Practicing health care without Health Information Technology (HIT) is unthinkable these days. But what if your used to working in an environment HIT-rich environment and have to switch to a less high HIT environment as can happen to many residents during their education or after their education. They are used to the academic medical centers were health information technology has become a foundational component of patient care. Medical training in these environments generates dependence on HIT.
These physicians who transition away from HIT-rich environments perceive their care as less safe and less efficient.
What is Health Information Technology?
Health Information Technology consists of tools that allow comprehensive, timely, and secure access to and management of medical information by both providers and consumers.
You can think of:
- Telemedicine systems (medical information is transferred via telephone, the Internet or other networks for the purpose of consulting, and sometimes remote medical procedures or examinations.
- Personal digital assistants.
- Wearable sensors.
- Inpatient and outpatient-focused electronic health records (EHRs).
- Bar code medication administration systems.
- Personal health records.
- Best practice guidelines and evidence databases
How was this study done?
a cross-sectional survey study involving medical students and residents who had graduated from Vanderbilt University Medical Center (VUMC), an HIT-rich Academic Medical Center. The authors distributed surveys to 679 graduates from 2001 to 2003 who transferred to other institutions.
60% of surveys were returned and analyzed. 78% of them reported a transition to a less rich HIT environment. In comparison with the group who transitioned to a higher or comparable environment of HIT they reported:
- feeling less able to practice safe patient care
- to be hampered to utilize evidence at the point of care
- to work less efficiently, it was taking more time to gather patient history information and to
retrieve pertinent documentation - were less able to share and communicate information
- to work less effectively within the local system
- more issues with handwriting interpretation and felt less confident about drug interactions and prescribing safely
There are some down sides to rich HIT environments as well. There was a significant difference between the perception of communication with colleagues, with those in HIT-rich environments perceiving worse
collegiate communication.
Conclusions
Health Information Technology is very useful for prescribing drugs (warning for interactions, dosing), readable health records and information retrieval such as guidelines and evidence information for patient care as well as patient history. HIT acts as a safety net that help trainees deliver safe care with confidence.
This safety net provides a level of comfort for trainees acquiring the skills of their
profession while frequently battling anxiety and fatigue.
Maybe they should also train residents for environments that do not provide a technological safety net, they may help their graduates make smoother transitions.
Performing Without a Net: Transitioning Away From a Health Information Technology-Rich Training Environment.
Kevin Johnson, MD, MS, Davin Chark, MD, MSc, Qingxia Chen, PhD, Alexis Broussard,
and S. Trent Rosenbloom, MD, MPH
Acad Med. 2008; 83:1179–1186
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This is a concern I’ve had more and more. I plan on staying within the bubble of academia (for as long as they’ll have me) but I wonder about the real world beyond the walls of academia and our institution. With all of the technology that exists during training, I think residents are less and less making an effort to remember drug side effects, interactions, etc. (but of course using that time to learn other things). This is trickling down to medical students who have been heard to wonder out loud about why they need to memorize e.g. drug interactions. I remember when I memorized about a gazillion (really–a gazillion) drug interactions during second year of medical school. The only time it was useful was when I rotated at a community hospital and one of the residents out there was about to give a patient two drugs that had a nephrotoxic interaction. At our institution though, I get the little red flag on the computerized order entry before I even have time to think about whether the drugs I just ordered will have an interaction.
I think this is simply a function of the increasing amount of information we have to learn during training–something will be sacrificed but must be compensated somehow. As a result, good, robust HIT will eventually be a requisite at all places of health care.
[...] Information Technology (HIT) has also its “side effects”. Dr. Shock discusses a recent study about the “safety network” that HIT creates among physicians [...]