Which of the following statements is true: *** (Scroll to see answer)

a) Computers are killing us!
b) Software is eating the world!
c) Both 
d) Neither

The relationship between physicians and informatics is complex at best. IT reaches into almost every aspect of medical care today – it is necessary and unescapable. And in many ways a godsend: Nobody who works with a PACS, or a functional laboratory report system, or a prescribing app would go back to the old days. In fact, when those systems crash our clinical output almost grinds to a halt. Unfortunately, that happens – but more insidiously, most systems don’t crash and burn, they simply limp along, wearing us down in dozens of little ways. A cryptic error message here, a broken link, oops a screen freeze, a system error … nothing that a reboot won’t fix,  … and so on.  Such shenanigans are daily experiences for many – which is maddening and, tragic because of its devastating impact on care giver burnout, patient-care giver relations, and health outcomes. However, the days when we can default to hand written notes and a paper chart are dying or already dead (which is also a good thing – providing we have acceptable options).

I wish I could tell you what that acceptable option is – sadly I can’t, but I think we will start to see functional integrated systems in the next decade or so. Systems that are clearly an improvement for patients, physicians, administrators, and health care systems. What do we do in the meantime. Basically, we suffer – lets be honest change always sucks a little bit by its very nature. Even more so, when our fate is in somebody else’s hands. And especially when those hands are not skilled to do the job. 

This sounds a bit inflammatory but it’s really just the bare and simple truth – here’s why:

• • The vast majority of programmers and system designers are not health care workers.
  • The vast majority of health care workers are not programmers or even have any management training.
  • Consultation between care givers, management, system designers, and programmers is rare – and difficult.
  • Functional systems can only arise out of such collaboration.

There is hope on the horizon. If you have been involved in health care reform flying under the banner of “Six Sigma”, “The Toyota Way”, “Lean management”, or any system inspired by the work of W. Edwards Deming, you have seen a taste of the future. Unfortunately the future often has a bitter taste, as most often such endeavours are invoked in crisis situations. Truth be known, this type of multidisciplinary, ground level, solution building is a complex process that require years to master. Most often such approaches are used to address a problem rather than to build a system. Programmers are rarely involved, or are invoked at the last minute to implement the will of the working group.
This sounds fairly discouraging, but there is a silver lining: Thousands of problems have been addressed successfully with such methods. People who have acquired the skills to do such work are zealous converts. Their numbers are growing.

What is a physician to do. I have  3 suggestions:

1. 1. For starters, learn the language of our collaborators. Medicine in the 21st century is a team sport. Collaboration, communication and teamwork are recognized skills for medical professionals. Most health care systems offer leadership and management courses – take one (or more). These are not the equivalent of a MBA, but they allow you to talk to an administrator or manager using common language and common frames of reference.
   2. Get involved with some form of quality control initiative. Ideally something that is multidisciplinary. If you have A “Lean Healthcare” team or something equivalent, in your institution, connect with them.
   3. Upgrade your IT skills˚˚˚ (see how below). They will help you in the short term, and prepare you to be part of future solutions.

*** The correct answer is all of the above.