Few days back, I spent time at the Dompe District Hospital (a modest 100 bed hospital where people go for clinic visits but not for surgery) observing the impressive progress made in re-engineering work processes and introducing ICTs. The story is well told in Roar.lk.
All the doctors worked with laptops and barcode readers. Each patient presents a barcode. When scanned, the entire medical record pops up on the screen. Entries based on that visit are added by the doctor during the examination (not an assistant). I stood behind the pharmacists and observed how they worked. Patients would line up and present, not a scribbled prescription, but the barcode. When it is scanned, the prescription pops up on the screen along with some comments about possible issues, if any.
Based on what I knew about the problems faced by those introducing ICTs to US hospitals and medical practices, one of my first questions was about how they managed to get the doctors to type. I was told that the trick was in minimizing the typing: as the first 2-3 letters were entered options would be presented, allowing the physician to choose the appropriate word/phrase. It seemed from the happy faces of the doctors that Sri Lankan innovators had solved a problem that American writers writing in 2018 appear to think is still unsolved:
In the early 2000s, electronic medical records and electronic prescribing appeared to solve the lethal problem of sloppy handwriting. The United States Institute of Medicine estimated in 1999 that 7,000 patients in the United States were dying annually because of errors in reading prescriptions. But the electronic record that has emerged to answer this problem, and to help insurers manage payments, is full of detailed codes and seemingly endless categories and subcategories. Doctors now have to spend an inordinate amount of time on data entry. One 2016 study found that for every hour doctors spent with patients, two hours were given over to filling out paperwork, leaving much less time to listen to patients, arguably the best way to avoid misdiagnoses.
Of course, the two systems are fundamentally different. The American system is extremely demanding of information because of the insurance model. In Sri Lanka, where the hospital is government operated and treatment and medicine is free, the information requirements are much less.
But it was in the pharmacy that I thought the most benefits were visible. Errors caused by physician handwriting or inattention were effectively addressed. The daily stock tally is now automatically done. This indeed is efficiency. There is no need to plead for its opposite.