbulence", but hey, a lot of people pay good money for this kind of thrill! On previous flights, some china has been broken in the business class cabin, but, so far, no serious damage has occurred.

"Also, we want you to know that although based on the best available evidence, the take-off and landing protocols currently in use have been shown in recent literature to correlate only mildly with what we consider to be true measures of 'quality' - passenger mortality. Therefore we will similarly dispense with these 'spoon feed' techniques and approach each take-off and landing as a natural experiment, hoping to learn something new as we go. In this way, our professional judgment will not be compromised.

"Sit back enjoy the ride, and you may wish to freshen your drinks."