A year ago my friend Amy Berman (@NotesOnNursing) introduced me to the Choosing Wisely movement. Over dinner Amy told me her own story of choosing a path that did not include aggressive treatment for her cancer and how she was opting instead for a higher quality of life so she could continue to do the things she loved. Before Amy, I never thought to weigh the negative impact a treatment plan could have on my quality of life vs the clinical/longevity benefit of that same plan.
A couple of weeks ago, almost exactly 1 year after my dinner with Amy Berman, I had breakfast with Natrice Reece (@NatriceR), e-patient advocate and #MedX speaker. One of the topics we discussed was Choosing Wisely – specifically the need for patients and doctors to sit together and really discuss whether a test/treatment was necessary. That conversation got me thinking about whether Health IT needs to adopt its own version of Choosing Wisely.
Health IT folks are first and foremost problem solvers. We love to dive in and fix things. We are quick to throw technology at every challenge [Note: I am stereotyping]. Yet, I’m sure many of us have first-hand stories of IT project that have gone awry – projects that seemed like the perfect solution to a problem but on further reflection should never have been green-lit in the first place.
I was once involved in a project that was supposed to solve the problem of urgent messages not getting to physicians. We built an entire secure messaging platform that required users to type in their message on a “portal” which would then automatically try to reach out to the physician through different communication channels. It was a complete flop. The user-interface was clunky, nurses spent 5x more trying to type in a message vs dictating it and the communication technology was unreliable. In the end the organization went back to using a centralized call center that would dispatch messages.
Had we properly gauged the impact of the proposed system on the end-users, nurses and doctors, we might have recognized that the problem wasn’t really a problem of technology – it was a staffing/training issue. Looking back, we should not have chosen the aggressive technology treatment. We did more harm than the problem itself was causing. We didn’t choose wisely.
Over the past several years there has been a huge push to adopt EHRs. There is no doubting the benefits of EHRs in the long term. However, I believe that many healthcare organizations would love to go back in time and make a different decision about their EHR implementation. Given the resulting pain, anguish and disruption to their organizations, I believe many would opt for a more simplified/less aggressive implementation.
It takes a lot of personal and political will to slow down in healthcare. We have a healthcare culture that expects us to “DO SOMETHING” and there is an expectation to act immediately, without pausing to think through the consequences. Those of us in Health IT are in the same boat as our clinical peers. We are under extreme pressure to solve problems by “IMPLEMENT SOMETHING”. This pressure blinds us to the potential negative impact the solution can have.
That is why we need to adopt the equivalent of the Choosing Wisely movement in HealthIT. Before we start any project we should weigh the benefits against the disruption the technology will cause. Only when we have that perspective should a decision be made on whether or not to move forward.
Do you think HealthIT needs an equivalent to Choosing Wisely?