Recently my wife and I welcomed our first child into the world. In addition to the general excitement (if not frequent bewilderment) that comes with being a new parent, his birth of course led me to spend a few days in the hospital, a place I typically try to avoid. During our stay, we were served with the highest care by a dizzying number of nurses, aides, and doctors who were constantly checking in on us, which naturally led to the need for a lot of patient handoffs and communication about what had transpired during the latest shift.
Throughout the many doctor visits during the pregnancy, I actually had been impressed with the way the hospital system had integrated technology into its workflows. I know that it had recently undergone implementation of a new electronic medical records system, and the doctors and nurses always had our latest information – including lab results – at their fingertips, had seemed quite comfortable taking notes directly on a computer, and fed that information quickly to the front desk for checkout or to send electronic prescriptions to our pharmacy.
Once in the post-delivery ward, however, it felt like we had stepped back in time. While each room contained a very nice new computer screen and keyboard connected to a remote desktop, during our time there it served little more purpose than as a nightlight. Doctors and nurses carried around index cards or scraps of paper with a confusing set of notations about each of their patients. Often nurses would take several seconds of flipping the cards over and turning them around until finding the corner relevant to Sam’s last feeding time or when Tracy was due her medications, with each nurse employing a unique organizational system that only she seemed to understand. During each shift change, the outgoing and incoming nurse would then take up to 10 minutes to share what happened during that shift; while the outgoing nurse read off her paper, the incoming nurse furiously transcribed the information onto her own notecard.
As a healthcare IT investor bombarded with entrepreneurs touting the digital transformation underway in our healthcare system, our son’s first few days in the hospital provided a sharp reality check about how much further we have to go to realize the full potential of that transformation. I asked one of the nurses, who had been at the hospital long enough to have cared for multiple generations of children in the same family, about her feelings toward the new electronic medical records system, and why she doesn’t use the computer. She replied that she isn’t comfortable typing directly into the computer because it prevented her from fully engaging with her patients, in large part because she is an inefficient typist. As a result, she would spend up to 15 minutes per patient (and cared for 3-4 patients each night – so up to 8% of her working hours) during every shift going back to the computer at the nurse’s station to translate her handwritten notes back into the EMR, which she found highly frustrating and not enjoyable.
For the most part, the antiquated pen and paper approach seemed to work well, as each nurse and doctor had his or her own method to the madness. Yet the prevalence of handwritten notes to manage our care remained just that to me – madness. Hospitals and EMR vendors must work to leverage the advances in smartphones and tablets to enable more efficient data collection during patient interactions. Each nurse already carried a mobile phone for us to reach her; why not make those devices also able to run a set of well-designed apps to replicate the notes the nurses take with pen and paper? One of our portfolio companies, Canvas, has a platform that would allow hospitals to do just that – and even provide the flexibility for each nurse to design her own app to capture the necessary data in whatever way she found most helpful. At the same time, our experience in the hospital also reminded me of the dangers of becoming too enamored with technology. Our nurse would likely have felt just as, if not more, uncomfortable entering data into a tablet or her smartphone than on the computer already available to her. So, while I hope that my next experience in the hospital offers a bit of progress toward a more digital age, I will temper my expectations as we meet with entrepreneurs because it will be a slow journey away from good old pen and paper.