Medicine: Submitted by Marcus Martin and Diane Snustad

We received many more responses to the survey than we expected. This either attests to the interest in the subject or the compulsive nature of physicians. There were many very thoughtful replies and it was hard to condense them without feeling that we were doing some of them an injustice. However, there were some thoughts frequently mentioned through the responses and we will try to summarize these and also give some specific comments.

I. What do you see as the clearest gains and losses brought thus far by the use of networked computers at UVa?

A. The medical school faculty felt there have been a number of gains from the use of networked computers at UVa.

1. The most commonly mentioned was the speed and ease of communication and the benefits of e-mail.

2. Also, they are pleased with the increased accessibility of information through the Internet, literature search and databases. Ease of access to patient data is also alluded to frequently. Another benefit was the ability to avoid phone tag, phone time, and the meetings. A number of faculty commented on the ability to collaborate more effectively both within the University and outside. Similarly, the ability disseminate information quickly to colleagues both at the University and other institutions is seen as very beneficial. Several people noted that computers improve upon teamwork and problem solving.

3. Several faculty mentioned the educational benefit. One department chief noted that they posted their lectures so that anybody who wishes could access them. Also noted was improved access to educational material and the ability of students to ask questions by e-mail.

4. Improvement in research capabilities was also mentioned a number of times. It was noted that networks are essential to research and that collaboration for research was enhanced. In addition, the rapid dissemination of research was made possible.

5. Patient care issues were also discussed. It was noted that the physicians could use e-mail to contact UVa physicians and refer patients. Several people felt that patient care was improved by increased access to patient information, as well as access to literature.

B. Problems and losses noted by faculty.

1. Privacy is one of the biggest issues mentioned both in terms of private communication and confidentiality of patient records.

2. Noted also was the difficulty associated with needing to upgrade systems, new systems and repairing the systems.

3. Also frequently mentioned was unimportant or unsolicited e-mail and queries (including surveys).

4. Lack of interpersonal contact since computers took over communication.

5. One person noted some stress related to increased expectations because of queries and other input.

6. Another commented on the danger of information search becoming an end to itself and taking time from other things.

7. There was concerns about viruses and too much time spent on network marginal gain.

8. One faculty member also noted lack of UVa technical support for Windows 98 creating problems using the latest technology.

II. What do you see as the greatest possibilities, limitations and dangers these machines pose in the future?

A. Possibilities for the future.

1. The possibilities mentioned most often by the medical school faculty was paperless medical charts and more comprehensive patient records.

2. One faculty suggested integrating the medical record with the library, common national guidelines and drug interaction programs.

3. Telemedicine and teleradiology were also mentioned several times.

4. The director of laboratory indicated that they intend to have patient data as a lifetime record in the future. This may be available to search as a database.

5. Improved research capabilities.

1) It was also felt that technology would improve interdisciplinary research and would broaden networking with colleagues.

2) A number of people noted that potential for clinical outcomes research and the improved capability to work with large amounts of information without being overwhelmed.

6. Web based education and continuing education was discussed as a future benefit. One person also noted the ease of updating medical skills from online education.

7. Patient care issues included the ability to access the entire patient record, increased efficiency of care and the ability to search for information.

8. Another person noted that technology could allow working people with aging parents or small children to continue work.

B. Limitations and Dangers.

1. The biggest concern the medical school faculty had was loss of privacy and patient confidentiality.

2. Also there were concerns about the infrastructure in terms of keeping up to date with support services and coordination of systems.

3. It was noted that things change quickly in the computer world and UVa is generally slow to change.

4. Y2K was also mentioned as a concern.

5. Several people mentioned the worry about crash of the system and the need for a backup plan.

6. Several people noted limitations of communication through computers and the decrease of interpersonal contact. One person noted the "absence of paralinguistic information that is part of conversation" and another noted problems with "missing the nuances of personal contact".

7. The isolation of students by decreasing personal contact with teacher was also mentioned.

8. Several people mentioned the possibility of decreasing real productivity with computers. This would include people doing nonessential on the computer, unsolicited e-mail, the ease of groups of persons to contact large number of people creating nuisances and a waste of time.

9. Difficulty learning systems, especially multiple programs, was also mentioned.

10. One person noted that we may overwhelm ourselves with information and have no time left for anything else.

11. Another problem unique to the medical school is that if patients have access to e-mail communications with their physicians then the question of liability, excessive drain on physician time and more care for less pay arises. In addition, record keeping errors would be hard to stop and correct before legal or insurance correspondence goes out.

III. What priority should the University place on information technology?

The medical school faculty seem to be fairly united in saying that UVa should have a very high priority in improving the information technology. Several people noted that we are behind in this area. It was noted that this was essential for maintaining leadership as an academic and research institution. A number of people also indicated that efficient high quality medical care would depend on adequate information technology. Additional comments follows:

A. "We are in the business of information and should be on the cutting edge of the use and development of this technology."

B. "Priority should be high since it will save time from increased access to information and decreased cost."

C. "Our future depends on it.

D. "To do otherwise is to risk leadership as an academic institution."

E. One suggestion involved improving the bandwith of the hospital intranet and internet by upgrading routers, bridges, etc, and allocate smaller sub-domains.

F. Increase the availability of shared resources such as mass storage, imaging, scanning, etc.

G. It was also noted that "UVa could spend a lot of money purchasing individualized systems to meet the archaic needs of every individual and entity rather than fostering improvement and streamlining our processes which can then take advantage of the technology - this is difficult because it requires that many individuals change the way they have been doing things for many years."

IV. Please add any additional comments you would like to call to our attention.

A. There were some specific comments on areas that people thought the University should pay attention to in the development of technology, including:

B. Good internet access, telemedicine, online databases, full text journal, online patient record, new and more support systems and individual priorities.

C. One faculty member urged a gradual evolution to avoid a "one size fits all mentality". He also urged to avoid systems that help administrators but increase work in the field.

D. One person suggested finding someone to lead the way and let them do the job unhampered by local politics.

E. Another urged providing technical support for design and implementation and IT ideas/projects of the faculty.

F. A number of faculty suggested that the University provide more support for Macintosh computers. They note that most major research universities have been using the Macintosh and/or UNIX. It was noted that all the molecular biology and scientific software used is Macintosh based.

G. There was also a plaintiff cry for systems to be evaluated by the actual users and people with real world computer expertise.

H. There was a comment that the University should make every effort to get all UVa members on the same system ASAP.

I. Another person said that it would be useful to have a central computer education system that could teach department potential more efficient techniques for conducting department business.

J. The director of the medical automation research center indicated that information technology will be eclipsed by the advent of robotic technology. "The University should be gearing itself up for the robot technology revolution which will be a trillion dollar industry for the next fifteen years and touch all aspects of our lives."

K. There was a concern about using the computer as a goal rather than a tool. It was suggested that real productivity needs to be carefully measured scientifically to see if computers are being impediments to doing real work.

As we hope you can see from the above summary of comments, the faculty of the school of medicine have a great number of ideas regarding this subject. It was difficult to resist the temptation to quote everyone directly. We hope we have done justice to them in creating this summary.