The Cost of Technology

Abstract

No one was more surprised than the physician himself. The drawing was unmistakable. It showed the artist-a 7-year-old girl-on the examining table. Her older sister was seated nearby in a chair, as was her mother, cradling her baby sister. The physician sat staring at the computer, his back to the patient-and everyone else. All were smiling. The picture was carefully drawn with beautiful colors and details, and you couldn't miss the message. When he saw the drawing, the physician wrote a caption for it: "The economic stimulus bill has directed $20 billion to health care information technology, largely funding electronic medical record incentives. I wonder how much this technology will really cost?"Why was the physician so surprised? Let me tell you about this guy. He joined our pediatrics residency with the rest of the new interns after a two-year stint as the medical officer aboard an aircraft carrier in the Persian Gulf, a position he had assumed after a single year of general internship in the navy. During the assignment, he had seen this floating city of more than 2500 through every conceivable medical problem from homesickness to pre-eclampsia, traumatic amputation, and myocardial infarction. He learned to make decisions as significant as diverting an entire aircraft carrier in order to get a patient to a tertiary-care hospital in Bahrain. When you spend a moment with this young physician, you sense innate kindness, humility, and connection to a larger purpose, be this family, country, patients, or hospital. He also has charisma. Students, colleagues, faculty, parents, and kids of every age connect with him. The enjoyment seems mutual. You find him crouching down to mee his young patients at eye level. Evidence of his love for children has grown outside the hospital as well. He and his wife have had three kids during his residency. He was an obvious choice for chief resident and is now in that position. This is a physician's physician, a doctor who delivers humanity and competence throughout the day, although if you asked him about these attributes, I'll bet he'd say they are some of his aspirations, not accomplishments.So it came as a stunning piece of feedback-not surprisingly out of the crayon of a babe-that his patients might be seeing him in a new way since the rollout of the electronic medical record. From my perspective of 20 years practicing primary care pediatrics and internal medicine and more than two years into juggling the needs of patients with those of the computer, this child's drawing powerfully expressed the deep frustration and concern of many physicians, including me.When a physician focuses on a patient with complete attention, this simple act of caring creates a connection between two human beings. Almost immediately, the patient begins to feel, well, cared for, and this becomes a first step toward helping that person feel better. This connection between people is also one of the

Künstliche Intelligenz: Herausforderungen und Nutzen in der Intensivmedizin

“…Durch die konstante zeitgenaue Dokumentation jeglicher Daten und Speicherung aller Eingaben in die elektronische Patientenakte muss hierbei ständig mit dem Computersystem interagiert werden. Der Patient ist damit oft nicht mehr primärer Mittelpunkt der ärztlichen Tätigkeit [7].…”

“…Des Weiteren kann durch ANN und "Deep Learning" die Spracherkennung immer mehr in der Klinik zur Dokumen-tationsunterstützung genutzt werden, umwie in verschiedenen medizinischen Bereichen bereits etabliert -Zeit und Kosten zu senken [3,29]. Außerdem kann maschinelles Lernen routinemäßig gesammelte medizinische Daten mit Wissen und Behandlungen verknüpfen und so bei dem rapide zunehmenden medizinischen Wissen eine evidenzbasierte Medizin ermöglichen [7,12].…”

Bringing compassion into information systems research: A research agenda and call to action

“…Historically, the practice of medicine tended to be about the healing process, and the personal connection between the patient and the physician (Dranove, 2009). With the advent of medical and information technologies and complex networked landscapes of providers, hospitals, physician offices, insurance companies, and accountable care organizations, this personal touch has by and large become missing from health care practice (Lown, Rosen, & Marttila, 2011; Toll, 2012). Notions of efficiency and standardization have become central in many large hospital systems, and govern remuneration structures, much like they would in a traditional commercial setting, such as a manufacturing company (Starr, 1982).…”

“…More recently, though, industry and academia have prominently called for “re-humanizing health care” (Dugan, 2004; O’Connor & Lanning, 2001; Rathert, Vogus, & McClelland, 2016). This call challenges health care organizations to devise creative ways of using medical and information technologies to bring back the human connection and individual attention that is sorely felt missing in present-day health systems (Lown et al, 2011; Toll, 2012).…”

Update of Image Credit and Word Choice

“…In the A Piece of My Mind article titled “The Cost of Technology,” published in the May 5, 2020, issue of JAMA , the credit line for the image was inadvertently omitted and the word “pre-eclampsia” in the second paragraph should have been “sclerosing cholangitis.” This article was corrected online.…”