Perhaps a problem with writing a blog is that your message may be reaching entirely the wrong audience. One of my blogging colleagues, Barbara Duck of the Medical Quack, sent me an e-mail yesterday that illustrates my point. Barbara said;
“With Health 2.0 reading this week, I got a little overwhelmed. I guess all of the technology is great but when you sit down and try to explain it to a group of doctors that only have a fax and maybe a computer or 2 in their offices that are still paper guys, well it’s not a pretty picture and literally scares them. I did a talk a couple weeks ago and covered a few different areas and it was the first time any of them had heard of or seen HealthVault, so there’s a long ways to go. Sometimes when you are communicating with all the brilliant minds on the web you somewhat may lose track or forget about the “real” world that is out there when it comes to technology…… One meeting with the real world cures that in a few minutes though.”
Barbara’s words ring very true. Working at Microsoft, I get exposed to amazing technologies every day. Some of that technology is still in our research labs. Some of the tools I use regularly to do my work aren’t yet available to the general public. Then too, my job takes me around the world where I get exposed to advanced Information Communications Technologies in healthcare that are not yet widely available.
Yesterday I did a keynote for a national conference of clinical case managers. I’d say members of the audience were mostly female nurses between the ages of 40 and 60. I’m sure a lot of the information I shared with them seemed more like Star Wars than anything close to the reality they work in every day. I also encounter lots of physicians who are totally clueless that there will soon be penalties if they are not using electronic medical records. And just like Barbara Duck has experienced, the majority of community physicians and other clinicians I meet have never heard of HealthVault, Amalga, Google Health, Keas, American Well, PatientsLikeMe, Navigenics, 23andMe, and so on.
Dr. David Blumenthal (I wonder if most docs have even heard of him) has announced a “workforce training initiative” to educate more health information management professionals with expertise in electronic health records and related technologies. He says at least 50,000 new jobs are needed in the field. I would add, based on what I’ve experienced, that we will also need training for perhaps ten or twenty times that number of people; i.e. most of the physicians, nurses and other clinicians who are currently practicing in offices, clinics and hospitals all over America.
It’s not that these folks have their heads in the sand. Most of them are working so hard day to day in patient care, trying to stay afloat and keep their practices from going under, that they literally don’t have time to come up for air. So what happens when we expect them to use all of this technology and also give 45 million more people access to their services? That is going to call for one hell of a training program!
Bill Crounse, MD Senior Director, Worldwide Health Microsoft
Training and re-training is a big issue, not just in the US but around the world. Medical school's didn't teach us about technology (well - they taught us about stethoscopes, ECGs and x-rays, but that's about it!) so physicians will need on-the-job training to bring them up to speed.
At the University of Auckland, we're about to take our Health Informatics courses onto the web so that doctors and nurses can get training wherever and whenever they need it.
But that doesn't go far enough. Training needs to start in the medical schools and nursing colleges. Health Informatics should be a continuous stream throughout medical schools so that med students learn how to apply technology in a variety of contexts and environments that they will work in.
Now... just think; If doctors and physicians are "behind", and they're in the industry, imagine the actual technical knowledge of the average patient? And, the Patient pays the bills (directly or indirectly)... right? Sounds like we need to train them too.
Jim and Chris,
Thanks for writing. You both make excellent points. Yes, this isn't a problem limited to the US, but for physicians and other clinicians around the world. And yes, learning how to use technology must begin in our academic training programs and continuing education programs. Also, the patient must be part of the solution. That is why Microsoft is making deep investments in consumer health solutions such as HealthVault.
Bill Crounse, MD
I agree with both comments. There's a huge educational gap in both sides. Most physicians don't see much value in using EHRs or other health related app. But, incentives aren't align for them to be. Why should they invest time and money and get nothing on return? Given that most clinicians don't know about "HealthVault, Amalga, Google Health, Keas, American Well, PatientsLikeMe, Navigenics, 23andMe" how can they foresee the long term value of rich medical databases in their practices?
On the other side, some people lack nutritional and health education. Without generalizing, many are used to a paternalistic approach and wait for physicians to tell them how to take care of themselves. And even then, they don't do much because their chronic conditions won't manifest the downsides until later in life. This explains the staggering percentage of obesity in the country (for i.e.). So yes, PHRs and other technologies are great tools to take charge of our own health, but if we want the majority to use them, education is key.
Guido Davidzon, MD
Thanks for sharing your wisdom, Dr. Davidzon.
Hi Dr. Crounse,
It might have been a typo, but the Amalga website that opens from the blog is that of a construction company that is working on the Heathrow's Terminal 5. I believe the URL would require a correction there.
Good catch, Manish. The link to Amalga has now been fixed. Thank you for drawing this to my attention.