Review by Vincent J. Felitti, MD, Associate Editor
Many improvements to our practices have resulted from computerized
information systems: E-Script, the wonderful pharmacy refill system;
KPDS, the archaic but nonetheless valuable laboratory results system;
and RTAZ, the radiology reports system. Electronic mail, too is
improving the efficiency of consultation and patient communication
for many of us as we learn to use it. Many physicians include e-mail
addresses on their business cards.
These advances are important because the most troublesome of all
problems we face in medical practice is not having patient information
available when we need it. In our knowledge-based profession, who
of us has not cringed at not having the medical chart when we see
a complex patient, or at having to reorder recently done radiology
or laboratory procedures because the results could not be located?
Business @ the Speed of Thought suggests the beneficial
results that digitized information can bring to any complex human
endeavor, including medical practice. The book gives clear examples
of how successful companies use computers to integrate multiple
activities. Many examples are applicable to Kaiser Permanente. For
instance, why do we use lab slips instead of ordering tests directly
from a computer screen, especially when test results are posted
on a computer screen? Bill Gates frequently poses basic questions:
"Do you have people moving information around, or do your computers
handle routine process flow while people handle exceptions...?"
(p 60). Translating these questions to our own clinical practice,
we might ask: are our clinical guidelines still hand-delivered via
interoffice mail when they could be placed in a digital library,
where they would not be lost or discarded?
The book extensively discusses use of the Internet and leads me
to wonder: How might we use the Internet to enable patients
themselves to make the most of their appointments? Do barriers to
making appointments accomplish anything other than increased anxiety?
Conversely, how often might patientdoctor-patient e-mail accomplish
the work of an appointment in less time? How might individual physicians
or modules use the Internet in their practices? Is everyone familiar
with Internet Grateful Med, the remarkably rapid and simple access
service of the National Library of Medicine? Should we develop a
questionnaire for use on the Internet to collect a standardized
medical history on each member nationwide? If so, how frequently
should we collect this information? Current technology certainly
provides the confidentiality to gather that information safely,
but what additional skills would we need to use the information
productively? And perhaps the most basic question of all is also
posed by Gates: Does it make sense to invest huge sums in developing
custom software, or should we build on the enormous R&D investments
of the software industry and customize their applications to meet
our needs? The promise of the electronic medical record has led
to its own mystique. To date, its effect often has been to provide
an excuse for deferring action on current problems because they'll
disappear once we get the EMR.
The closing lines of Business @ the Speed of Thought resonate
with the choice we have: "If we sit back and wait for the digital
age to come to us on terms defined by others [we will lose] ...
Digital tools magnify the abilities that make us unique in the world:
the ability to think, the ability to articulate our thoughts, the
ability to work together on those thoughts." (p 415)
This straightforward book is written by a man who identified the
unmet needs of people who were trying to work collaboratively, and
then built the world's largest fortune by successfully fulfilling
many of those needs. The book will be useful reading for physicians
who want to participate actively in making Kaiser Permanente the
organization that it has the potential to be.
Business @ the Speed of Thought: Using a Digital
Nervous System. Bill Gates, Collins Heminway. New York: Warner Books.
1999. 470 pages. $30. ISBN 0-446-52568-5
