The Voice of Reason

It’s one of those great conundrums. Despite medicine being a highly intellectual field often at the cutting edge of science, we all too often remain near the bottom in terms of our information technology use. Maybe it’s the culture of medicine, a view that one should master everything and do everything despite knowing that this is an impossible goal? Maybe it’s lagging on the part of administration who may not understand the potential role of technology in the daily workflow of their physicians? Or maybe it’s just that we as a profession have never sat down and tried to understand what we’re missing, what we can do, and where we should go with the incorporation of informatics technology?

I choose to believe it is largely the last of these: that we as a profession have not yet began to put proper thought and action to purpose in terms of intelligently using technology to augment our abilities as clinicians.

Think about this scenario: You are on the wards covering 16 patients. Most of your patients are receiving multiple medications – anti-hypertensives, antibiotics, etc. – and let’s say one of them was getting a transfusion overnight as often happens. The team notices that patient begins having trouble breathing and chooses to administer a dose of Lasix which causes resolution of the problem. However, this same patient has a reaction to Lasix and develops allergic interstitial nephritis, which manifests with increased creatinine and reduced GFR on the next set of labs.

Now, let’s say the team notices this and starts treatment with steroids. The team then begins following kidney function and continuing treatment all the while also trying to care for the other 15 patients. And in the pressure to see everyone, follow-up on everything, and complete the documentation required each day, the team responsible for this patient forgets one thing: this patient was receiving medications that require renal adjustment prior to the renal insult. And those medications are now likely no longer appropriate for the patient’s renal function.

This is not an outlandish scenario. In fact, 1 out of every 10 medications given in hospital are either the wrong medication or the wrong dosage.

So, how could this have been caught and prevented? As you may have guessed, informatics.

What if we had an intelligent computer software system that did things like constantly monitor patient labs, check for guideline adherence, and monitor medications? This system would have easily caught the problem. It could, each time labs are drawn, calculate a GFR and then run that value against the dosing of the patient’s medications. Medications overdosed would then be automatically held and flagged for review by the physician with an order for a recommended dosage placed in the system pending approval. The system would then send an alert to the doctor’s cell phone notifying him/her of the flag so that action could be taken.

This is but one example, but it’s not hard to see the role. Given the will, I could easily type out dozens more example of where technology would play a crucial role in patient care and in creating a safer system. Not only would it create a safer system, but it would help take the burden off doctors who are already overly stressed and pressured for time in today’s strained care environment.

The best thing of all about this story is that the technology exists. Nothing I have listed here would be beyond the programming abilities of an undergraduate computer science student.

We have the technology. We have the resources. We have the intelligence to design these systems.

Now all we need is the will of creation and implementation.

Filed under: Medicine, Presentations | Tagged: healthcare, informatics, Medicine |