What I Learned about Health IT in Medical School 9/5/12

The short answer is that I learned almost nothing about health technology during medical school (and it’s not like I was in school all that long ago.)

I used Epic, Siemens, Meditech, VistA, Allscripts, and a few others in my ambulatory rotations. Of course we had paper as well. I learned how to find lab values, relevant past notes, and enter information. I did a couple of research projects and had to scour old charts, which amazingly was faster for me to do on paper (one of our locations) vs. the EHR (our other study location).

Shifting to mobile health and non-EHR HIT, I had access to several applications through my school’s enterprise license. My school actually required medical students to buy Windows Mobile PDAs from Dell — it was built into our tuition. Most students never used them and replaced them with iPhones or Android phones or nothing at all during the last couple years of school.

Like any good med student, I listened to those above me and became an Epocrates user. I tried several other mobile apps for note writing, drug calculations, pediatric milestones, and a few other things, but never found anything I used as much as Epocrates (there’s a reason it is/was the poster child of mhealth success).

I think I tend to mention this a lot, or at least I think I do: there is a significant lack of knowledge and access to HIT information within the physician community. When I say that, I mean the younger community — the smartphone-and-Facebook using docs. After speaking with friends about this blog and my interests in health technology, I’ve been recruited to give talks to departments on health technology trends, specifically outside of EHR.

It’s obviously not that doctors can’t grasp technology, it’s that it is not a part of the way they have learned to practice. This includes younger docs and those still in training.

Med school and GME training is focused on learning to see patients and solve their problems, which aren’t always clinical in nature. As an afterthought — and a constant pain for many residents — it is also about thoroughly documenting patient encounters in the record. Read this for a very good assessment of the problems with letting the documentation format drive clinical care. The larger reasons and potential power of health technology in care (data exchange, mobile health, patient engagement, secure communications, telehealth, etc.) — what I try to write and read about — are not really covered.

HIT is not the only thing that med students and residents have to learn about on their own. They need to learn about public health to help patients navigate our system, especially at academic centers that take all comers. The problem is that students and residents don’t have to learn about mobile health apps or telehealth or any other HIT-related topics to do their job. And if they don’t learn it while they are learning how to practice, it’s going to be an uphill battle later on.

Maybe health technology is seen like practice management, something that is deferred until after training. Or maybe a better comparison for HIT is genetics and personalized medicine. All medical students learn genetics from a basic science perspective, but little is covered (for me, anyway) in terms of how it fits with care decisions. Both personalized med and HIT are still working towards future perceived potential, so that’s likely the reason.

The bigger problem and challenge for app developers and health technologists is not that physicians aren’t learning what apps to prescribe, it’s that doctors aren’t learning how those apps fit into the care of a patient, or how the provider is supposed to interpret data from a patients app, or how to use telehealth or secure messaging to reduce costs and improve outcomes. I don’t think all doctors should become CMIOs, but if technology is going to be big part of care delivery, maybe we should start training the future frontline workers about it and how they can leverage it.

We need more clinical HIT-driven care programs within academic programs, and more integration of technology into the clinical cases used to teach students and residents. Hopefully more academic centers will integrate students and residents into the interpretation of data from apps and remote encounters as those services become more widely adopted. This will certainly help extend the view of patient data.

Also, cases that are used in medical education can easily be updated with the addition of things like patient-reported data or remote follow-up. If you’re reading this and are familiar with the current  best-practice case education, I’d be curious to learn if any of them now include technology as part of the learning. They didn’t when I learned them.

There are some positive trends when it comes to the use of technology in medical education. Many schools (Yale, UC-Irvine, Stanford, and several others) and residency programs (UChicago IM, MCW Plastic Surgery, lots more I can’t list) have begun issuing — and I think more importantly, integrating — iPads for education. Some programs have set up task forces to find new ways to leverage these devices. My understanding is much of the use of these devices is for education, like digital note taking, electronic texts, recorded heart sounds, and journal club prep (via GoodReader is the example I know of). This is a great first step to get students and future physicians used to using mobile devices in professional settings.

Then there is the addition of informatics as a medical specialty, a great trend, but one that only effects a small percentage of docs. Recent discussion of adding heath IT to medical board exams also underscores the importance of health IT in medical education. I don’t think that adding health IT to boards is really a great answer, as it will just be an afterthought and something students cram and forget, but again it shows the perceived importance of the subject.

I’m sure there are several other ways to integrate technology into clinical training, including just presenting more technology topics at grand rounds and department conferences. What I know for sure is that a lot of the physicians I talk to want to know more about these topics, but don’t have access to them as part of formal training and don’t have much time for it outside of training. The big benefit with younger docs is that they generally get technology, mobile or otherwise, so it takes a lot less effort and time for them to understand it and come up with new ways to leverage it.

If you’re a med student, resident, or practicing doc, what’s your opinion?

Travis Good is an MD/MBA involved with health IT startups. More about me.

  • Abe Froman

    Not a med student or doc, but as someone who has implemented and supported clinical systems for more years than I care to admit, you make a very important point. We always used to say that older docs who shied away from technology would be replaced by “the Atari generation” – those who grew up with computers as a part of their everyday lives, and they would embrace technology and be our advocates. The problem now is that the concept of that technology – especially in the mobile health arena – is so broad, innovative, disruptive, and unproven that usefulness and usability are not guaranteed. I agree that there should be more of an HIT component as part of med school and GME, but what that looks like is not yet readily apparent. Having just come out of a meeting in which we discussed how to operationalize omics and personalized medicine over the coming years, I think that is definitely an area in which we should be harnessing the brains of our Atari generation and involve them in crafting solutions that leverage useful technology.

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