Comments on: Why are doctors such Luddites?

They're quick to embrace new medical technology, but don't ask them to use a computer. CBSNews.com's Charles Cooper explores a generation gap.

[DONNA WAUNN]

I doubt that any of us "computer literate" people could practice medicine so why do we expect Doctors that are already overworked & underpaid to be computer literate. In order to keep up with medicine they must spend hours & hours. If you ever need a good Doctor believe me you wont ask if he can use the computer to "twit" or whatever. I say let Doctors be Doctors & hire a clerk to do the typing etc.

[Bill_I]

Same reason I have Edison and Verizon mail their statements, even though they get paid online. They are printed on paper and easy to file. No hard-drive crash will erase those pages! --- There also seems to be no standard system for medical records, only the Veterans Administration seems to come close to becoming an interchangeable medium. Right now its a tower of Babel, so the medical profession stays with the tried and true 8 1/2 x 11 format, which can be faxed anywhere.

[lowild]

There is clearly a broad range within the medical community regarding actual adoption of technology and the pace at which there is conversion to EMRs. Whether that has to do with age, typing skills, perceived time savings for the physician, practice or hospital or cost for conversion or any combination, every practice is going to be unique. What is changing is how patients want their information. For patients who are working with multiple physicians to manage a chronic condition, paper files are inefficient and unwieldly. It would be far easier for them to share information with each other electronically. Physicians who offer the ability to log in and make a doctor's appointment, or log in and get the results of a test are going to appeal to a certain patient. Whether that doctor chooses to Twitter, email, text or call a patient's family with updates is personal choice, and should be guided by best practices. Creating a system that works efficiently for both physician and patient is a collaborative effort, but one that will be well worth the effort. Hopefully, at its core, it is guided by the desire to provide better care, and better outcomes.

[drwam]

Electronic medical records (EMR) as of 2009 are an expensive sham. I am 54 and I use every new gadget I can get my hands on in my personal life. But our hospital EMR system (from Cerner) is typical of the other systems I have used---poorly designed, slow, and 1000% proprietary. The brutal truth is that our current technology does not suffice. Consider the amount of information one can pack on a printed page versus what one can visualize on a tablet computer. Paper wins and wins big because current displays are low resolution. Data entry is easy with paper and will ALWAYS take longer with a keyboard. Keyboard dependence means EMR turn your doctor into a typist. When you go into an office or ER with EMR, your provider sits there typing as you talk to them. They cannot look at you as you speak and surely cannot think as well or as freely. Computers are great for checklists but medical histories are narratives and cannot be reduced to checklists. SOMEDAY, when we have handwriting or speech recognitiion that is useful, this will all change. As of now, we are still a long way off. But the biggest sham about EMR is the MYTH of portability. All the systems I have seen are proprietary and one hospital cannot read another's records easily, sometimes even if they use the same company's software.
For any of this to make sense, President Obama needs to not be fooled into wishing that EMR will save money, because wishing that will lead to billions being spent on dead end closed systems. All systems should comply with a common and extensible format of data storage with the goal being the complete portability of patient information from system to system today and with future systems. Those standards are going to have to be specified by the largest health care pay---your federal government. This will be a big problem and it will take a long time to resolve. For now, lets take some useful baby steps and define some basic standards that will, coincidentally, ensure open competition between vendors.

[toddtee]

I'm 73 and have taken to many of today's tech products because they're so much more convenient in the long run, but most of my age seem reluctant. Perhaps it's because I learned long ago that you only remain ignorant of new things for as long as you choose to do so, and that learning new things is often not easy, but if not undertaken leads to stagnation.

[stigmattaman]

"So why aren't more doctors early adopters of services like Twitter? As soon as a new MRI machine or microscope comes out, they tend to be all over it."

Hmm, one is an essential tool for getting your job done in a more effective way and the other has nebulous benefits.

FACEPALM

[dsherr1]

Cynicism 101

The issue of EMRs is at the core of resistance. EMR => Evidence Based Medicine => Outcome Based Treatment Oversight. When Tech is controllable or speeds the work by the Physician, they use it to the hilt. But not control of them, real or potential.

How to rationally dispatch health care to individuals so that we get bang for the buck! Most expensive system in the world, 37th in health status. This is the social issue, not to mention the excessive demands on the System because of the aging Boomers.

We need to change the cost structure of care to render more effective and cost efficient care. But, ah, therein lies the challenge ever since the onset of Medicare in 1965. Customary and Usual pricing only works in a competitive situation of which Health Care is not an example. Too much gaming possible with the current system. Just ask the Fiscal Intermediaries who might respond accurately in a fit of honesty.

[EarDocL]

Why are tech. journalists hung up on name calling?

The comments are to the point. Most but not all doctors are trying to go to electronic records. Let's look at a few facts instead of name calling.
The University of Pittsburgh reported a near tripling of hospital mortality when they switched to a fully computerized order system in their hospital.

The recommendation from EpicMed is to cut clinics in half for up to 6 weeks to start the use of an EMR. The VA has never regained the clinic numbers since it switched to an electronic record.

My institution had a 5 day computer outage and we are still tallying the cost in lives and dollars. Careful what you wish for. EMR's are oversold and they underperform. Most of the software is lacking and the execution of the transition is costly and deadly. At least there is some consistency, we blame the doctors no matter what is wrong.

[pentest]

Electronic health records are a bad idea. The security and privacy implications are too high to trust to systems that can never be trusted.

[alt_bob]

Doctors have many things to learn each hour of their professional lives. Medical journals, new drugs and their applications and of course all the new actual treatments and tech-stuff. And you want them wasting time with lousy software and bulky equipment that requires more time to input information than it will ever be worth while treating an ill or dying person? We have no analysts yet to define a replacement for speed and information content of their scribbling.

Younger doctors will try to use it, but the software applications are not yet mature and some of them will give it up for paper in order to treat vice waste time going though a multiple choice list. Not fun to hit return and get an error message a box or field not filled in and the dumb-ass programmer lost all your input and you have to do over. You want to be, say on an operating-table and that occurs - it will.

And finally of course is security, security, security. There is no secure software yet for broad use. Only limited access military systems come close, not yet close enough. Do you want emloyers to know of diabetes or such in your family tree and thus not hire you or take more dollars ourt of your pay for your insurance?

It might could be done today with voice recognition, motion sensors, and imaging tools, and some of algorthims available, but time and cost is close to getting a shuttle nto orbit. And then the testing in parallel to real treament is out of sight. You want to be first to let computer be final say that it was your left or right nee was the one to be replaced? Not yet I would think.

[alt_bob]

Doctors have many things to learn each hour of their professional lives. Medical journals, new drugs and their applications and of course all the new actual treatments and tech-stuff. And you want them wasting time with lousy software and bulky equipment that requires more time to input information than it will ever be worth while treating an ill or dying person? We have no analysts yet to define a replacement for speed and information content of their scribbling.

Younger doctors will try to use it, but the software applications are not yet mature and some of them will give it up for paper in order to treat vice waste time going though a multiple choice list. Not fun to hit return and get an error message a box or field not filled in and the dumb-ass programmer lost all your input and you have to do over. You want to be, say on an operating-table and that occurs - it will.

And finally of course is security, security, security. There is no secure software yet for broad use. Only limited access military systems come close, not yet close enough. Do you want emloyers to know of diabetes or such in your family tree and thus not hire you or take more dollars ourt of your pay for your insurance?

It might could be done today with voice recognition, motion sensors, and imaging tools, and some of algorthims available, but time and cost is close to getting a shuttle nto orbit. And then the testing in parallel to real treament is out of sight. You want to be first to let computer be final say that it was your left or right nee was the one to be replaced? Not yet I would think.

[Been_there_Saw_it_before]

My family is near to and has used the services of Washington Hospital in Fremont, California. They have a pretty good electronic system for some of their records, especially lab reports. Using that as a basis, I offer the following comments:

Everyone can see my records, the doctor, nurses, insurance company, and the technicians at every level. The only person who has trouble seeing it is me. I need to fillout and sign a medical release form for everything.

The nursing staff wants all the information, but they do not take the time to read it. My wife's experience with allergies is a prime example. In the record, on her wristband, on a note attached to the wall above her head, and in the dietary special instructions, yet they still give her all the stuff that will cause problems. She dilligently asks what is in "it", whatever "it" is at that time. And still, on numerous occasions has had to till them that just because an ingredient is shown in the "inactive" portion of the label, it will still cause major problems for her.

Someone walks in and starts asking questions and it is obvious they have no clue as to what the problem is, have not done their homework, and are likely to cause more problems if just acceded to. She and we have had to make this point all too many times. One do-good nurse spread a cream all over her legs to make them better, and a week later all the skin came off.

We do not need on-line records as much as we need record readers, in whatever form the records are in. I speak from too much personal experience and it is a sore subject.

[Been_there_Saw_it_before]

My son is a medical records supervisor in a doctor's office. Listening to him talk about some of the doctors makes me wonder if cave man had it better.

[BSinton]

Way down south in New Zealand, the medical centres I have used have had the Doctors using computers for a least 10 years.

Looks like we are years ahead of America in this field, even if we are years behind in a lot of others.

[seehunt]

I have been using Electronic Medical Records for over 7 years now and they have both pluses and minuses. The good things are the expected, no bad handwriting, easy to view old records etc. The bad is VERY bad, at least in my specialty. It takes me MUCH longer to enter data on a computer than it ever did on paper. My specialty is very data intensive and using a computer has increased the time spent , and my costs, of seeing patients by 50%. No insurance plan recognizes this. I am a fairly good typist, but typing in all those fields is time intensive, and computer systems, looking to create a thorough and anal chart keep reminding me if anything is missing, even when not pertinent to that patient's case. The computer systems I use, which shall remain unnamed although they are two of the biggest around, are horribly inneficient in speeding data entry. Without well written software to speed up this data entry computing has been a nightmare for me, and I am employed and do not rely on volume to make a living. When more private docs see these increased times to see patients and document everything, you will hear the screams all the way to Washington!!!

[mp44]

For me, it is the interface of doctor with the EMR that is a problem for me to completely convert over to EMR. About 5 years ago, I bought a java based cross platform EMR software. My small office uses the calendar portion of the EMR and enter phone calls and messages into the EMR.

When I'm with a patient, I like the ability to make eye contact, use occasional hand gestures and if I have to type all the information in, I can't make the eye contact and use gestures to emphasize or convey concepts. On the other hand, I can write quickly and legibly without constantly looking at my paper and can still use gestures with pen in hand. If there was a reliable handwriting recognition software, that would make getting information into the EMR so much easier!

Another issue that makes things a bit more problematic for me is that I'm a dyed in the wool Mac user and the smaller numbers of applications available for Mac. I think that part of my own problem is a shortage of time to look around and see if there is a Mac compatible handwriting recognition software available. Last I looked in 2008, there didn't seem to be anything to fit the bill.

Any time you digitalize medical information, I think it makes it more vulnerable to being breeched. I try to take precautions of having my office network hard wired because I just feel too uncomfortable with the security of wireless networks. I remember back in the late 1990's, I would use email to correspond with patients, but after reading about a breech of security of the medical information at a US medical school by some hackers in The Netherlands, I just stopped using email all together.

[mp44]

Additionally, I am not able to quickly put things that a patient is saying into words. I cannot begin to think about how many times diagrams and drawings and the jotting of notes in the margain have been so helpful in helping me recall pertinent things from a previous visit. How do I put those things into the EMR and still have it show up along side text?

[mikeburek]

Doctors have to know so much information and know so many different skills and techniques by almost 2nd nature. Once you have found a technique to learn something so deeply, it's hard to change. It's almost the same argument of DVORAK vs QWERTY. If you can type fine with QWERTY, why learn Dvorak? Whatever style you already know if basically "muscle memory." That's very hard to change. Now imaging you try to learn the new style, but every time you make a typo, that's a patient you just killed. Oh, PS, you need to immediately get through as many cases as you used to before.

Or try adjusting the height of a drummer's drums. Pretty simple to hit a drum, right? Well, just watch what happens.

[xenotar]

My particular annoyance with my doctors concerns telecommunication ability of lack of it. These men and women of medicine are dedicated, skilled professionals. My ire rises though when it is necessary to exchange information when not standing in front of them at the office.

In summary, doctors accept messages on answering machines. They seem to love facsimile technology, even if it is older than I. But try to send them an email, or ask them to send you an email, and it's no, sorry, we don't do that. The BS answer to why always centers around confidentiality. I would just like to know what professional organization such as the AMA has put out the word to docs not to allow it. Does anyone know?

Sometimes I think it is simply to ease the workload by making it difficult for patients to contact them. After all, I don't think there is a billing code yet for sending an email.

On the other hand, my attorneys have no compunction whatsoever about exchanging emails on sensitive topics.

Why the hell are physicians so afraid of electronic mail? If they want confidentiality it is easy enough to incorporate public key cryptology into email systems and get all the confidentiality one could ever need.

X.

[df2009]

As a physician ... I couldn't agree with you more!

[Sam Papelbon]

"Why are doctors such Luddites?"

because they are skill-based professionals who receive a very high salary. technology that would make it easier to do their job means that less-skilled people would be able to perform just as well as they can. as technology advances, eventually there will be places like 'slick joe's surgery shop' on the corner where you can have a tumor excised for $19.95. doctors do not want this future, even if it means people will have cheaper and more accessible health care.

[df2009]

Spoken like someone who clearly does not understand nor appreciate that physicians are professionals. The act of prescribing a medication or performing a procedure is only a small component providing health care to sick patients. Listening to a patient at the bedside, providing compassionate/empathic care, promoting research, teaching students, advocating on behalf of patients in public health/government initiatives etc... etc...

Try purchasing that online for $19.99!

[pearldive]

Information is power. The less the patient knows the less infringement upon the doctor's path through his day. I guess that's a nice way of putting it for the doctors who feel that way. The old school way of thinking is the Doctor is God.