For the month of March, we caught up with Dr. Gregory Schmidt, a PGY-5 General Internal Medicine Fellow, on the future of medicine and technology, medical record work in Africa, healthcare system design, and his writings at gregoryschmidt.ca.
A long-term interest of mine has been in understanding healthcare system design, and the role that technology can play in improving healthcare systems.
The opportunity arose to work with a group in Kenya (AMPATH) that has been a global leader for over a decade building electronic healthcare records and healthcare systems. I couldn’t pass up an opportunity to learn from them directly.
I am very thankful that the UBC General Internal Medicine Fellowship program is very supportive of all its residents in their fifth year pursuits.
Why are you so interested in electronic health records?
As physicians we use electronic health records every day, and they are a continuous source of frustration. It’s hard to ignore them.
Initially I became interested in designing better medical record user interfaces. But soon realized that the real power of the electronic health record is not to act as a digital filing cabinet, but in its ability to transform how we think about healthcare delivery.
The electronic health record is where the physical and digital worlds in interact. Its critical role in healthcare will only grow.
So, where do you see the future of medicine going?
If you look at healthcare from the perspective of a developed nation you find the annual rise in costs is completely unsustainable, and a system where the variability in care is far too high.
If you look at healthcare from the perspective of a developing nation, you realize five billion people do not have access to healthcare of any reasonable quality. When you think of healthcare from a global perspective, most countries do not have anywhere the number of physicians they need nor the resources to pay them. This is compounded by the fact that the highest burden of disease is outside of developed nations.
To me, the solution to both of these problems is technology. If we can offload a lot of routine patient monitoring, diagnosis, and disease management to digital systems, in theory we can drop the cost of the ‘knowledge’ part of healthcare to that of moving around electrons. The same cost of a Google Search – almost free. This is particularly exciting, because now we have a scalable model.
Imagine being able to provide a community health worker in Kenya with a clinical system in the palm of their hand that can assist in diagnosis and disease management. The same types of clinical tools could greatly augment the clinical skill of a nurse in a northern nursing station.
Health informatics also has the benefit to help expert physicians by providing more advanced tools to assist in diagnosis and disease management. Also, it can help patients and their families take better care of themselves.
What is the biggest challenge in healthcare informatics today?
There is a large divide between those ‘inside medicine’ and those ‘outside medicine’.
Insiders, such as physicians, generally seem satisfied with the status quo. They are overall hesitant of change. Outsiders, such as those in the technology and engineering sectors, look at medicine as an industry that has much more potential than it currently achieves.
Understanding how to better bridge these groups will be an area of growth over the next decade.
You run your own website, www.gregoryschmidt.ca, where readers can find a variety of thoughtful blog posts on technology and medicine. How did you first get into writing? What inspired you to publish your posts?
It was a slow start. As a child my writing grades were so bad that I had to do remedial spelling and grammar. Some summers my parents had me write a page each day, on any topic, before I went out to play.
During ward rounds and in the clinic in medical school and residency I kept two sheets of paper, one for the patient to-do list, and the other for jotting down observations about how the health system can be improved. It became very apparent that during my residency there was not enough time to act on any of these ideas. That is why I started writing the blog in third year residency.
Writing provides the enjoyment of working with an idea, without the hard part of having to actually spend time implementing it. It also provides a benchmark in time, where people later can call you out for being correct – or wrong. Writing also allows me to take an idea that has been on my mind, and then after writing about it, free up that mental real estate for something else. I wish I started the blog earlier, I have a backlog of hundreds of posts to write.
The running theme that connects all your articles is healthcare system design – from discussing electronic health records, to future technologies in the field of medicine, and even architectural design in hospitals (down to slow hospital elevators!). What is healthcare system design?
In undergrad, I read Tracy Kidder’s Mountains Beyond Mountains, and was captivated by the story of Paul Farmer and Partners in Health building healthcare systems.
Around 2013 I started using the term ‘healthcare system design’ to describe my interests. By this I mean the intersection of medicine, systems engineering, design, economics, architecture, philosophy, ethics, communications, and ultimately business and technology. The exact list of topics is always in flux.
Obviously, one person cannot be an expert in all of these domains. But I think there is tremendous benefit to broad exposure and training across these fields if someone is interested in helping build really well functioning healthcare systems. Neglect one of these domains and the entire system falls apart. Combine insights across these domains and some really cool innovation can emerge.
A personal favourite of mine, as an outsider to medicine but still a visitor in hospitals, was your “Navjunk” article on the various different ways hospitals try to navigate their patients and staff throughout the hospital. What are some of your personal favourite topics to write about?
The Navjunk article, “Navjunk = horrible hospital navigation (+ a solution)”, ended up being remarkably popular. It is a play on the word ‘chartjunk’. Chartjunk is a term coined by Edward Tufte in 1983 to describe visual clutter in graphs and charts that take away from the information being presented. Tufte’s works has been a foundational inspiration in my work. It was really cool to see that Tufte liked the Navjunk article too.
It’s hard to identify a favorite topic. The target audience is myself, and what I am interested in at the time. The fact that other people read the posts is a bonus. Over time the articles have become more eclectic and a more authentic cross section of my interests. I assumed this would be a deterrent to readership, but so far it hasn’t.
Where do you hope to take your website, and your writing, in the future?
Finding time to produce content is always hard. It is often a tradeoff between watching a movie Friday night and buckling down to write.
The most enjoyable part of the website has been the people who contacted me after reading an article. The world is a very small place.
I hope the website can continue to act as catalyst for discussions on improving healthcare.
How can people contact you?