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July 1, 2009
One of the joys of practicing medicine is being able to see in a very
practical way the benefits of advances in medicine and ophthalmology. As
a group we can be proud of the quantum improvements that have clearly
increased the quality of our patient’s lives. Not too many years ago the
only plausible treatment for glaucoma was pilocarpine which caused
significant peri-ocular pain and diminished vision with pupil
constriction in patients most of whom also had cataracts. Now we have
B-blockers and prostaglandin inhibitors that are well tolerated and
effective. In the past 40 years we have leaped from intra-capsular
cataract surgery with aphakic spectacles to small incision surgery with
almost instantaneous visual rehabilitation. We have gone from hard
contact lenses to toric soft lenses; we have gone from sulfa antibiotics
to fluoroquinolones. The list goes on. The April 18, 2009 issue of the
Economist
states “Innovation and medicine go together… In modern times medicine
has been transformed by waves of discovery that have |
Robert C. Campbell, MD
Parkwood Eye Center,
Elkin, NC
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brought marvels like antibiotics, vaccines and heart stents.”
The Economist further goes on to point out, “Given its history of
innovation, the health care sector has been surprisingly reluctant to
embrace information technology [IT]”.
Cameras, television and Wal-Mart are digital, why not ophthalmology? The
penetration of EMR’s is remarkably low, perhaps 15% or less. As a
practicing ophthalmologist I believe I know why the penetration is low.
It is easier and cheaper for me to draw a circle on the patients chart
to indicate the spot of the corneal ulcer than accessing an electronic
record and moving the mouse to the appropriate location on the cornea.
The appropriateness of this reluctance to embrace EMR’s is further
verified when reviewing records from an emergency room patient who is
subsequently referred to my office for follow-up. For something as
simple as a routine metallic foreign body the hospital emergency records
are a litany of useless information about what time the nurse took the
patients to the exam room, vital signs I do not need to know about and
multiple other inane comments that, in a practical sense, have nothing
to do with caring for the patients which is simply removal of the
foreign body and referral to my office. As a busy ophthalmologist I
don’t have time to review 5 pages of largely pre-populated useless
information.
As I think further on the conundrum of medicine’s lack of embracement of
IT, it reminds me of the early years of phako-emulsification and
intra-ocular lenses. The pioneers of phako were creating nightmarish
disasters of corneal decompensation by destroying the endothelium during
surgery. If the surgery did not damage the endothelium the anterior
chamber intra-ocular lenses did through chronic inflammation. Myself and
the guru’s at my corneal fellowship training program were dead set
against phako with its corneal disasters. Well, here we are several
decades later and indeed the modern phako devices with small incisions
have lead us to perhaps the most successful surgery in all of medicine.
I believe the same will be true with EMR’s and IT in medicine. What
seems a disaster now will someday evolve to yield benefits that we can
only imagine. In the same Economist article an executive, baffled by the
backwardness of America’s costly health care system, states, “My
receptionist, my shipping clerk and even industrial robots on my factory
floor use e-mail, so why can’t I e-mail my doctor?”
Well, with the
innovative technology supplied by patient portals our executive’s wish
has come true.
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