Using Computers to Bridge the Physician-Patient Interaction

by Vijay Yanamadala

We are currently facing a shortage of more than 90,000 doctors within the next 10 years, with Healthcare Reform projected to exacerbate this shortage as 30-40 million Americans are brought into the health care system. This problem will affect all areas of medicine but will likely hit emergency room and primary care medicine the hardest, and these are the areas where we already face substantial shortages today. According to the American College of Emergency Physicians, in 2007, patients spent an average of 4 hours and 5 minutes waiting in emergency rooms throughout the US, and this number has since steadily increased. Thus, physician-assisting technology will become imperative if we are to meet the healthcare demands of the near and distant future.

With new Healthcare Reform legislation and the American Recovery and Investment Act, hospitals and physicians will adopt electronic health records by 2015 or face financial penalties. Computers will thus fundamentally redesign the way physicians deliver healthcare to patients. Existing electronic medical records software focuses on storing patient information in electronic format with some added features such as scheduling, automatic reminders, and checks of medication incompatibility. Large scale implementation of such systems at places like Kaiser Permanente Healthcare have demonstrated that computers have substantially improved outcomes and decreased medical errors by ensuring that certain standards of care are met for all patients across the board.

However, with the recent advent of IBM’s Watson, supercomputers are beginning to participate in clinical decision making and guidance at esteemed medical centers like Columbia University and the University of Maryland. Computers will actually assist physicians in ways that increase their time with patients, free them to engage in the more demanding and challenging aspects of medical care, and reduce the amount of time needed per a patient. Now it will be essential to write software that utilizes these new computer capabilities to maximize their value to the healthcare system.

Every physician-patient encounter, whether it is in an emergency room, primary care setting, or specialty care clinic, involves four basic tasks: 1) history taking; 2) physical examination; 3) assessment and diagnosis; and 4) developing a comprehensive plan of action. During clinical history taking, physicians ask the patient to lay out their chief complaints and use carefully worded probing questions to analyze a patient’s symptoms to arrive at a diagnosis efficiently and accurately. The history is the most important part of the diagnostic process, and it is well established that over 80% of diagnoses are made based on the history alone.

A history can take 46% of a physician’s time. However, because of modern time constraints, most physicians are not able to elicit a complete medical history, without which the probability of medical errors increases dramatically – recent studies have shown that time constraints only allow emergency room physicians to ask 55% of essential questions and primary care physicians to ask 59% of essential questions.

We are now in an era where software can effectively ask history questions in a less time constrained manner, thus reducing medical errors and improving patient outcomes. Indeed, the majority of a medical history can be accurately and efficiently obtained by a computer. A 2007 study showed that effective computer software nearly doubles the number of important history questions asked of patients in the emergency room (> 90% of essential questions were asked by the computer) with a mean completion time of only 5.5 minutes. Furthermore, the vast majority of patients enjoyed or even preferred the ability to give a thorough health history by using a computer and 92% of patients would use a computer again in this manner. Indeed, numerous studies have shown similar outcomes with computerized histories. Thus, computerized history taking provides a power new medium in medicine.