Rethinking medical professionalism: the role of information technology and practice innovations

Physicians who do not use the tools of information technology (IT) such as electronic health records and computerized entry of prescriptions could fall short of professional standards, according to a new review.

Although technology cannot replace thoughtfulness and caring, it is increasingly difficult to be a competent doctor without tech support, contends David Mechanic, Ph.D., of Rutgers University in the June issue of The Milbank Quarterly.

However, it is important to view health information technology "as a tool and not as a substitute for physicians' vigilance and judgment,'" said Mechanic, who analyzed scientific literature, Web sites and his own experience working with medical professionals.

The "increasing complexity and demands of patient care, along with an explosion of medical knowledge, can make it increasingly challenging for doctors to provide care that is fair, economical and aligned with the best practices," Mechanic said. Tools like evidence-based treatment guidelines delivered to a doctor's computer "can help physicians overcome some of these barriers - barriers that must be overcome if they are to be considered competent physicians delivering the best care."

"In addition to having more active patients, physicians now have many more treatments, options and choices to consider and explain," he said.

E-mail communication with patients, automated reminders and specialized Web sites and disease registries can help doctors do more in the smaller amount of time allotted for patient care, the study suggests. Automated reminders can also help patients stay on top of their chronic diseases.

However, physicians in the United States have been slow to adopt health information technology. Because of high implementation costs, larger managed care programs and large group practices are more likely to use these systems than smaller independent doctors' offices, according to Mechanic.

However, Mechanic and others say cost is not the only factor that could make smaller practices - which make up the majority of physician care in the United States - reluctant to adopt new health information technology systems.

"One thing that we're seeing is that in order for health IT to be used effectively, the software has to be modifiable to fit physician needs and work flow. Software also has to align with other IT systems; for example, electronic medical record systems must work well with existing or new systems for billing and e-prescribing," said Michael Harrison, Ph.D., a senior research scientist in health care organization and systems at the Agency for Healthcare Research and Quality. "At the moment, only the biggest systems have the ability to build software that fits their own needs or fully adapt available products."

Larger health care organizations can tailor these systems to their physicians' needs, disabling unnecessary alerts in a computerized physician order entry system, for example.

Many clinicians in smaller practices "seem to expect software products that come off the shelf to be immediately useful to them. Instead, without appropriate customization to the physician's needs and the workflow of the practice, the pre-constructed software may actually interfere with the clinicians' work," Harrison said.

By Becky Ham, Science Writer
Health Behavior News Service