Big Data / Shmig Data: Thoughtflow 2015 and the Coming Age of Incessant Data
By Samuel R. Bierstock, MD, BSEE
In the years following the Institute of Medicine’s “Crossing the Quality Chasm,” there was widespread acknowledgement that we could do a better job in caring for our patients and a shared belief that the path to accomplishing that task lay in the adoption of clinical information systems. That idea was great, but actual attainment of the goal was hindered by the failure of vendors and designers of electronic clinical information systems to fully understand the full vantage point of their target end users. Clinicians simply resisted the structured workflows that designers assumed would make for acceptance. There followed more than a decade of physician resistance, dismal adoption rates, and billions of dollars spent in implementation efforts to encourage clinician utilization of EHRs.
It was not the long anticipation of the attrition of aging computer-resistant retiring physicians, nor was it their replacement by tech-savvy young doctors that caused the uptick in the number of clinicians using electronic health records (EHRs). It took the good-old US government and the mandates of Meaningful Use to do that.
Unfortunately, neither can the increased adoption of EHRs by physicians be attributed to a better job in the design of clinical workflow processes by vendors. In fact, if anything, the financial pressures on hospitals fearing loss of Meaningful Use dollars and associated penalties resulted in pressure being exerted on physicians to use whatever hospital EHR systems were in place in spite of negative impact on clinical efficiencies and the ability of physicians to get their work done. As a result, we embarked upon and remain in a period of administrative / medical staff friction wherein hospital administrators need their medical staffs to be using their EHRs while many physicians feel impeded in simply getting their work done and view hospital pressure as purely financially motivated.
In 2003, I first described what I felt was the missing essential ingredient to physician adoption of EHRs. The widely heralded and sought-after workflow support was not the answer. Workflow is a mechanical approach to a goal or task – “do this, then do that” and “click here, then click there.” It seemed clear to me that what needed to be supported was not workflow, but Thoughtflow, a concept I defined as the process by which a clinician identifies, accesses, prioritizes, and acts upon data and information.
In 2006, my article entitled “Thoughtflow — The Essential Ingredient for Physician Adoption of Implemented Technologies: Why Clinicians Have Still Not Adopted Clinical Technology and Where Vendors and Clinical Leadership have had it All Wrong” received a very widespread and supportive response. While a great many changes in EHR design could have helped support Thoughtflow, they were slow in coming and for the most part inadequately based on a true understanding of what it is like to practice medicine. A decade later, they remain essentially missing. …read more