Dinesh Palipana, OAM, LLB, MD, is a senior resident in the Emergency Department at the Gold Coast University Hospital and lecturer at the Griffith University. He is a disability advocate and researcher in spinal cord injury. He was the recipient of an Order of Australia Medal for service to medicine in 2018.
I once bought a great pen. It had a light woodgrain body with my name engraved across it. With its smooth rollerball, the pen was perfect because I didn’t have to apply much pressure to write—a boon, given the limited finger function that I have as a result of a spinal-cord injury.
So when I started my shift in the emergency department a few weeks ago and noticed that the pen wasn’t with me, I was momentarily annoyed. But then I realized that I rarely use a pen these days. Satisfaction washed over me; the very thing that I spent weeks learning to write with had now become largely redundant, thanks to electronic medical records.
Because of a car accident some years ago, I had to take time off from medical school here in Australia. When I resumed my interrupted medical studies in 2015, I found that our hospital had an electronic medical records system. Working with bulky folders and piles of paper would have been a challenge, given my new situation.
I was happy, but the system wasn’t perfect. I remember striking up a chance conversation with someone from the hospital’s digital team one morning. We were in a line at the coffee shop—the true lifesaver of any hospital—and she agreed to explore getting electronic medical records available on a tablet for me.
She succeeded, and my life soon became even easier. I was able to access results quickly and type notes on the go with the knuckles of my thumb. I gradually sped up to about 50 words per minute. There was no cumbersome workstation on wheels to push during frantic surgical-ward rounds. I could scan paper forms into the tablet and fill them out electronically, then send the filled forms wirelessly to the nearest printer. And the forms were more legible than the handwritten ones had been; the anaesthesiologists, for example, complimented them during surgical pre-admissions clinics.
The system got even better when I could use voice recognition. Since then, I’ve interacted with medical records even more quickly using a microphone. This not only saves time, but it improves the accuracy of what are hopefully more eloquent notes. Several other doctors in our hospital have seen me using dictation and then adopted it for their own practice.
For a time, I still depended on paper. Medication charts, pathology requests, and radiology requests remained stubbornly old-school. Nothing made me cringe more than being handed a two-page list of someone’s home medications and having to chart it for an admission. Written medication charts can be unsafe for a host of reasons, including the, err, “rich variation” in doctors’ handwriting styles.
In my view, paper was messy. Paper was illegible. Paper got lost. Paper didn’t protect privacy. Ironically, these were the very reasons that used to defend the use of paper for so long. However, in 2019, our hospital went completely digital. I can’t even begin to express how this has affected efficiency and safety in the most positive way.
Time saver = lifesaver
If a minimally interactive patient turns up, we can see their records across many of the state’s hospitals. We can understand critical parts of their history rapidly. Their medications are in the record. Surgical histories are accessible. Having this information promptly at hand can save a life.
The system saves time, too. A doctor can write a new note and quickly populate relevant fields through the record. Then, the next caregivers have meaningful contemporaneous records to work from. Previously, this process took much longer.
The electronic medical chart alerts the doctor about things like allergies or reduced kidney function. It automatically examines medication interactions. These are invaluable tools that deliver better, quicker, and cheaper health care. In a time- and money-stretched era, these tools make a difference. Instead of compromising quality of care to save money, we increase quality at lower cost.
Technology has also been an advantage in research. Ever since the spinal-cord injury changed my motor function, my dream has been to see therapies that restore movement. We now have a promising spinal-cord-injury research project built on existing science that harnesses thought-controlled drug-augmented rehabilitation using a digital twin of the patient to produce optimized neurorehabilitation. It’s a mouthful, yes. But, our hope is to see people taking steps again.
Until we see effective therapies, though, technology allows us to bridge physical gaps. What we use in the hospitals today has allowed me to function effectively as a doctor, and further developments like digital twins, surgical robots, and artificial intelligence hold much promise for our future.
But the greatest use of all this technology, as Dr. Eric Topol said in his book Deep Medicine: How Artificial Intelligence Can Make Healthcare Human Again, is not reducing errors or our own workloads or even curing disease—it is the opportunity to restore the precious and time-honored connection and trust between a doctor and a patient.