The spiral of new technologies
General internal medicine specialist and health technology entrepreneur Dr. Adam Hofmann joined the QMA’s Board of Directors in April 2018. Dr. Hofmann is the creator of a Web and mobile app that allows physicians to communicate more efficiently. He’s also a regular contributor to the English-language media on the subject of technology and healthcare. QMA-Info met with him to try to gain better insight into the rocky relationship that Québec physicians have with new technologies. At a time when almost everyone owns a mobile phone, makes online transactions, and uses connected devices, it’s hard to understand why some physicians in Québec are still resisting using electronic medical records (EMRs).
Dr. Hofmann points out the paradox in this situation: “Yes, doctors are usually the first people to take an interest in science and innovation. Just look at how quick they are to embrace new drugs or advances in the field of genetics. But they aren’t necessarily up to speed when it comes to communicating information or putting innovations into practice.” Most doctors in Québec work in the public healthcare network, in environments over which they have no real control. “The perfect example of this is doctors who still send their consultation requests by fax—a technology from 1990s that’s neither secure nor efficient,” Dr. Hofmann lamented.
Emerging from the IT paradox in Québec’s healthcare system
According to Dr. Hofmann, in order to upgrade, the government needs to “put pressure” on physicians while also helping them transition to the new technologies. “If we give them the tools, they’ll end up using them in their daily practice once they realize that they’re faster, more secure and time-saving,” he explained.
Still, it’s a valid question why Québec is lagging so far behind, especially since it’s been several years since other Canadian provinces digitized their public systems and started using electronic medical records. “If we’re being honest with ourselves, we need to admit that the rest of Canada and the United States are less sensitive about these things. So, a technology developed in Alberta will be more readily accepted in British Columbia or Ontario, for example. But, quite simply, there are also a lot fewer options when it comes to the importing and exporting of new technologies in Québec, largely because of the language barrier,” Dr. Hofmann stated.
So, yes, Dr. Hofmann definitely feels that Québec is trailing the pack when it comes to innovation. But this can also be seen as an opportunity to learn from others’ mistakes and to design better systems. “We stand to gain from all this, so let’s do it,” Dr. Hofmann urged. While the United States are light years ahead of us in terms of electronic medical records, our neighbours to the south continue to discover unexpected effects of incorporating EMRs into their practices, as Dr. Atul Gawande describes in an excellent piece written for The New Yorker entitled Why Doctors Hate Their Computers. The electronic medical record has become much more than a simple tool doctors use to follow their patients—hospitals use them to improve the relevance and quality of care, monitor patient safety, ensure compliance with protocols and best practices, define the population needs of a given territory, etc. This is not a seamless process; in fact, having to enter information in the computer creates more office work for physicians, weighing down their practice. Studies also show that it’s one of the factors contributing to the increased burnout rate among U.S. physicians since 2014. Several hospitals have already found organizational and technological solutions to these new challenges, but increasingly people are realizing that adapting to new technologies is a never-ending cycle.
Proliferation of new technologies
This will also be one of the challenges we face with artificial intelligence. “As a technology, it’s still in its infancy, and we’ll need to make sure we fully understand all of its possible benefits, but also its other effects,” Dr. Hofmann stated. He realizes that not all technologies will be winners and reminds us that we’ll need to learn to always balance physicians and patients in the equation.
But is it possible to ignore artificial intelligence or the proliferation of connected health devices? “No,” he replied. Solutions exist that have already been proven effective. Last spring, a study showed that an artificial intelligence system, specifically a convolutional neural network, could be more effective than dermatologists at identifying skin lesions and moles. Other similar advances have taken place in radiology, pediatrics, etc.
We’ve embarked on an endless spiral of innovation and there’s no getting off it now—unless we no longer want to be able to give patients the care they deserve. The upshot: Physicians need to learn to deal with these advances and make them a part of their everyday practice.
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