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As we all woke up early Friday morning, news feeds and social media were ablaze with the news about a software update glitch that was starting to wreak havoc on computer systems around the world. The first e-mails from our institution came in, and there was that line that we all hate to see: "Prepare for downtime procedures."
This is when we revert to non-technology-based modalities of taking care of patients as best we can: Handwritten notes, copying down insurance information manually, verbally relaying communication around the practice about what is needed, handwritten orders on NCR [no carbon required] forms for nurses to pick up, and paper prescriptions for patients to -- gasp! -- take to their pharmacies. I'm breaking into a cold sweat just thinking about it.
As we headed into work on buses and subways, that thankfully seemed to be working just fine, the ramifications of this one tiny part that apparently underpins so much of what we depend on started to come to light, and our thoughts turned to what the day held for us.
The world of healthcare has become intimately and utterly dependent on technology. For the most part, this is a good thing, but sometimes we've taken it too far, gotten to the point where we can't function without it.
When we arrived at work, we were not met with the "Blue Screen of Death," as all of our computers seemed to be humming along just fine. Accessing the electronic health records (EHR) system, where we spend most of our day, seemed to happen without a hitch.
Looking at -- that industry's complete chaos and inability to pivot, improvise, and make do without -- scared the pants off of me.
Looking back through past decades of healthcare, we've gone from talking to our patients -- examining with them with our hands, eyes, ears, and our stethoscopes, and writing our progress notes in pen on sheets of paper -- to a time where almost everything we do is linked to some form of technology.
Colleagues of mine at many hospital systems around the country were affected far more than we were, with some systems shuttering outpatient practices and canceling everything but emergency surgeries.
At our institution we fared pretty well, with our IT services reporting that only certain systems were affected, including some human resources systems and certain modules used for electronic prescriptions.
The technology we have is incredible; with it we have an advanced healthcare system that offers so much. The interactions I had with patients this week were recorded and transcribed using voice recognition backed by artificial intelligence (AI), a virtual AI scribe, crafting what is supposed to be a reasonable facsimile of the medical interaction we had.
In some ways, this takes a lot of the drudgery out of our day-to-day lives, the need to type endlessly in the chart and click all those boxes within the EHR to stay compliant. But systems like this often seem to create something that's cold and impersonal, missing the forest for the trees.
Reading back over what the dictation system created, I sort of recognize what it produced as a version of what had taken place in the exam room, but without the nuance and personality of real life.
Technology helps us in so many ways as we try to take care of our patients, from electronic communications and results reporting to amazing imaging and other high-tech advances.
But at the heart and soul of healthcare is an interaction between a doctor and a patient, with the latter coming into our office, emergency department, or hospital, and telling us that they are sick, that something's changed, that something is going wrong. Then we use our clinical knowledge, our brains, and the tools we have to try and figure out what is going on, and then, hopefully, what we can do about it to help them get better.
I think the crash of this bit of technology on Friday should remind us of the humanity in healthcare, the need to reaffirm and entrench the relationship between patients and everyone on our healthcare team because, without this, the best technology in the world is not going to take good care of people.
No robot, AI engine, or machine-learning system will ever replicate the humanity of human nature, the one-on-one interactions we have with patients: a nurse who listens, a medical technician who comforts as they draw blood, a social worker who lets a patient cry, a doctor who really pays attention.
The technology has incredible inherent value, and I never really want to go back to the days before we had it. I love that we can do point-of-care ultrasounds to get an immediate answer whether this patient is fluid overloaded or has pneumonia; that pulse oximeters clipped to a patient's finger can let me know they are in worse trouble than they seem; and that I get critical labs results sent to my Apple Watch where they scream to get my immediate attention.
But our utter dependence -- that fear that rises up in our hearts when we get the announcement that we're going to "downtime procedures" -- should make us rethink how much we've come to depend on these interrelated systems running in the background that control the lives of our patients.
Because something like this is surely going to strike again. And again.