W H AT ’ S YO U R O P I N I O N ?
Where are the long-awaited benefits of digitization? Several dozen years ago, when health care computerization was beginning, hopes related to digitisation were high. Computers were to automate many activities. And so they do, but a fairly common effect has consumed the added value of IT. Today, a statistical physician is more and more burdened with reporting obligations. During a patient’s visit, they spend a lot of time in front of the computer filling in electronic medical records and entering data. After observing the work of 36 doctors in one Swiss hospital, researchers drew alarming conclusions, then published in the Annals of Internal Medicine. The doctors spent 5.2 hours per shift at the computer, 1.7 hours with the patient and 13 minutes on both activities simultaneously. Interestingly, research conducted half a century ago suggests that doctors devoted a similar amount of time to patients as today.
Where are the profits of the huge technological progress in health care? Today, digitisation primarily benefits the payer, who receives consistent and full reporting data, and the health care system, meaning its organisational structure. What about doctors? Why has computerization failed to reduce the time required for paperwork? A computer should make things faster, thanks to templates and dictionaries, and more convenient - since the data entered were supposed to be automatically used in various reports. Hardly anyone believes that this is what happened. Unfortunately, the advantages of technology have been uti-
lized differently than expected by medical staff. Health care has become the victim of the rebound effect known in nature, described for the first time by the British economist William Stanley Jevons. A classic example of this phenomenon is electricity. Why does energy consumption in some cases not decrease despite the introduction of energy-saving light bulbs? The reason is not that new bulbs are not better than the old ones. It is because users simply leave them on for longer, knowing that... they are energyefficient. Nowadays, a similar problem is affecting health care. In the 1990s, when a significant number of reports were made on paper, a limited number of documents was required. The payer could not demand more, as it would exceed the capabilities of doctors and health centres. Today, the National Health Fund and organisations in the healthcare market may impose further requirements, knowing that service providers have the tools (computers) to develop even the most sophisticated reports. In this way, the time that was to be saved by the doctor has been absorbed by the rebound effect. Patients may also face the same problem in the future. Technologies are improving at a great pace. Algorithms will perform preliminary data analysis, artificial intelligence will help the doctor make therapeutic decisions, voice assistants will convert natural speech into structured medical records without having to tediously type data with the keyboard, many classic measurements of patient’s health parameters will be entered into the e-file from devices existing in the patient’s home. Theoretically, the doctor will be able to finally take care of the patient and devote more time to them. Will the proportions reverse and will the doctor be able to talk to patients and focus on their worries in the new reality? Will health care be therefore more human than today? Not necessarily. However, this “gift of time” obtained through technology can be wasted, as was also described by Eric Topol in his latest book. An efficient doctor with time reserves will have to see more and more patients and in this way everything will remain the same. Technology alone is not enough to make medicine patient-friendly, which we have already learned in recent years. This should be borne in mind by those responsible for health policy.
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