Information Technology Medical Education and Quality of Care
Pisacano Leadership Skills Development Symposium
Scottsdale, AZ — April 3, 2004
Richard Rathe, MD
Associate Dean for Information Technology
Associate Professor of Family Medicine
University of Florida
The Future
The future ain't what it used to be.
Yogi Berra
The future will be better tomorrow.
Dan Quayle
The Past
Trying to plan for the future without a sense of history is like trying
to plant cut flowers.
Daniel Boorstien
Rediscovery
In spite of appearances, most of the answers are already worked out.
Our job is the rediscover these insights and apply them to our current
circumstances.
Central Question
With regard to information technology, are healthcare and the practice
of medicine fundamentally different from other endeavors?
If not, what can we learn from other disciplines
Pointing the Way
I’m here to challenge you!
We should generate more questions than answers.
Concepts to help you with “bean counters” and “propeller
heads”.
Information Technology
It’s not just computers…
Computers and Change
The corollary of constant change is ignorance. This is not often talked
about: we computer experts barely know what we're doing.
Ellen Ullman
Information Overload?
It has become increasingly difficult to keep abreast of and to assimilate
the investigative reports which accumulate day after day…. one suffocates
through exposure to the massive body of rapidly growing information.
German Surgeon 1872
… or Underload?
The great push is always away from individual skill and engagement --
a horse took all sorts of information and insight to handle, a Model T
less, and a Honda Accord virtually none.
Bill McKibben
The definition of the problem, rather than its solution, will be the
scarce resource in the future.
Esther Dyson
Technology, Good or Bad?
Technology is Not Neutral
Each technology makes it easier to do some activities, harder to do others:
The easier ones get done, the harder ones are neglected.... Each technology
poses a mind-set... That soon pervades those touched by it, often unwittingly,
often unwillingly.
Donald Norman
When the only tool you own is a hammer, every problem begins to resemble
a nail.
Abraham Maslow
Why Computerize?
Victims or Beneficiaries?
We generally deploy computers because we want to control something.
Ralph Horky (Shands Healthcare VP)
The “Four Efficiencies”
Do more in less time
Increase the diversity of tasks
Communicate with others
Transform the work itself
(Paraphrased from Donald Norman
Things That Make Us Smart)
Computers and Education
- What we need is NOT more information, we need more context.
- Context is worth 80 IQ points.
- The only successful way to predict the future is to invent it.
Alan Kay
“Just In Time” Information
The right information
At the right time
In the correct context
In a useable format
ACGME Competencies
patient care
medical knowledge
practice-based learning
interpersonal and communication
professionalism
systems-based practice
Competence
Competence is a state of controlled incompetence.
Ronald Epstein
Continuing Education
Old Model: Fly to Aspen, Listen to a Lecture over Breakfast, Hit the Slopes
New Model:See Patients, Generate Questions, Seek Answers, Get Credit
Closing the Loop
Increased Quality, Quantity and Timeliness of Feedback
Appropriate Oversight
Richer Assessment (Portfolios)
Clouds on the Horizon
The Lecture as Sales Pitch (PPT)
“Post-Web” Environments (Portals)
Excessive Regulation (HIPAA)
Worms, Viruses, Trojans, Spyware
“Post-Web”?
World Wide Web
Public/Open Standards
Searchable
Information Design (Sometimes)
Portals
Locked Down
Not Searchable
Proprietary Standards
Erosion of Training
At UF, our students:
No longer write chart notes in most areas
Are not allowed to access the digital radiology system
In addition:
No one is allowed to look up their own medical record online (in response
to state laws)
What is Quality?
W. Edwards
Deming
Quality Improvement
You do not have to do this...
survival is not compulsory.
Quality by Inspection
Inspection with the aim of finding the bad ones and throwing them out
is too late, ineffective, and costly. Quality comes not from inspection
but from improvement of the process.
The Quality Improvement Cycle
Measuring Quality
In God we trust…
all others must bring data!
Making It Work
Continuous or at least periodic effort
Involve all stake holders
Data driven, move the system-wide performance in a positive direction
Address outliers as needed
Patient Safety
Very similar to quality improvement
Focus on process, not individuals
Focus on “near misses”
Voluntary reporting, involve front line stake holders
The paradox is that as we advance into the future the need for change
gets greater and greater (to cope with changes in population, pollution,
etc. and to make full use of our new technologies) but the possibility
of change gets less and less because everything is already committed.
Edward de Bono
Donald Norman
Links
Norman
http://cogsci.ucsd.edu/~norman/
Deming
http://www.hkbu.edu.hk/~samho/tqm/tqmex/deming.htm