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Doctors Feel Vulnerable, Less Efficient Without Technology

December 1, 2008

Doctors who receive training in a technology-rich environment but transition away to less modern facilities to practice after graduation say they feel less able to provide safe and efficient care, a new Vanderbilt University Medical Center study shows.

“Performing Without a Net: Transitioning Away From a Health Information Technology-Rich Training Environment,” is published in the December issue of Academic Medicine, the journal of the Association of American Medical Colleges (AAMC).

Kevin Johnson, M.D., associate professor and vice chair of the Vanderbilt Department of Biomedical Informatics

Kevin Johnson, M.D., associate professor and vice chair of the Vanderbilt Department of Biomedical Informatics

Nearly 80 percent of the 328 Vanderbilt graduates who responded to the survey had transitioned to environments with less health information technology (HIT) and reported “feeling less able to practice safe patient care, to utilize evidence at the point of care, to work efficiently, to share and communicate information, and to work effectively within the local system,” according to the study.

“Going from being a medical student where somebody is always watching after you, to a role where you could potentially make a mistake that could actually harm a patient, is already hard enough,” said the study’s lead author Kevin Johnson, M.D., associate professor and vice chair of the Vanderbilt Department of Biomedical Informatics.

“But when you get there and realize that the systems they have are less functional and less pervasive than the systems with which you are familiar, there is an entirely new set of challenges you have to master.”

Technologies known to improve quality through safety and efficiency in health hospital systems include computerized physician order entry (CPOE), electronic medical records (EMR), and lab results reporting systems.

Johnson said his study illustrates why the transition plan from medical school should include assessing residents’ abilities to use conventional technologies in the absence of electronic health records and CPOE.

“These results support greater adoption of HIT and underscore the need for formal system-specific education for new trainees, faculty, and staff transitioning to a new system of care,” he said

Fourth-year medical student Jimmy Carlucci said he is paying attention to whether or not potential residency programs are utilizing electronic medical records and electronic order entry as he searches for his residency.

“Part of my interest in this comes from my experience that having HIT at one’s fingertips makes practice much more efficient, eliminates redundancy, and provides a safety net,” Carlucci said.

“But I have to admit, part of my concern stems from fear that transitioning to a training program with less HIT will be burdensome and put me at a disadvantage compared to residents who didn't have some of the luxuries I've been afforded through Vanderbilt's HIT.”

Bryan Harris, also a fourth-year Vanderbilt medical student, said working at a hospital that is still primarily paper-based would put him at a disadvantage.

“I strongly believe that high quality health information technology significantly increases the quality and safety of patient care,” Harris said.

“When entering a medication order, for example, the computer might alert the physician that he/she is likely making an error. While we will never be able to remove all error from the health care system, we must strive to minimize it to the greatest extent possible. We owe that to our patients.”

Johnson said the survey responses in his study pointed to the fact that “you never get so good that you don’t need a net.”

“We were very surprised to get answers this polarized when asking about perceptions of a person’s own level of ‘safety,’” he said. “And you could make the case that efficiency translates into safety as well.”

“When people start saying that they feel less efficient, what you have to worry about is not that they are working until 10 o’clock. You have to be concerned about the behaviors they are adopting so that they can get out by 10 o’clock. Are they watching out for drug interactions? Are they as careful about reviewing a patient’s medical history? That work is more difficult in environments without order entry systems or electronic medical records.”


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