Making the Tool Work for You: Modern Tech Talk with Dr. Wen Dombrowski

Dr. Wen Dombrowski, a former CIR delegate, develops technology and business solutions to drive innovation in patient care and improve the quality of life of our more vulnerable populations.

When did your fascination with technology and new media begin?

During college, I did bioinformatics research using computers to understand genetic data, and I did my summer internships with community health clinics building Access databases for their diabetes registry. Our organization was one of the first in the nation to participate in the IHI/HRSA Diabetes Learning Collaborative, and it was an eye-opening experience to learn first-hand how data and information systems can be used to improve the care of groups and individuals.

When I was a resident at St. Luke’s Roosevelt, the hospitals were implementing an Electronic Medical Records (EMR) system. I became involved with the process by giving feedback to make the EMR more user-friendly and safe, and eventually became the go-to person for residents and attendings for reporting system glitches and seeking advice on how to utilize various features. It happened naturally as I participated in the process.

Because I was a CIR delegate, my colleagues also told me about other operational issues. It was a great position and environment to be in because the administrators understood how critical resident input was. Residents deal with the challenges of patient care every day; we literally provided frontline care 24/7 so we noticed things that other clinicians and administrators didn’t notice.

Do you feel that EMRs have altered the relationship between the physician and patient?

Before EMRs, if you wanted to find the medical history of a patient from two years ago, it was almost impossible as you had to hunt for charts around the hospital and sift through hundreds of page. But with an EMR, the information is right at your fingertips, and in the clinical setting, access to information is invaluable.

What’s important to remember is that technology is a tool. Take a hammer, for instance. I could give you a hammer and you can use it to smash things, or you could use it to build something meaningful. It’s the same with technology. Unfortunately, most physicians aren’t trained in best practices when it comes to technology. For example, there are ways to position your computer between yourself and the patient so that you are able to maintain eye contact. Another way to setup the computer screen is with both the physician and the patient facing the screen; this way, your patient is a part of the process as well. But considerations like this aren’t often considered when designing exam rooms and clinics. The architecture and layout of a room can drastically impact the physician-patient dynamic when technology is concerned.

Where do you see medicine and technology headed in the next 5 years?

It’s important to realize that medical technology is not only about EMRs, it’s a broad range, including (but not limited to) point of care diagnostics, digital treatments, and information tools.

Information and technology are becoming more democratized. Online information resources and artificial intelligence are more readily available. If a patient is worried about symptoms, the first thing they often do is Google it. This is just foreshadowing what computers can do as more robust data sources and algorithms are developed.

There are medical devices that used to only be available in hospitals or ICU, but nowadays, many of those diagnostic devices or treatments are portable or even downloadable as an app on a smartphone. An example is the ultrasound: It was this huge machine that could barely be moved and used to cost over $20,000, but now you can buy a portable ultrasound for $500. Diagnostic tests are becoming less expensive and less bulky, partly because of the innovation that is happening in developing countries to make care more accessible.

In the U.S., patients are becoming more vocal about valuing convenience, access, and affordability. Most people work during the day and it’s not feasible for them to take a day off to go see a doctor. They want to be able to take care of their needs where they are. And for people who have a disability, it may not be as easy to get to a doctor, so treatment at home would be preferable. Many of the new technologies offer the convenience of treatment at home. It is shifting healthcare away from hospitals toward self-care, telemedicine and home-based care.

One concern, however, is the current Graduate Medical Education (GME) system focuses on inpatient care; the majority of residents train to be hospitalists. Most residents have very few primary care and homecare experience, whereas patients’ preferences are moving away from hospitals. There is so much that can be done safely at home or remotely, and with the advent of miniaturized technology, it will become a reality sooner rather than later.

What role do residents play in the new role of technology in medicine?

It’s important that there is sufficient training for physicians on how to provide technology-enabled community and home-based care, including understanding how technology tools and data can be used to improve population health. We need to maximize the use of technology to improve, tailor and customize care, rather than impersonalize medicine.

We keep reading about the doctor shortage in media, but it is only true if based on traditional models of care delivery. If artificial intelligence and telemedicine were more widely available, then it will free up doctors to focus on harder, rare, interesting and more complicated cases, while nurses and allied healthcare professionals support less ill patients in self-care and healing. Technology has the ability to completely challenge and change every aspect of how we practice medicine.  Physicians have a critical responsibility to learn about and adopt the technologies that will help them help their patients.