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Do Doctors Dream of Electronic Records?

A former Apple CEO says healthcare missed the PC and Internet revolutions. He loads the blame squarely on the shoulders of reluctant doctors.

When I first came to healthcare fresh from completing my MBA, my head was full of ideas of quality management. In leading my first electronic patient record programme in a London teaching hospital, I found doctors warmish at the prospect of having transactional information, like diagnostic test results and visit information, but distinctly cool at the prospect of recording outcome information.

Evidence-based healthcare should encourage the analysis of the relationship between process and outcome, but much clinical practice still seems to have no evidence base. Could this be the reason for slow uptake of electronic records?

In an insightful article in Information Week one chief medical officer supports this view, pointing out that most doctors still prefer medicine as an art rather than a science. That being the case, electronic records would represent a cultural mismatch.

In the UK all GPs now use computers to automate their practice and information from them them is used to manage the Quality and Outcomes Framework (QoF). For me QoF has some way to go before it manages quality rather than process. Nonetheless, GPs regard themselves as being at the forefront of medical computing.

GP systems have automated GP practice and eliminated some routine tasks, but this is hardly a revolution in care delivery. My former GP was one of the last to computerise his practice and the main benefit for me was that I was handed a typewritten prescription--though I did have to go back among the sick in the waiting room to an erratic printer to collect it. It is difficult to identify the direct patient benefits of GP automation. Given it began in the 1990s, this is very disappointing.

It is unfair for doctors to shoulder all of the blame for the slow uptake of IT, but they must shoulder some of it.


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