U.S. Airways Flight 1549 and Technology Dependence in Healthcare

June 15, 2011

Though it may be true that some disaster or electrical outage may thrust tech-savvy and tech-dependent physicians into unfamiliar and uncomfortable territory - that of practicing medicine “the old-fashioned way” - proper development and appropriate implementation of information technologies has the promise of benefiting millions of patients on a daily basis.

Recently a healthcare colleague made an interesting comment about unintended consequences of high-technology healthcare.

She said that ten years from now, when supposedly all physicians will be totally converted to EHRs and using computerized physician order entry (CPOE) and clinical-decision support systems (CDSSs), we face a real danger if there is an electrical outage or other emergency that renders computers and technology systems useless - providers won’t be able to practice medicine. They will be so totally dependent on technology that their ability to even function in a clinical setting will be severely impaired or completely lost.

She referred to the episode of U.S. Airways Flight 1549, where Captain “Sully” Sullenberger was able to pull off what has been called “The miracle on the Hudson.” Because he possessed fundamental, “old-school” piloting skills, honed from years of flying relatively low-tech gliders, he was able to gain the maximum gliding distance out of the doomed Airbus 320 and land it (relatively) gently on the water. Many observers and aviation experts have opined that a younger pilot, and one that perhaps was more savvy with (and dependent on) technology tools like autopilots and such, might have not been successful in saving those 155 passengers.

In the future of automated- and technology-supported healthcare, would providers be unable to practice medicine if the lights go out and they lose their precious workstations, tablet PCs, and iPads?

I thought about it for a few moments, and at first was beginning to buy into the argument. But then I began to think about all the aviation technology that is employed on thousands of flights and millions of passenger miles every day. Those technologies increase efficiency and safety, and no doubt help augment the skills of all kinds of pilots. It may be true that not every one of those tech-savvy (and tech-dependent) pilots could do what Captain Sully did. Indeed, perhaps most pilots could not do it. But that ignores the fact that although the 155 survivors on Flight 1549 owe their very lives to the piloting skills of Captain Sully, literally millions of passengers owe their very lives to aviation technology every day.

While technology may cause some loss of skills necessary to safely glide an Airbus 320 to a safe landing on a river, that technology - autopilots, instrument landing systems, collision-avoidance radar -benefits all pilots and all airliners and all their passengers on literally a daily basis.

So it may be true that some disaster or electrical outage may thrust tech-savvy and tech-dependent physicians into unfamiliar and uncomfortable territory - that of practicing medicine “the old-fashioned way.” Perhaps in extreme cases the loss of technology could have dire consequences for some providers and some patients.

But what about the use of technology such as telemedicine that allows remote and rural patient to gain potentially life-saving access to specialists that are typically only available in large metropolitan areas? What about clinical documentation and record-keeping systems that prevent duplicate medical tests, and their associated costs and side effects to patients? What about drug-drug and drug-allergy interaction systems that prevent what could otherwise be a life-threatening combination? What about the reduction or elimination of vast amounts of administrative waste and inefficiencies in a system that seems to consume more of our GDP each year? And lastly, what about eliminating once and for all the curse of poor physician handwriting and other manual issues that lead to tens of thousands of preventable medical errors each year?

Doctors in the future may not possess the innate skills of the old-fashioned “country doctor.” But I argue that the proper development and appropriate implementation of information technologies and automation in healthcare has the promise of benefiting millions of patients on a daily basis. This more than offsets the downside of isolated episodes of temporary loss of access to that technology.

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