While intently staring at the computer, attesting to the electronic health record content and accuracy of a recent encounter, my elderly patient quipped, “Aren’t computers wonderful, doctor?” I smiled, nodded and replied, “Yes, ma’am, for the most part, they certainly are.”
Thinking there was little more to say, she added, “Never in my lifetime did I ever think I’d see this. I tell your technician about my eyes, and they put it into the computer. You then examine my eyes and put more information in the computer. And then the computer tells us the best way to take care of my eyes.” I smiled, nodded again and replied, “Yes, that’s our ultimate goal here.”
I did not have the heart to share the harsh realities with her, that, to date, EHRs have fallen short of the mark. That they have adversely impacted productivity, added significant cost (hardware, software, IT support, scribes, etc.) and – in the minds of many – have detracted from the doctor-patient relationship. And I certainly did not want to bring up the fact that most EHR systems do not even talk to one another.
In all fairness, EHRs are still in their infancy – a state in which we work for EHRs as opposed to EHRs working for us. The goal, of course, is for artificial intelligence (AI) driven software to change all of this, to enable EHRs to assist us with difficult differential diagnoses and in dialing up a perfect treatment plan for each and every patient. The question is whether this is a lofty aspiration or a reality within reach.
By all indications, AI-driven software ranks among the most impactful disruptive technologies of the past decade, rivaling the likings of 3-D printing, self-driving cars and cloud computing. The concept is brilliant – harness a machine’s computational skills to analyze existing conditions, symptoms, clinical findings, diagnoses and treatment protocols, all in the spirit of providing clinicians with a powerful ally. It is a sort of humanizing of the EHR to create what is akin to a curbside consult ... with a very bright colleague. We have already had a taste of this with visual field progression analysis for glaucoma and corneal topography diagnostic indices for keratoconus.
While AI EHRs are far from prime time, they are very much representative of a disruptive technology. Harvard Business School professor Clayton Christensen is largely credited with coining the phrase disruptive technology and detailed the concept in his 1997 best-seller, The Innovator’s Dilemma (Management of Innovation and Change). Disruptive technologies are recognized as having tremendous upside, often displacing sustaining technologies and profoundly altering the way things are done, conceptually for the betterment of all. The flip side of disruptive technologies is that they are just that: disruptive. The maturation of a disruptive technology is often a lengthy journey, one marked by setbacks and collateral damage along the way, even in health care.
Like virtually all other industries, eye care is witnessing its share of disruptive technologies. While the ultimate goal is one of improved patient care, in the short term it might not always appear as such. In this month’s issue, our feature article, entitled, “Educating patients essential in the age of disruptive technologies,” offers sage advice for dealing with disruptive technologies. Our contributors – widely known and well respected – provide unique perspectives on how a variety of disruptive technologies will likely play out. While their comments are quite varied, they share a common theme. It is one of embracing disruptive technologies, employing them in a meaningful way and, above all, patient advocacy. In doing so, their wisdom is clear: seize the opportunity to influence change ... or live with the consequences.