If I could gaze into my profession’s crystal ball when I was still a pre-med college student 10 years ago, I would have been stunned by contemporary doctors’ dysfunctional relationship with electronic health records (EHRs). I have more than a half-dozen free apps on my phone that empower me to video chat with friends and family continents away, cloud-based apps that let me create and share media-rich documents on any device — yet I’m stuck spending half my workday fighting with EHRs that look and function like mind-numbing spreadsheets. Not what I signed up for!
I grew up shadowing, and later working, in my father’s private medical practice and had the privilege of getting to know his patients and their families on a personal basis. When medical school exams kept me from spending my Saturdays in the office, my dad would come home and say over dinner, “By the way, Ms. Muller asked about you today,” as if she were an aunt asking about her nephew. His patients became in many ways a large, extended family that inspired me to devote my life to a profession I regard as sacrosanct. The work is selfless, the science fascinating, but what I love most are the personal connections I make with people everyday: sitting eye-to-eye and listening to others’ problems, fears, and dreams, and helping them live better lives.
It took me by surprise. While I was busy taking exams, a handful of EHR oligarchs emerged to save us from ourselves and our own handwriting. Hospital by hospital, clinic by clinic, our profession succumbed to “Spreadsheet Syndrome.”
Before entering Mr. Jones’ exam room, Dr. Patel glances at her EHR to see her patient in numbers: tabulated lab values, an archive of old notes, imaging reports, and test results. Laptop in hand, she enters Mr. Jones’ room, offers her hand and a tired smile, and immediately starts typing her note, checking and ordering tests, and entering prescriptions and referrals — while Mr Jones fades behind the wall of numbers on her screen.
I first heard of Amazon’s Echo while developing a voice-activated web app, in the context of an academic research project, which passively “listens” to a patient-physician encounter and delivers relevant reference information. My research mentor and I both thought that it might be interesting to port the app to Echo, and I invested $150 and a few weeks of time to build my first two Alexa “skills” (apps for Amazon Echo): a health tracker and a yoga coach (which has been used by more than 3,000 yoga fans at the time of this writing).
How software is designed profoundly influences how we think. I watch both amused and saddened as medical students and interns’ eyes glaze over endless rows of numbers only to find themselves drifting further and further away from their patients rather than actually knowing their patients. Instead of stopping by a patient’s room to ask him or her why they hospitalized last month when visiting their family in the Midwest, we find it easier to just review the EHR from the comfort of our desk. In the process of drowning healthcare professionals in minutia, EHRs obscure our ability to see the forest for the trees.
I believe strongly that the patient-physician conversation is the cornerstone of medicine. The best technology we can implement in the healthcare setting should be invisible – or as inconspicuous as possible.
One of my early endeavors along these lines was a Google Glass app (Vidrio) that passively “listened” and “watched” during patient-physician encounters to generated structured documentation from unstructured audio/video data. We won the 2014 MIT healthcare hackathon with this app, which was intended to liberate healthcare providers from the need to type their notes while interviewing patients. While my colleagues loved the concept (and countless doctors have asked me to pilot the app in their own practices), it seems to solve one problem while creating another. I’ll be the first to admit that I wouldn’t feel comfortable having a candid conversation with my own doctor if they wore a pair of Google Glass during the visit.
Rather than letting a device stand between patients and their doctors (literally and metaphorically), the Amazon Echo can quietly sit in the corner of an exam room, answer questions when called upon (“Alexa, give me a trend of Mr. Jones’ kidney function over the past year”…”Alexa, did Mr. Jones get his flu vaccine this year?”), then quietly fade out of the conversation. How’s that for minimally invasive software?
I’m working to save my profession from Spreadsheet Syndrome by helping doctors use Amazon Echo to interface with their EHRs. It’s about time we start using technology to help us spend more time doing the most important and satisfying part of our work: listening to our patients.
Omar Metwally, MD