No, that's not it at all. What GP is saying is that they cut the human expertise low enough that full-time workers weren't needed. The manpower savings never materialized because an app built for experts is faster than one built for casual users, and also because those experts, even with the high training cost, were ultimately cheaper per hour than the highly compensated people who now have to do the job because we 'made it easy'. First you devalue those experts by making their job harder, then you get rid of the job and make it someone else's, split between entry level staff and your most expensive employees.
> AFAI can tell, the effect of tech overall is to cut some jobs while making the remaining ones harder and more stressful, while increasing so-called context switching.
You still got there in the end.
If their employment status was the same as everyone else’s, there wouldn’t be any effort to replace admin staff with someone getting paid 10x as much unless there was actually a 90% reduction in work (doubtful).
Remind me again why do I have to manage my own meetings and prepare so many powerpoints and fill in so many forms as a... well, my position doesn't matter, because everyone is doing the same, no matter their role?
This is so much like hearing of engineers that will not hire a $20/hr maid due to egalitarian reasons so they squat in filth or waste all their free hours cleaning, all while capable and willing cleaners starve. Insane.
Also there are plenty of costs to employing others besides the hourly cost. Large organizations have huge fixed costs to cover them. Consider:
- liability
- maintaining of knowledge and training to hire help
- skill to source and hire people
So a part of the job has always been the record keeping, OTOH, as one of the other users mentioned, I've seen enough Dr's using their computer records systems to know that software is mostly garbage. The Dr's spend 2-4x the time dealing with the shitty UI as actually typing in the notes now.
(In the end he basically retired instead of convert to electronic records).
For those that seemed to transfer successfully, I noted that at Mayo Clinic, the doctors use live dictation software and dictate at least some of their notes into the system while the patient is present near the end. This immediate review sometimes brings up a few new questions (from either Dr or patient), and a bit more notetaking. So, it looks like a very efficient system. They also have no apparent shortage of staff organizing things.
That said, I doubt every medical organization and office has the same quality setup as a top world-class institution. At some level of degradation, the system becomes more of a hindrance than a help, and that point is likely fairly near the top levels (so most of it is a hindrance).
What form would give validation error or warning that a note the Dr is making either raises a new question by the patient or is in conflict with something the patient knows?
(& yes, from what I could see, there were also fields for patient data, date, etc, that are presumably validation-checked)
What I've noticed is that EMR has greatly reduced the amounts of screw-ups or delays caused by not having the right information at hand, or having to repeat tests. Also, since there's now a terminal in every examining room, I can see what amount of effort is required to use the EMR tool (Epic in the case of my provider), and it doesn't seem all that onerous. I can guesstimate the additional amount of time that they spend outside of clinic hours, completing their records for the day, and again, it doesn't seem onerous.
For a few years I had to fill out a lengthy medical history form, every time I visited a clinic, but that's pretty much gone today. My primary care doctor just retired, and her replacement took up the baton without skipping a beat. She can also easily delegate to her physician's assistant or nurse practitioner, so they can all work as a team, with instant access to the same information.
Now I have noticed something interesting. The urgent and primary care clinics all have a terminal in every examining room, and the clinicians perform their examinations while seated at the terminal, except when they actually have to poke around. That's where it seems quite efficient.
In the hospital wards, they still don't have a terminal in each room, meaning that each clinician has to look things up at centralized terminals, remember them (or not), and has no access to information. If they need some information, they will come back with it, next time their make their rounds, which might be the next day. And they screw up. My dad had an episode that took him through an ER, to a regular hospital bed for a few days, then to a rehab ward. I had all of his records at my fingertips thanks to MyChart on my laptop. The doctors and nurses were lost, they completely overlooked the documented diagnosis that was at the root of is condition, and didn't believe me about it.
Some of the nurses in the hospitals now have a terminal on a wheeled cart, that they bring on their rounds.
What I'm guessing is that in the days of handwritten records, the doctors were mostly winging it.
100% agree.
The Office suite is, in some ways, the worst thing that happened to corporations. Thanks to computers, everyone can now easily write a report, fill in a spreadsheet, or manage their meetings. Which means that everyone now has to write reports, fill in spreadsheets and manage their calendars. This used to be a separate job. You had people specializing in those tasks, and they were focused and efficient at it. Now, everyone does it on their own, and not only we suck at this, it's also distracting us from the "main" job we're supposed to be doing.
The older I get, the more I feel computer revolution was in big part a bait-and-switch.
You're not the only one with that bait and switch feeling.
Then the computerized systems "replaced" that staff but all that really means is they cut the human time needed low enough that full-time workers weren't needed, but didn't eliminate it, so now that's another thing doctors have to do themselves.
AFAI can tell, the effect of tech overall is to cut some jobs while making the remaining ones harder and more stressful, while increasing so-called context switching.