A Possible Explanation For The Stall In Productivity

When technology is used to manage as opposed to produce goods or services. A couple of weeks ago, the Boston Globe described how Partners, the largest hospital system, is stumbling through the adoption of its new electronic records system, EPIC (in a tangential way, my work has been affected by this shift). It is, as the kids like to say, problematic (boldface mine):

Judy Lydon had a busy routine as a maternity nurse at Brigham and Women’s Hospital. She moved from room to room taking care of women and their new babies, checking vital signs, changing diapers, helping mothers hold and feed their newborns for the first time.

Then came the new computer system.

Now, she says, she’s become a captive of the keyboard, spending far more of her time recording every blood pressure reading, every feeding, every diaper change. The demands of the new system are so taxing and time-consuming, Lydon said, that the computer has come between her and her patients.

More than once, Lydon says, she has burst into tears on the drive home. “I know people throughout the hospital, and they find the same thing: it’s tedious, labor intensive, and you feel like you can’t do what you want to do,” said Lydon, a nurse for more than 30 years.

The new software that the Brigham’s parent company, Partners HealthCare, bought for its hospitals and clinics is modernizing the way it tracks patients’ medical care. Doctors and nurses will know more about their patients more quickly — from emergency room visits to medications. Partners executives say this will result in safer care.

But for Lydon and other nurses and doctors at Partners, the new system has become a disruptive presence. They say it has an insatiable demand for information that, keystroke by keystroke, click by click, overwhelms the already tightly wrapped day inside a hospital, eats away at time with patients, and sometimes forces them to work longer shifts. Simple tasks like ordering medications and tests can take several minutes longer, forcing patients to wait around while staff navigate the system….

One doctor said she would spend half her days on the computer. And because her monitor was attached to a wall, she had her back to patients. After months of this, she decided to retire early.

“It usurps the physician-patient relationship,” said the doctor, who still has other appointments at Partners and asked not be to be identified by name. “It was very difficult for me. It factored into my retirement.”

…Specialists in the industry say the programs on the market now are not as user-friendly as health care workers would like.

“It is incredibly disruptive for physicians and nurses to make use of a new electronic health record,” said Dr. Steven J. Stack, president of the American Medical Association. “The current generation of electronic health records are not very usable. They are not well designed to increase our efficiency and to make our work easier — but rather, they slow us down.”

Many hospitals in fact report being less efficient after adopting new electronic health record systems, according to the research firm IDC Health Insights.

They’re more about billing and complying with mandates than about what’s really useful to the physician to help us take better care of patients,” said Dr. Glenn A. Tucker, who chairs the Massachusetts Medical Society’s committee on information technology.

Lest you think this is due to something in the Boston water, this also seems to be the case in Tennessee (boldface mine):

But for several years, economists have asked why all that technical wizardry seems to be having so little impact on the economy. The issue surfaced again recently, when the government reported disappointingly slow growth and continuing stagnation in productivity. The rate of productivity growth from 2011 to 2015 was the slowest since the five-year period ending in 1982.

One place to look at this disconnect is in the doctor’s office. Dr. Peter Sutherland, a family physician in Tennessee, made the shift to computerized patient records from paper in the last few years. There are benefits to using electronic health records, Dr. Sutherland says, but grappling with the software and new reporting requirements has slowed him down. He sees fewer patients, and his income has slipped.

“I’m working harder and getting a little less,” he said.

I’ve also seen this anecdotally in other workplaces (e.g., systems like Agile). These systems are often a boon for managers and data crunchers, but for the actual workers, they often don’t really make a difference in getting their work done (other than they waste time fiddling about on the computer). They can be useful, especially in a workplace or business that really has no clue about what’s going on (e.g., who’s completing what, and how quickly). But too often, these systems are designed to make it easier for managers to manage, not for workers to complete their work. While good managers are important, they aren’t actually doing the work. They are, however, often the ones deciding whether or not to purchase the software.

I suspect, when it comes to productivity, there’s some very important natural history here that won’t be captured in simple theoretical models.

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8 Responses to A Possible Explanation For The Stall In Productivity

  1. PaleoGould says:

    So many systems are designed w/o worker input, and realization of the realities of the worker responsibilities. Thus you get something unwieldy, with the potential to collect all the data the managers want, without considering the cost to employees working.
    Basically, there is a trade off between being lean and unobtrusive, and being comprehensive. And managers prefer latter, employers need former.

  2. Kevskos says:

    To many programs have the pull down/fill in the blank format. It does prevent errors as you must choose an acceptable reply but they pull you away from the keyboard to the mouse. It takes a fraction of a second to type AZ but several to pick it out of the pull down menu. I imagine it is programing like that that is taking up most of the time. However, some of the time is also because they are being forced to leave a certain amount of information that they may or may not have been leaving before.

  3. Nicky says:

    From what I have heard, there is a two-year window in which productivity drops because everyone is getting used to the system. It is more difficult for older, non-technical people, too. I have relatives and friends in the health care field, both users of Epic and employees at the company. The health care workers tell me Epic is heads and tails better than any other software they’ve used, but that it takes time to get used to it and make their days easier. The Epic employees know there is a learning curve, and they’re always trying to make things easier and more intuitive. They do employ nurses and doctors, to get a clinical perspective on the design.

    I’m sorry your work has been affected by the changes, but I do believe the electronic records will be a net benefit for society.

  4. Rick Wayne says:

    “Agile”? Are you referring to a product, or agile practices (as in agile software development)? Because if you’re focused on results rather than box-ticking, the latter have seriously improved productivity. Of course if it’s tool-centered micromanagement BS hiding behind an “agile” label for sexiness, that’s entirely something else again.

  5. Talk I went to recently noted we just do a really crappy job of measuring productivity. Think of what the smartphone has done to photographic productivity and how photographic productivity is measured as an example. (We take a lot more pictures, but the industry has plummeted.)

  6. Greg says:

    * Some of these systems are really awful.
    * Some are terrific – my health care org uses electronic health records. My doctor types while she is talking to me. My records are never “lost”, they can call up x-rays and tests. They can get a graph of my blood test results over time. There’s no wait for records from a specialist or from a hospital stay to be transcribed and sent over – everything is in one place.
    * Legacy health record keeping involves writing stuff down and having it transcribed by a clerk so the productivity gain may not be obvious to the nurse. If the nurse is a crappy typist (or just irritated by the process change) it may be a productivity loss.
    * Many of these systems help prevent medical errors (scan your wristband, ask you your birthday, scan your medicine…). Fewer medical errors makes the system more productive
    * Management may view tons of data as a productivity gain – although more info is not always “better”
    * Your boss decides if you are more productive, not you.

  7. kaleberg says:

    Some years back my local health clinic was changing computer systems and my GP was carrying around two laptops, one for the old system, one for the new system. He was one of the more computer saavy doctors, so he was learning the new system in parallel with using the old one so he could help teach others. Brave man.

    Now he is using EPIC which is pretty awful. The prescription component, for example, doesn’t default the units of measurements for drugs. One has to first specify the drug, then the unit (e.g. milligrams, drops), then the dosage. There is no list of standard dosages even though some drugs, like propecia, are only sold at one particular dosage. Are those standard capsules for an uncommonly used drug 30mg or 35mg? The pharmacist can’t substitute quantities, so it can take an extra round to get things right.

    Then my GP was referring me for hernia surgery and the software only had two options: (1) yes, there was prior hernia surgery and (2) unknown. Surely the designers realized that many people might actually know that they have never had hernia surgery before. It’s not the sort of thing one fails to notice what with all the surgical prep and multiple weeks of recovery. (Granted, one is usually unconscious for the surgery itself.) This kind of thing will probably be fixed eventually, but right now it is sort of sad. Are we really back in 1975?

    • starskeptic says:

      The best thing I could say about EPIC’s lab component, Beaker is that it could not have been designed with input from people who have to use it…

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