Health IT at the Bedside
When a Doctor Is Also a Son
Jain (MBA '07)
Courtesy Sachin Jain
As a physician, I’m a great believer in health IT. So I’m always confused by how slowly and unevenly it has been adopted in medicine, a field where new technologies and techniques are often embraced with vigor. To be sure, new technologies can suffer from poor implementation. Systems need to be selected, workflows altered, and the inevitable kinks ironed out. Change is hard. Yet, in my experience, after an individual or organization undergoes the transition from paper to digital, few would ever pull the plug and say, “Paper is better.”
Last December, I moved to Washington to join the Office of the National Coordinator for Health Information Technology, part of a multi-billion-dollar Obama administration initiative to speed the development of a nationwide, interoperable electronic health information system. Two months later, my new job took a surprisingly personal twist when my mother phoned to say that my father had been admitted to our local ER with unexplained fevers and chest discomfort.
We soon learned that my dad’s past records — from care that took place across several doctors’ offices and hospitals — were unavailable. As his physicians puzzled through the fragments of his history, my mom and I did our best to fill in the gaps. Clinical decisions are only as good as the information you have to make them. As competent and well-meaning as my dad’s doctors were, they lacked the best possible information. No central repository of his medical history existed. His primary care doctor was unaware of what his specialists were doing. A summary I had once written was now outdated. As much as any medication, my father needed health IT.
This need became obvious during his hospitalization. One mistake occurred when Dad, a diabetic, was ordered not to eat anything in advance of a test but was still given his usual dose of insulin. At hospitals that have modern IT systems, when food is being withheld for studies, corrected insulin orders are automatically suggested in the computerized order entry system. Another worrying incident occurred when a CT scan of Dad’s belly showed a “spot” on his liver. “It’s probably a benign collection of blood vessels,” his doctor told me. “But it is something we’ll watch closely.” I was able to tell her of a similar, earlier finding so, indeed, it probably was nothing. “Good to know,” she told me, scribbling this information down in her wire-bound notebook. Remarkably, in this Internet age, without the assistance of a hand courier or FedEx, the hospital would be unable to access my dad’s prior scans.
After getting to know his doctors, I asked them about their experiences with health IT. My dad’s primary physician, a highly engaged and thoughtful practitioner, believed on balance that IT systems caused hours of extra work with little real benefit. Paper wasn’t perfect, she told me, but it worked. By contrast, my dad’s cardiologist proudly used his iPhone to order Dad’s new prescription from CVS and automatically check for any drug interactions. The hospital, like many community hospitals and doctors’ offices, did not have electronic records, but his office did. Would he ever go back to a paper prescription pad? “No way.”
My dad is better now and back home. The fevers went away without treatment — and without a clear diagnosis or cause. His chest pain was the result of a blockage of his main coronary artery. As for me, I’ve returned to Washington with a renewed sense of purpose. As a physician and the concerned son of an aging parent, I can hardly think of a better job.
— Sachin H. Jain (MBA ’07, MD ’08,) is a special assistant to the National Coordinator for Health Information Technology in the Obama administration. He was previously a resident physician at Boston’s Brigham and Women’s Hospital and a member of the faculty of the Institute for Strategy and Competitiveness at HBS.
