Significant Impact Does Not Require Significant Technology
Wednesday, July 14, 2010
| Paul Robichaux
About the Author: Paul Robichaux is an IT consultant.
I’m a 28 year old IT consultant married to a dermatology resident. In the past, our professional lives rarely crossed; but this all changed when she opted to do a year of research during medical school at The Center for Connected Health (CCH). During her year of research, I was constantly fascinated by how technology was being used to improve patient outcomes and increase people’s access to quality healthcare, and the ingenuity of new healthcare products such as Vitality’s Internet connected pill bottle cap. I was particularly interested in how underserved communities can benefit from readily available technologies, such as an EMR. As a result, my fascination turned into a mini project which came to fruition this past April. As an inspiration to my interest in Healthcare IT, I wanted to share with the CCH community the outcome and vision of my mini project.
Last year, my wife, Venessa, and I decided to do a voluntourism trip in April to a remote Fijian clinic, The Mission at Natuvu Creek. Venessa would assist the resident doctor with seeing patients in the clinic and I, with the buzz of CCH’s Connected Health Symposium still fresh in my mind, decided to try implementing an EMR. This was something that was within my technical capabilities and would have the added benefit of saving time and allow them more reporting options. I decided on a design which would allow them to go completely paperless: a centrally located EMR published over a wi-fi network, accessed using multiple laptops. However, like any project, I encountered both financial and technical setbacks which didn’t allow me to follow this plan. Instead, I would assess the clinic’s operations once we arrived and build and implement what made sense; knowing that this trip might end up only being exploratory.
After spending the first week of the trip getting familiar with their daily processes, I started building their EMR—it would essentially be a copy of their existing paper record with additional support to track specific diagnosis. With only one laptop, the paper system would still be required with the information entered into the computer after the visit.
Even though the EMR did not get implemented until our last day at the clinic, its impact was immediately noticed. Before, all their records were filed alphabetically. Now patients are be given a patient number and filed accordingly, reducing the time spent at the end of the day filing records. In addition, finding files immediately became more efficient. To locate the patient number they could query a patient based on any number of fields, including first name, last name or village. These efficiencies are so simple and expected that I had taken them for granted during my initial plan of implementing a complex system. Recently I sent the clinic an update to the system which allows them to create monthly reports breaking down patients by village, diagnosis, and number of patients each doctor has seen; a process normally done by hand and tallied daily—now it is done in seconds. This is valuable information that can be used by the clinic to justify donations as well as promote the clinic to doctors in medical fields showing the most need.
Venessa and I see this accomplishment as the first step to bringing truly “connected” health to a population in need of specialized care. Our goal is to setup a real-time teledermatology service in the clinic in which Venessa and others can help diagnosis patients. The remoteness of the clinic has the added benefit of helping a population in desperate need of specialized care, however, at the same time presents unique challenges to achieving this goal. The lack of high speed Internet and costly equipment required for real-time teledermatology in addition to a large time difference must be overcome. In the meantime, the next step towards achieving this goal is to arrange a store-and-forward process in which the resident doctor can fill-out a form in the EMR specific to dermatology, attach pictures, and within the application, email to a listserv of dermatologists.
Since learning about CCH, I’ve been introduced to some of the newest applications of technology in healthcare. At first, I was intimidated when I set out, afraid I wouldn’t be able to have the impact that others have made on improving patient care. However, my experience proved that even the simplest technology can have a significant impact. Hopefully, that impact will grow with each improvement we make.