Too Many Screens, Not Enough Compassion.
How storytelling can save technology from becoming an obstacle in HealthCare IT
My Mom was a nurse for almost 50 years. Most of her career was spent in the emergency room, dealing with critically ill people. She had many harrowing stories; like the time a man strung out on PCP tried to choke her to death and it took five co-workers to pull him off. Nurses in the ER risk their lives and personal health everyday in hospitals, but I am sure most of them don’t consider this the hardest part of their job. A recent survey showed that inter-department communication is the hardest part of patient care. In high pressure, high stakes environments communication between doctors, nurses, nurse practitioners and a myriad of hospital staff can mean life or death for patients. Even the wrong move from a janitor can endanger the life of a patient. One article calls this the “Silo Affect.”
“The ‘silo effect’ can be very damaging to a hospital system. It occurs when hospital staff members strictly focus on their function (e.g., social work, discharge planning, utilization management) and forget how their function influences other healthcare professionals. When this happens, communication between disciplines becomes very difficult.”
Imagine a world where my mother knew that this patient was a drug user currently under the influence of PCP and had access to the last few people who dealt with him, etc. If she had his complete story she may have avoided almost being killed. That was in 1979. EHRs (Electronic Heath Records) didn’t really exist. Now we have EHRs, but we also have HIPAA. How do we protect patient privacy, and also explore ways of giving hospital staff the right information about the patient at the right moments? Why does innovation in privacy seem to slow down and complicate technology? I think I have some answers, but first another story. Hope you didn’t just eat lunch — it involves blood.
In college I volunteered as a chaplain at children’s hospital. One night, two children came in. One almost went through the windshield and had glass embedded in her face and arms. The ER was understaffed and slammed. One of the nurses found me in the hallway and beckoned me for help. “Father, please help me keep this girl calm and still.” They needed to pick the glass out of her arm. She was screaming and crying uncontrollably. I took a deep breath and mustered all the ‘Jesus’ I could fathom. “Look at me sweetie,” I said, as if to my own daughter. “We are going to be ok. Take a deep breath with me. Good. Now tell me where you go to school.” I found enough serenity to have a normal conversation with her as the nurses injected local anesthesia into her trembling, bleeding arm. I breathed deep again for myself, to keep from blacking out. As I left her, she asked “Would I stay close by that night.” She wanted to know God was protecting her. I smiled and let her know I would be right outside the door. Later they would tell me that her mother and aunt did not survive the accident.
My heart was ripped to shreds. None of the experiences from that night were recorded as a part of her medical file. Only the technical information about needing stitches was noted in her chart. There would be no information about her mom, her aunt or his sister present in the report. Nothing about her response to spiritual counseling at the moment of trauma. A combination of HIPAA rules and lack of system infrastructure was the reason noted by the Charge Nurse. “We have to log information in three different systems just to stay in compliance. There is no where in the system for storytelling.” But isn’t that just what health care providers need? To know the complete story of the patient so they can give comprehensive care? In my frustration I decided to write my own report, with recommendations and resources. I slept in a chair and the next morning I made sure to present the Dr. with the handwritten report, making it a point to share all of what had happened. She was astonished to say the least, thanked me and was able to use the information as a starting point for wholistic care for the patient. I love telling this story but “Minister Brian to the rescue” is not very scalable. That was 1996, HIPAA was just passed, and now we have Care Coordination, Patient Centric Care, Case Management and powerful EHR software. But have we solved the problem? Or did we trade in a bunch of complex paperwork for screens? One last story, this doesn’t include blood, but my son almost died.
About 4 years ago I took my kids to Las Vegas for an national academic & arts competition. Before leaving Sacramento my son felt sick for a few days and just as a precaution we took him to his doctor. The Dr. cleared him for travel but started some routine blood test that would take 2 days to come back. Hours after we arrived in Vegas the same Dr. called with an urgent message: he found something in Caleb’s test and told us to get him to the hospital immediately. Caleb’s fever was due to an infection in his blood, but they didn’t know what type of antibiotics to treat him with without doing a blood culture, which as I noted before takes two days. Long story short, Caleb got very sick and could have died all because the two hospitals could not communicate effectively about his health data. It took me having an emotional break down and pleading with the two healthcare organizations to get them to communicate so he could get the proper antibiotics. Not surprising now that I know some starling facts.
“Only 44% of hospital staff said they’re able to share patient information within and across the care organization where they predominantly practice.”
Only 44% and that is INSIDE the organization. So don’t get sick or have an major accident while you are outside of your city—you might die. Without knowing your medical history, the people treating you might kill you.
How do we fix this issue? Axiom88 is working on AI using IBM’s Watson that will humanize the experience of inputing information into popular EHRs. The software features a panel where a person can talk to the app using a familiar FaceTime type interface and reports are generated dynamically using AI and key words.
I interviewed my Mom for this article and she admitted that the most effective way of communicating information was the Daily Flash Rounds; Nurses in the ER didn’t have time for detailed reporting. “Stabilize and discharge. That is all we had time for.” These days the dashboard of most EHRs look like the cockpit of an airplane…too many controls. To create value for patients we need to humanize the reporting by humanizing the inputs. If our goal is to tell a story about the patient then we should be finding ways to allow the most natural storytelling to occur. Right? Instead I think the screens are winning. We are in the apex of the screen olympics. Whose screen has the most stuff, whose screens are the prettiest, whose screens are accessible from the most places. When storytelling is the focus we will have less screens, not more.
Years later I followed up with the hospital in Atlanta to check on my CPE credits. As the head chaplain gathered my information, he noted that he had heard of my name. “Actually, hold on a minute,” he said and put me on hold. There was an undelivered note buried in my file from the girl that terrible night. “Dear Minister Davis, thank you for helping take the glass out of my arm.” The latest screens might be new and cool, but there is no denying the lasting power of a story told, and re-told from one human to another. Let’s use the screens to convey the story, not bury it.
Axiom88 is an engineering first digital agency. As a development agency, we are the perfect fusion of left brain, right brain thinking, using our multitalented staff to create beautiful functional software that is architected to delight users and easily scale as the scope of app increases.
