Foolish Youth

“You will do foolish things, but do them with enthusiasm.”
- Sidonie Gabrielle Colette

The first time I heard that computers would revolutionize the way we take care of patients, I was all in. As a family medicine resident, I served as the champion for our newly-installed electronic health record (EHR). The system was awkward and not much more than a fancy word processor, but I loved it for the promise it held, and I tackled becoming an expert with enthusiasm. If someone asked how to most efficiently document a visit or wanted a template customized, “go ask Jen” became the most frequent answer.

After finishing residency, I opened my own practice and returned to the world of paper charts out of necessity. The disappointment of having lost my fun clinical “toy” meant I developed a plan to move back to using a computer for patient care as quickly as possible. After researching the more than 200 options on the market, I volunteered for a statewide quality improvement project and lobbied my medical community to move to an EHR together as early adopters. In 2011, when the Meaningful Use program rolled out, my love of technology and competitive nature ensured I was the first physician in Kansas to attest.

We were all young and foolish once.

I volunteered for any committee, task force or board that had the words “health” and “electronic” in the name or the mission, and perhaps most meaningfully served on the Kansas Health Information Exchange as a board member and review committee chair, responsible for credentialing the first HIE in the state. I was thrilled to be selected for the inaugural class of Health IT Fellows by the Office of the National Coordinator and push firsthand for metrics that mattered in the Meaningful Use regulations. I was convinced that eventually we would get it figured out and someday soon computers would make my job easier.

It took more than 15 years to disillusion me, but eventually, the shortcomings of electronic health records outweighed my enthusiasm. I will still argue that my current use of an EHR allows me to do things I couldn’t do when I lived in a paper world; population health wasn’t even possible when the chart was in a folder on the shelf, for example, but the dream of a perfect tool that simplified my daily work and presented key information at the point of care has not yet become reality.

Should computers be a tool used in and by the house of medicine? Yes! Will we achieve success by iterating on today’s EHR options? Hmm. I have my doubts. I believe it will take a significant redesign to achieve the dream product envisioned in my foolish youth. Occasionally, I see a new EHR or app that shows promise. I am following the AAFP’s Health IT Innovation Project with interest and believe artificial intelligence may help deliver that which is much needed. I maintain my optimism that someday there will be tools to help everyone in healthcare: the physician, the system, and most importantly, the patient.