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Can healthcare IT get its message across?


Technology can be distracting. Just try talking to a teenager holding a cell phone or an iPod. To be fair, teenagers are not the only ones. A day doesn’t go by when I don’t see someone driving and talking on a cell.

Technology can be distracting. Just try talking to a teenager holding a cell phone or an iPod. To be fair, teenagers are not the only ones. A day doesn't go by when I don't see someone driving and talking on a cell.

Ironically, one of the most distracting technologies is designed for the car -- and its makers know it can do as much harm as good. Every time I switch on this technology, a GPS affectionately named Gabby for its propensity to talk, it warns me that "failure to pay full attention to the operation of [my] vehicle could result in death, serious injury, or property damage." Gabby advises me not to enter route information or make adjustments while driving. Yet it encourages me to do just that, most obviously with a button labeled "Detour" in the lower left of her screen. Not much chance I'm going to push that one in the garage.

Now the healthcare community is being asked by the Obama administration to adopt a different kind of GPS, one that guides its daily practice of medicine. The Interoperability Showcase at HIMSS 09 was an eye opener. There, spread across multiple kiosks, were different kinds of IT products built by different vendors, each talking to the others, sharing data, displaying them on screens and -- for the most part -- doing it very well. It's hard not to be impressed by how well these machines navigate differences in software, hardware, data type, and format. What providers do with the information, however, is another matter.

At a kiosk simulating a terminal in an emergency room where a faux patient lay bleeding faux blood, a dozen or so records popped up, showing the patient's history collected from several facilities: demographics, blood tests, recent CTs. Buried in all those data may have been some information that ED docs might have found useful. But who, I wondered, would take the time in a busy emergency room to read through them? Who could do so without being distracted from life-critical duties?

John D. Lee, director of human factors research at the National Advanced Driving Simulator at the University of Iowa, has looked into how we handle technologies when we're behind the wheel. Technologies that distract or impair make drivers more likely to crash, Lee wrote, in a paper published last month in the Journal of Safety Research. But he also noted that technology can be used to improve performance, although not necessarily in real-time. Lee cited a study in which young drivers were recorded on the road and given feedback afterwards. Most paid attention to the feedback and made improvements to their driving.

There are lessons here for healthcare. Systems that share and combine medical data are a great start, but just pushing these data to the point of care is not enough. The systems that do so have to be smart enough to sift through the data, tag those that can make a difference in the care of patients, then present them in a way that fits the environment without distracting or slowing patient care.

HIMSS 09 demonstrated that we are making progress. Medical data can be gathered and successfully transmitted from different facilities to where patients are being treated. Once there, these data can guide providers through the patient care process.

Much like my own Gabby keeps me on track when I'm in danger of missing a turn, healthcare systems can remind providers of tasks that need to be done and warn them about mistakes before they happen. Getting this information through to busy providers, however, is a challenge. Another is to improve future care by providing the feedback on past care that changes medical practice.

Whether these challenges are met will depend as much on how this guidance is presented to caregivers as on its validity.

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