This week, we were asked to read “Why Doctors Hate Their Computers“, and article written by Atul Gawande. It was a wonderfully written article that gave insight into the period of time where hospitals adopted the new Epic software system, and how they suffered through the process. It gave different outlooks on the computerization of enterprises, the pros and cons, and the contrast between human-centric work environments (adaptable ones) and computer-centric work environments. Adopting this technological overhaul was a major step in healthcare that hospitals across the nation decided to undertake. It came with training for nearly all employees, the hiring of technical staff, policy and routine changes for care providers, and a tremendous amount of headache.
The article dove into statistics of career satisfaction that healthcare providers in different specializations report. On average, doctors spent about 2 hours on their computer for every patient-facing hour the spend in the clinic. There was correlation found between this and job dissatisfaction, and especially between time spent on the computer and burnout rate, as reported using the Maslach Burnout Inventory. Doctors in specialties such as Emergency Medicine, who spend large amount of their time logging information into computers, reported significantly higher rates of burnout and job dissatisfaction when compared to a specialty like Neurosurgeons, even when they spent significantly less time at work. With the overhaul of Epic, doctors had to spend even more time on their computers logging patient information, often after hours and at home. Patients were booked for double the time slots they had previously been booked for, effectively halving the amount of patients seen per day. Not only this, but in a study done by the University of Wisconsin, it was found that the average workday for doctors increased to around 11.5 hours. While reading, it was pretty concerning to think about how these people who are trying to take care of others are doing so on such extreme schedules.
It wasn’t just learning curves that seemed to make the job harder on doctors. The senior vice-president at Epic, Sumit Rana, called one issue “the Revenge of the Ancillaries.” Since Epic was a system that would be used in every position in the hierarchy of the hospital, there were often disagreements regarding what administrative staff wanted the software to do and what doctors wanted the software to do. Since doctors had been used to calling the shots (for the most part) regarding patient healthcare, having restrictions placed upon them was a difficult thing. Not only was there the tension of having to learn and implement a new software system into their daily routine, but there was also tension “politically” in their work environment due to administration.
So who was the real customer for the system? I think it is clear to say it was hospitals, and the technology from a sales perspective was aimed at ease of use for doctors and administrative staff. However, Gregg Meyer, the chief clinical officer at Partner’s Healthcare who oversaw the introduction of Epic, put it really well in my opinion. “‘…we think of this as a system for us, and it’s not’, he said. ‘It is for the patients.’” Meyer is convinced that it will improve over time. The Epic system is new and absolutely massive. In 10 or 15 years, national EMRs will be far better than they are even today. There will be many of the same issues, however there is a tremendous amount of benefit that comes from it. According to the article, “In the first year of the study, deaths actually increased 0.11 per cent for every new function added—an apparent cost of the digital learning curve. But after that deaths dropped 0.21 per cent a year for every function added.” A system that does that seems worth the headache in my eyes. I hadn’t at all considered this viewpoint before reading this article, and it made great sense to me.
I think there is a lot that can be learned from this article far past the domain of hospitals, EMR, or even software in healthcare. The article referenced “The Mythical Man-Month” by Frederick Brooks which I found pretty interesting. It dives into the human aspects of software engineering and working in a computerized workspace. The actual development environment and technology used within the workspace has changed, however things like the scaling of collaboration and teamwork in a project-based environment have remained largely the same. Within the book, Brooks coined something called Brooks’ Law, which states that “adding human resources to a late software project makes it later.” Clearly even back in 1975, they knew a thing or two about the complexity of introducing and launching software products on a large scale — and the implementation of Epic was another example of exactly that.