21st Century Medicine
There’s no mistaking it: every day, technology is changing our lives in ways that we probably never imagined. We’ve seen some astounding technological advances which have dramatically improved safety and patient outcomes. When medical interventions are required today, they are generally safer and less painful; patients get better more quickly and stay better longer.
Let’s follow the story of Henry, a typical 65-year-old man, from his first chest pains through heart surgery--all the way to his full recovery at home.
Scheduling. Henry is working in his garden when he stands up and is unpleasantly surprised to find he is short of breath and lightheaded. He senses a strange, uncomfortable swelling in his chest. Although the sensations are not debilitating, it is not the first time he’s felt this way. So his wife insists that he call Dr. Stephens, his primary care physician. Henry dials the number and is greeted by an automated attendant, a pleasant recorded voice on speaking to him through a system called an IVR, or Integrated Voice Response. An IVR is software that sits inside a computer or is attached to the physician’s telephone system. Although we are sometimes frustrated with phone menus and interacting with a computer, the purpose of the IVR is to triage your call and get you to the right person as efficiently as possible. Henry chooses an option from the menu and the IVR routes him to the appropriate person to make an appointment. He tells her about the chest pain and gives her his name and date of birth. She quickly locates his records on the computer and, thanks to the visual user interface in the scheduling system, can instantly see that there is an opening for Henry in Dr. Stephens’ schedule that afternoon.
The Office Visit. Henry arrives at Dr. Stephens’ office and goes to the computer at the reception desk. Since he has enthusiastically embraced technology—he e-mails and “Skypes” (video phone calls) his grandchildren and plays online poker—checking in for his appointment is a piece of cake. He selects the appointment and adds some more information about his chest pain. This is recorded on his record, along with the time he arrived.
All of the components that run Dr. Stephens’ practice (scheduling, medical records, pharmacy records, lab and x-ray results, billing) are linked together with various computer hardware and software systems. The Electronic Medical Record, or “EMR” maintains a paperless record of the patient’s health history and, ideally, is linked to other physicians (such as specialists and surgeons), hospitals, and pharmacies to provide comprehensive and up-to-date information to anyone who might be caring for a given patient.
The nurse calls Henry’s name and takes him back to the exam room. She waves a device across Henry’s forehead to record his body temperature. Dr. Stephens orders an EKG, or electrocardiogram, to diagnose Henry’s chest pain. The results arrive quickly and they include a complete interpretation—the advice of specialists—to help him make a more informed decision about what action to take. Henry’s EKG shows a troublesome irregular rhythm so Dr. Stephens makes arrangements for him to be admitted immediately to the hospital.
In the Emergency Room. Upon arrival, Henry is given a wrist band with a scannable bar code connected to sophisticated computer software. It is his unique identifier, like a social security number, and will serve as his interface to the myriad of technological helpers throughout the hospital during his stay. Everything that happens to Henry will be logged through the bar code, then checked and double-checked by both humans and software to ensure that Henry is getting the right treatment.
Henry gets an intravenous (IV) line. Not just the traditional bag with a tube hanging from a stand—this IV is attached to a “smart pump” connected wirelessly to the hospital pharmacy. To administer medications and fluids, the nurse must scan the bag with a handheld wand, scan Henry’s bar code, and scan the pump. The pump continually communicates with a database in the pharmacy checking for potential conflicts and errors.
Surgery. Based on all the data they’ve gathered, Henry’s clinical team determine that he needs a heart operation. In the operating room (“OR”), the surgeon is seated behind a big electronic box looking at a monitor. Thanks to advances in robotic surgery, Henry will have minimally-invasive robotic-assisted laparoscopic surgical procedure on his heart. Traditional open heart surgery requires a 10-12” incision in the chest followed by a rib spreader—both of which contribute to a painful recovery. Instead, very small, extremely high-tech sterile instruments, including a high-definition 3D video camera, are inserted into Henry’s body through tiny incisions in the stomach and between the ribs. The images from the camera are sent to the surgeon’s box and displayed on the screen directly in front of him, greatly magnified. The surgeon’s hands are connected to devices (think video game controllers) that respond to and refine his movements and guide the scopes inside Henry’s body. The surgeon can use these highly-precise instruments to gently move nerves and arteries out of the way, lessening the chance for damage. When he finds the artery that needs to be repaired, he removes or replaces it, or uses a tool to open it up. Then the scopes are pulled out and the incisions closed.
Now, this surgery might have taken somewhat longer (although as surgeons become more skilled, robotic OR time will decrease). But thanks to the tiny incisions, risk of infection is dramatically decreased, outcomes are better, and recovery is faster.
ICU and Recovery. Following surgery, Henry is taken to the Intensive Care Unit (“ICU”) where his heart rhythm and other vital statistics are monitored wirelessly by sophisticated software informed by cardiologists. The nurses follow specific clinical protocols developed using data about many patients collected over time. Along with technology, anesthesia agents have greatly improved. And what’s more, minimally-invasive procedures can be done with lighter anesthesia. So Henry becomes conscious more quickly and has far less pain (meaning fewer pain management medications are necessary). Foreign objects, such as endotracheal tubes and catheters, are removed more quickly. After a relatively short period of time in the ICU, Henry is moved back to his hospital room and soon thereafter is discharged to home. Henry’s hospital stay is about half of what it would have been with traditional surgery, meaning he is at lower risk for urinary tract infections or pneumonia, which can occur with long hospital stays.
Discharge and Follow-up Care. In years past, the patient’s discharge from the hospital was a dangerous juncture at which mistakes could happen. Today, many of the sources of error have been detected and remedied and the process has been improved. Henry’s medication list is checked through the pharmacy before he leaves the hospital. The discharging physician is able to reconcile the new drugs that Henry needs with the prescriptions he already has at home to eliminate confusion and decrease risk related to drug interactions.
When Henry returns to Dr. Stephens’ office for a follow-up visit, the doctor has received, electronically from the hospital, all of the up-to-date information about his surgery and hospital stay. All of this data is integrated onto Henry’s EMR, available to guide Dr. Stephens through the follow-up care. The EMR system runs the physician through a checklist of critical items to ensure nothing is missed and Henry receives the appropriate care and instruction. It’s not long before Henry is back in the garden again, feeling fit and well.
All of the technology in Henry ‘s story is fairly commonplace today. Unfortunately, the cost of implementing technological advances can be prohibitive to some hospitals (especially in rural areas and small towns) and physician practices. But there is no doubt that we will continue to witness exciting technological advances in the future of medicine.