ie8 fix

Why are doctors such Luddites?

May 20, 2009 4:00 AM PST
By Charles Cooper
Staff Writer, CNET News

During the course of a normal business day, Gregg Feinerman likes to send out Twitter updates. He's just like tens of millions of folks around the country.

But there's a difference: Feinerman is a Lasik eye surgeon.

"All the people working in our office are doing it, anyway, and I said, 'Why not also do it for patients?'" Feinerman said.

Feinerman's tweeting obviously is a rarity for those in his profession. More than a decade after the Internet went mainstream, only an estimated 17 percent of physicians have electronic health record systems.

Kaiser tablet
Credit: Feinerman Vision Center
("Using Twitter) is just a different way to do
outreach," according to Gregg Feinerman,
a Lasik eye surgeon in Orange County, Calif.

The big trade associations representing the medical establishment, such as the American Medical Association and the Medical Group Management Association, can't estimate how many of their members use the microblogging service, or for that matter, how many of them deploy consumer-facing technologies in their daily interactions with patients. But if anecdotal evidence is a fair barometer, assume the following: Doctors who grew up in an earlier era are likely to cling to their notepads and pens until the day they retire their stethoscopes. For their younger colleagues, by contrast, consumer technology is just another way to connect with patients.

In its Orange County, Calif., offices, the Feinerman Vision Center staff has set up a Mac notebook in the waiting room with a private Twitter account. As an eye operation concludes, updates go out that enable a patient's friends and family to read how the procedure has gone.

"It's just a different way to do outreach," Feinerman said.

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. But practitioners say information technology is hard for older members of the profession to incorporate into their daily routines.

In part, that may be because there are few applications in health care that actually delight doctors. There are still no medical equivalents to Apple's iTunes or iPhone. And like the rest of us, doctors are creatures of habit. But change is happening. With each graduating class of doctors, more physicians feel comfortable with technology.

A survey published in December by Vanderbilt University Medical Center hinted at this trend, though from a different perspective. The survey focused on doctors, mostly on the younger side of the spectrum, trained in IT-rich environments. Of the doctors who wound up working at offices with more rudimentary systems, the vast majority expressed unease about their ability to offer proper care to patients.

A medical generation gap, if you will, is coming into fuller view. In fact, it's something I first saw a few years ago, when I was rushed to the hospital after a hard fall that cracked my head open.

Upon my arrival at the emergency room, the thirtysomething physician who attended to me took notes on a tablet computer. He could then transfer the data from the consultation to a central server over a wireless network. (He also had a high-end smartphone hanging from his belt, just in case.)

As a technology reporter, all this intrigued me more than learning what was going on with my badly smacked noggin.

The doctor told me that age--usually the 40th birthday--often defines a physician's predisposition toward incorporating high tech into his or her daily interactions with patients.

A few hours later, I was in the recovery room when another ward doctor approached me. As he took out a pen to scribble into a notebook binder, I just had to ask.

"You don't like tablet computers?"

He gave me a hard look and mumbled something about how it wasn't his cup of tea. I'd say he was at least in his mid-50s. That was all I needed to know.

"If you don't use tech, per se, in your daily life, at all levels, and you're not comfortable with it, then it's unlikely that you're going to be as speedy (to embrace) technology," noted Dr. Todd Rothenhaus, senior vice president and chief information officer of Caritas Christi Health Care, the second-largest provider in Massachusetts. "If you're not a touch typist...or if you never use a mouse or are accustomed to using a PC as part of your daily activity, then there's going to be an enormous barrier."

Rothenhaus may be right. The hope within the Obama administration is that many of those barriers will crumble in the aftermath of the passage of the $787 billion economic-stimulus package, which includes $19 billion for health information technology and another $10 billion for the National Institutes of Health.

Clearly, the U.S. population is behind a concerted effort to digitize medical records, according to a recent poll (PDF) conducted by NPR, the Kaiser Family Foundation, and the Harvard School of Public Health:

"Fully three in four say it is important for their health care providers to use electronic medical records (EMR). A large proportion of the public also sees benefits to nationwide adoption of this technology. Majorities say that if the United States adopted greater use of an EMR system, their own doctors would do a better job coordinating their care (72 percent say this is at least somewhat likely), that the overall quality of care in the country would be improved (67 percent), and that fewer people would get unnecessary medical care (58 percent.) Just over half (53 percent) say there would be fewer medical errors."

In theory, that sounds like a slam dunk. But life usually turns out to be a bit more complicated. Consider the experience of James Dom Dera. An assistant professor of family medicine at Northeastern Ohio Universities Colleges of Medicine and Pharmacy, his practice made the decision to become a "paperless office" two years ago. However, the transition to electronic records proved more difficult than he envisioned.

Dom Dera, who was accustomed to quickly jotting down notes taken during patient visits and flipping through papers, says that only in the past year has he gotten his typing groove back.

"I'm actually starting to see the benefits of a class I took in high school: typing," said Dom Dera, who, at 37, is relatively young. "I've gotten pretty good at typing and clicking while still maintaining eye contact. At the same time, I'm cognizant that sometimes it's more appropriate for me to stop typing, close my laptop, and just listen. I guess that's the art versus the science of medicine."

Dom Dera and his colleagues, including the nursing staff, now use tablet PCs connected to a wireless network. Nothing is stored locally, and the data gets transmitted in real time without the need for a Save button, he said.

That doesn't sound anything like my doctor; he's terrific but definitely old-school. Getting back up to speed when it comes to using a keyboard only hints at the challenges older physicians face in trying to adapt to a world in which new technologies regularly proliferate throughout the larger society.

"That's exactly it," said Lasik surgeon Feinerman, who is 42. "I grew up in the computer age. This is just my generation. I still feel old when I come to the office, and most of the staff is in (its) 20s and 30s. But I'm trying to use tech and have a proactive attitude to make our practice fun and keep people in touch."



71 comments

Join the conversation!
Add your comment
As an older (55) technically savvy MD (my Lenovo X200T tablet is always with me), I think the biggest barrier is simply that almost any medical documentation or ordering task takes longer INITIALLY for the physician who does it electronically instead of in good old pin and ink. The time and work savings are either enjoyed by others (the clerks on the hospital ward, the nurses) or by the physicians later (when one needs to look something up) and are not immediately apparent. The ultimate goal, I think, is a completely portable medical record that belongs to/is possessed by the patient and provided to the MD upon an encounter, or is stored in the cloud somewhere (which obviously presents all sorts of privacy issues). We are very far away from Obama's vision and will have to spend a bunch before we realize any savings.
Posted by Jim_Wynn (1 comment )
Reply Link Flag
Hello Dr, can you quote a study showing that using an EMR instead of paper will allow the doctor to make more money, or be better protected legally? I think you will find none.

In the book "The House of God", there was a chief resident internist who proudly claimed he never met a person whose life could not be summarized on a 4x6 card. Until we get a computerized version of these cards, including size, weight and cost, paper will win.

The iPhone is not far, but still not enough pixels to display enough text.
Posted by emmanuelm (1 comment )
Link Flag
Lawsuits, HIPAA, FDA, State Boards,...

This twittering doctor is a lawsuit waiting to happen.
Posted by mdb002 (2 comments )
Reply Link Flag
I would agree with that.
Posted by mikeburek (418 comments )
Link Flag
Charles,

Sorry to hear about the skull banging. Sometimes the floor comes up and smacks you when you least expect it.

Interesting comment about docs not wanting to waste time keyboarding because chicken scratching on a chart is so much faster. This may be the biggest impediment to EMR.
Posted by rmva (385 comments )
Reply Link Flag
Interesting article and much to agree with. I would say that there are exceptions to the age rule. I'm a Pediatrician, 51, with 26 years of practice. In 2001 I wrote my own paperless medical information software for the office which includes a complete medical records module called PaperCutPro (www.papercutpro.com). I've actually been on the bleeding edge of this technology as we see 30,000 patient visits a year in 3 office locations which are all networked through my software. Not only am I using it for myself, but it is commercially available

The single most devastating barrier to adoption of these technologies in the private medical office is a lack of typing skills. It makes all other use of the computer simply too daunting for most practitioners.

The other thing is cost. Our software, like most, is not cheap. However we are soon to offer a monthly software as a service platform that will reduce the $50,000 to $100,000 investment to around $10,000. There are other aspects f this that I won't take time to mention, but the point is this. If a physician who doesn't type but does dictate, will fund an assistant to follow him around and completely operate the software, then he can channel the significant funds for dictation into technology, and provide the 'WOW' factor that my patients. It seems almost daily that I get comments from my parents that tell me they think that I'm giving better care when I use my computer!

Perception is reality for them. But also it is important to dispel one fallacy. Electronic medical records, as great as they are, will NOT reduce the cost of health care. They have the potential however to make it better care. :-)
Posted by pmbx (17 comments )
Reply Link Flag
Nice way to pimp your software on C/Net dork.
Posted by ewsachse (663 comments )
Link Flag
First of all I don't think Twitter or any other messaging system is going to pass muster with HIPAA. Regardless, there are several impediments to advancing an Electronic Medical Record (EMR). First off is the cost. Let's face it, there are few physicians who are willing to shell out $50,000 per doctor (yes, that is the estimate and about what it cost me - not including the yearly IT cost increase to the practice). That's a lot of money at a time when reimbursments are down from Medicare and insurance companies, when malpractice insurance continues to rise, and when there is an increase in overhead due to unbelievable, new (and ridiculous) paperwork and business restraints (look up new "red flag rules" for example). The new administrations' supplement will only partially cover this but it's a start. I could go on but you get the idea. Luddite? No. Just a lousy return on investment at a time when dissatisfaction with the profession is at an all time high.
Posted by j_berman (78 comments )
Reply Link Flag
I expect the typing problem is a big part of why doctors don't adopt the new technology. The other part would be something I have run into in my own field - it takes longer initially to produce a good record, even though it saves time and mistakes later.

If good voice recognition software were available, it might help the first problem. In the meantime, hiring a "gofer" to follow the doc around and type in the info might be a remedy, but this adds even more to the expense of converting.

The second problem is psychological and requires either self-motivation, financial incentive, or legal requirement to implement.
Posted by Cricker12 (43 comments )
Reply Link Flag
As a doctor would you consider yourself a Luddite?
Posted by Tanianet (6 comments )
Link Flag
At last the truth. It's the money. In my research on electronic healthcare for a forthcoming book, I was told in no uncertain terms: with MDs, free is not enough. They want to be paid to use the systems the Obama administration is willing to front. Doctors are as computer literate as anyone. They're not Luddites. There's another word, I just can't think of it at the moment ;)
Posted by dwineberg (7 comments )
Reply Link Flag
The canard that physicians are slow to adopt IT because we're old and don't know how to type is absurd, just as is the notion that as soon as the gen-x's rule the roost everything will be wonderful.

I'm over 60. My 4 MD partnership uses paper charts and a spiral bound appontment book. However, I run 3 operating systems simultaneously on my Mac Pro, configure dhcp MAC-address (not Mac) wireless security on our office LAN, run multiple parallel WiFi networks on my home LAN, and I'm an inveterate early adapter, when so doing increases productivity.

I have colleagues who've created their own EHRs for use in practices similar to my own who may be excluded from the stimulus bill IT benefit because obtaining "certification" for their programs will be so expensive as to consume all of the monetary benefit. They're likely to continue to use their own software, because it's been developed by people who know what doctors do--how they think, how they work, where and how they need access to data. In contrast many commercial EHRs turn care providers into data entry clerks

I use one of the most highly integrated EHRs on the planet every day in one of the hospitals where I care for patients. There IS no paper chart. Although I can now READ what everyone else has typed, it's often MORE difficult than in the old "paper" world to get a sense of what my colleagues are thinking. Patient progress notes have ballooned in size because of endless tables of boiler plate text that seeks to satisfy algorithms that calculate level of service for automated billing. Buried somewhere in there are the THOUGHTS of the person generating the note, but they're difficult to find.

A huge part of what successful physicians do involves applying heuristics and inferences, and when supposedly "world class" appointments software costs many thousands of dollars yet requires my staff to spend hours each month populating our schedule matrices so the software doesn't double- or triple-book patients, I'm not ready to discard my ten dollar appointment book.

Can IT make things better? Of course it can, but even the seemingly simplest tasks turn out to be difficult. For example, I care for patients in three hospitals and four outpatient dialysis clinics. Each of them has some semblance of an EMR. Each of them has struggled with the notion of "medication reconciliation" since that phrase first appeared (find out what the patient is taking, write it down, make sure everyone knows what the list contains at admission and discharge). NONE of those enterprises has a final solution implemented. Why, because it turns out NOT to be simple.

I'm exploring e-prescribing, at the government's urging. It ought to help. However, entering a prescription for 20 mg Lipitor turns out NOT to be a few clicks. A typical e-prescribing package will have DOZENs of entries for 20 mg Lipitor, because it needs to contain every packaging or custom contract packaging variation for the drug.

Yes, there are doctors who are Luddites. But the notion that they're the problem is not just ill-advised; it's dangerous.
Posted by jamesrob--2008 (1 comment )
Reply Link Flag
As a senior IT professional at a hospital with over 1500 physicians, I can tell you that MDs like you are the exception. I wish there were many many more of you. The agonizing truth, however, is that most (as in probably more than 75%) of the physicians at our institution are woefully technologically ignorant and unwilling to assist with tech progress. Typical reactions to new implementations and trainings are at least uncooperative and obstructive, and at most vehemently and unprofessionally belligerent.

That these are highly educated experts in their fields who somehow cannot grasp new systems is absurd. They need to take responsibility and assist with progress or get out of the way.

It was refreshing to see this put to light in this article.
Posted by juryrigger (18 comments )
Link Flag
Hi I am a UOM student in Ann Arbor and I am doing a article on doctors who are Luddites, is there any way I could get a contact from you to interview? Thank you
Posted by Tanianet (6 comments )
Link Flag
Hi I am a UOM student in Ann Arbor and I am doing a article on doctors who are Luddites, is there any way I could get a contact from you to interview? Thank you
i_franczyk@yahoo.com
Posted by Tanianet (6 comments )
Link Flag
Doctors on Twitter? Gee, ain't that grand? Now, they won't have to speak to the patient at all; they can merely tweet. If my internist ever pulled that on me, I'd be out the door at Warp-9. "Grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference."
I wonder when we'll lose the abitlity to speak to each other? We're obviously well on the way. Rod Serling was right!
Posted by setjeff15081947 (102 comments )
Reply Link Flag
My question is: What makes technologists sociopaths such that they can't understand that their focus in life is on computers and systems - while other professions - like physicians have other focuses and technology is useful only to the extent that it facilitates their primary focus - which is patient care.

A doctor does not need electronic medical records for patient care - and in fact, the electronic medical records will cost him time and money - and by definition, it causes a redistribution of his priorities away from the patient and towards the computer system. This does not serve the interests of the patient.

The other thing is privacy and confidentiality. Using an eye doctor as an example is ludicrous. Why don't you do an interview with a gynocologist or maybe a proctologist. Do you suppose those patients would want their medical records in electronic form to be available to the world - and don't even try to talk security because we all know that there isn't any real security.

SO STOP IT! BACK OFF! And stay out of other people's private business.
Posted by eyeswideoopen (15 comments )
Reply Link Flag
I will be the first to say IT is far from flawless or the end all problem solver - but it's closer than anything else has ever been. If you understood the potential of IT technology, you would understand that all the problems you described - are not anymore inherent to IT than to paper technology - but less so, and IT has the ability to better solve them if employed correctly. Better IT solutions are continuing to rapidly evolve and improve - paper not so much. Security - do you seriously think your med files in an office file cabinet at your docs - at your insurance company are secure where all their employees/ (neighbors?) can pour over them - where discarded records go into the public trash and blow down the street. The people that have the most problems with IT are the ones that understand it the least. I am sure every tool that has ever been invented had resistance to it's use. You have to wonder how long it took to transition from rocks to metal hammers. Don't feel bad, resistance to change and adaptation is very difficult for about 85% of the population. Unfortunately, it's that 85% that usually gets left behind or wiped out during times of dramatic change. The good news is that adaptivity can be a learned skill.
Posted by masonx (244 comments )
Link Flag
Hi I am a UOM student in Ann Arbor and I am doing a article on doctors who are Luddites, is there any way I could get a contact from you to interview? Thank you
Posted by Tanianet (6 comments )
Link Flag
Electronic records and computers are unable to totally replace the use of paper. A Lotus Note on your computer doesn't do much good when you're away from your system. A notepad isn't an instantly searchable device and has limited storage, but you don't have to worry about the batteries dying at the worst possible moment, nor about there being too much sunlight to read the display.

And a pen and paper are much more valuable in emergency situations for physicians. A blackberry is useless then you're marking a surgical site, or for making triage notes on patient's forehead.

And you can't use a tablet computer for an emergency tracheotomy.

Finally, I certainly wouldn't slam a notebook computer on a tabletop to get people's attention in an out of control meeting; but a good thick bound manual still works for that purpose.
Posted by Dr_Zinj (727 comments )
Reply Link Flag
Hi I am a UOM student in Ann Arbor and I am doing a article on doctors who are Luddites, is there any way I could get a contact from you to interview? Thank you
Posted by Tanianet (6 comments )
Link Flag
Hi I am a UOM student in Ann Arbor and I am doing a article on doctors who are Luddites, is there any way I could get a contact from you to interview? Thank you
i_franczyk@yahoo.com
Posted by Tanianet (6 comments )
Link Flag
the sweeping comment has substance though not universally true. doing too much of computing or upkeep of elaborate electronic medical records or using medical software at every step of professional life is not only time consuming but also unnecessary for that matter. my personal take is this entire technology application that includes medical record keeping,billing,professional presentation and medical office productivity software usagevetc. etc. should be left to medical i.t. assistants and doctors should put attention on their medical skills development. however doctors should maintain a reasonable level of computing skills themselves.
to talk on a personal note, i would say,as a doctor,i know,the dilemma of finding time out for professional studies if you are too busy with this internet thing! as a registered cnet user,i,m an avid software and internet enthsiast,,but has faltered professionally.i,m not repenting though!
Posted by sbose64 (23 comments )
Reply Link Flag
You are a DOCTOR?
You had better go back to school (elementary) and take writing, grammar, spelling, etc.
You read like an idiot. Or a 2nd grader.
Posted by raywkirk (40 comments )
Link Flag
I'd say it is also the expense brought on by the insanely and unecessarily complicated standards the industry created such as HL7. The medical industry is long overdue for the kinds of simplification of domain languages other technology adopters eventually have to achieve.

The medical profession will have to step up to the fact that it has consciously or sleepily enabled complexity barriers to communication and that these are now showing up in implementation costs.
Posted by Len Bullard (454 comments )
Reply Link Flag
For $200 you can buy a large locking filing cabinet. And your office already has a lock on the door. But with computers, every bit of software has to have these crazy standards.

How many kids have been snooping around and found a locked door and left, as opposed to seeing a computer and trying to get around passwords? Even in the movies, a password protected computer is simple, but to get past a locked door takes planning and, many times, a team. A password protected computer is not a barrier, especially with potentially limitless bounty to be gained. A locked door, though, is a physical challenge, and anything found in there would still have to be carried out and it is immediately obvious if a physical object is gone. Just looking at any random file on your computer, can you tell how many times it has been opened?

And once you hook up your computer to the internet, there is no need to even lock your office door anymore. At least in a law suit, you can ask the jury to take pity that only one time in thousands of days you were in a rush and forgot to lock the door. Once a computer expert starts listing the ways you could have protected your computer files, the jury will just completely agree, even through they have no idea what the computer expert just said.
Posted by mikeburek (418 comments )
Link Flag
The statement: "If you don't use tech, per se, in your daily life, at all levels, and you're not comfortable with it, then it's unlikely that you're going to be as speedy (to embrace) technology," misses the mark.

Doctors and nurses use technologies of all sorts every day, of which many would probably baffle the most bleeding edge twitteriffic tech adopter. The point is to adopt technologies that meet your professional needs.

Electronic medical records? Absolutely -- Europe is light years ahead of the US on this front. Twittering about the latest surgical techniques? Hm. Maybe - but I doubt that's the best fit for deeper research, study, and practice...

Using blogs, social networks, and the like to talk up your medical practice? Absolutely - if you have something edifying to say. Otherwise....just more noise, imo.
Posted by Spartanicus (10 comments )
Reply Link Flag
I'm 63 and a scientist/businessman. I bought my first PC - such as it was - in the early 80s and have stayed IT current since - using computers in correspondence, data analysis, technical literature searches, and info searching for basic problem solving in general. I see the computer as an extension of my brain - additional processors and a remote hard drive for the brain. Since I have also been involved in medical product development and had some association with parts of the medical profession, I have long noted the lack of IT literacy - if not IT phobia among med docs.

"Why are doctors such Luddites?" It's because that is the way they are trained. I think it is a very telling thing about how we educate doctors and the inadvertent consequences of that educational process. The education selects for specific types of learning processes/personalities. Unfortunately, that personality is apparently - Luddite in nature. Most people think practicing med docs are scientist - when in truth very have any significant scientific research experience. Med docs by in large are IMO very over educated mechanics - technicians who use rote memory to match the most appropriate canned solutions to a check list of medical conditions. In many cases, solutions and conditions are forced matches because of the docs lack of real problem solving ability. Unfortunately, fewer and fewer med docs are real problem solvers - in the way a scientist solve problems - through research and the process application of the scientific method. I don't deny that the medical field doesn't have a wide range of conditions and diseases that can be effectively treated through canned solutions, but we still need to have practicing docs who know how to use science to diagnose and solve medical problems. Today you can't be an efficient scientist without being IT literate and IMO you can't be a good practicing med doc. If our medical histories had been digitized 30 years ago, we would all be dramatically benefiting medically from the analysis of those histories (anonymous for research purposes) today. I read yesterday about a 50 year study on aging drawing near completion. Only problem is the designers of the study 50 years ago were clueless about the kinds of problems we need to be solving today - so the studies experimental design was very limited as will be its' results. Digitized medical records would have gone a long way to helping us understand medical problems by having a huge data base to sort and analyze medical problems. Our US medical profession has dramatically failed us by - and because they are such Luddites. You have to wonder if there have been any visionaries in the AMA at all in the last 30 years - or have they focused entirely on rapid patient turnover efficiency and better billing techniques?
Posted by masonx (244 comments )
Reply Link Flag
Having gone to an "elite" university and having had an opportunity to see who chooses pre-med, your words ring true. The ones who are pre-med are not the smartest or the most scientifically or logically talented. They are, by and large, simply the ones who can memorize tons of things. They take organic chemistry two or three times until they get it right, and otherwise major in history or other subjects that require a lot of memorization and instant recall of facts. Some major in chemistry, but again, not for research, but just because it requires a lot of memorization and is looked favorably upon by med schools. This is not to say that they aren't smart, but they aren't generally problem solvers. The problem solvers gravitate toward engineering or science, depending on how theoretical their minds are. And those who truly had a love of medicine and engineering seemed to gravitate toward medical device engineering.
Posted by ikramerica--2008 (2246 comments )
Link Flag
I agree that an MD is analagous to a 'mechanic' of the human body, however, I disagree that they are over educated. The reason has to do with the complexity and the consequences. A human body is much more complex and fragile than an automobile and the consequences for mistakes are much more serious with a human than a car so far more education is necessary to deal with these factors. This is also why they match conditions to canned solutions, it is expected that the solutions have been researched and validated by scientists and it is too risky and time consuming to experiment on patients each time they are presented with an illness. The current process has developed because it maximizes successful patient treatment while minimizing risk and I imagine most medical doctors are primarily concerned with patient care and are only interested in figuring out new solutions if the current ones fail or are inadequate (and not just out of curiosity or thirst for knowledge as a scientist would be). So I agree that the meidcal profession would not attract many scientifically minded people since at its heart it is a service profession and not a research or engineering one. I think the central matter is one of profitability, there would be many people in varied professions that would do exactly the same things as medical doctors if it were an option (i.e stick to paper and pen, dicate notes, etc). There has not been any real argument that making doctors switch has much effect on profitability of hospitals so there is not much pressure being put on the physicians to adapt to IT technology. The moment IT illiterate doctors stop getting hired or promoated, or start to financially suffer due to their IT illiteracy is when things will change. This is how it happened with most other professions that used to rely heavily on pen/paper/dictation.
Posted by gsigas (103 comments )
Link Flag
IT seems to be in the back seat at the AMA. All they seem to be worried about are extreme education costs forcing student's in residency to perform 24-48 hour straight shifts.
Posted by sting7k (1345 comments )
Link Flag
The health care information system needs a complete overhaul!!! I'm not a doctor, but I can already see the ridiculous amount of paperwork that needs to be done just for a routine checkup for my girls! Although everything is already in the computer system, we can't make appointments online, can't see our test results online, we have to call the office, talk to the nurse or the physician and have them "mail" the record to us.
Posted by winstein (460 comments )
Reply Link Flag
I read an article about doctors saying that they were too busy to learn how to use new technology even though they recognized it could help their practice. The article was written in 1899 and the technology was a stethoscope. This attitude is still prevalent among doctors today.
Posted by dutch_guilder (18 comments )
Reply Link Flag
This is the main reason I believe they are behind.

While doctors do use advanced equipment, they use it because a technical salesperson came in and trained them, hands on, to use it. A friend of mine does that for a living. He demonstrates new arthroscopic devices, and actually performs some of the actions on a real person to show the doctor how it's done.

So unless learning about the new technology is on the job training, or done at some fancy conference where they can play golf for 6 hours and learn for 2, they will not take the time to learn. Too busy.

Add to that that because doctors in practice are partners, not employees, all costs associated with new technologies are eaten by them. It's easier to pass the cost of a new device onto the patient than it is to pass the cost of new IT on to the patient, because of the way our "allowed/disallowed" system of insurance price manipulation works.

So when you combine the time factor of learning and the cost factor of not being able to recoup the investment through billing, it creates two barriers to adoption.
Posted by ikramerica--2008 (2246 comments )
Link Flag
What about the cost vs benefits? Investing many thousands of dollars in tablet hardware plus HIPAA compliant software to replace a legal pad and a few minutes of transcription time?

I'm totally a technologist but I'm not convinced the business payback is lurking around every corner. Sometimes old school still wins.
Posted by NearChaos (47 comments )
Reply Link Flag
Couldn't even provide a link to the guy's twitter feed?
Posted by swrobel (41 comments )
Reply Link Flag
The US always boasts about being the best yet here in Britain I visit my doctor who is in a group practice and he has my medical history on the his computer screen as I enter the room. This system has been in use for years. He can instantly compare how I am with previous visits and pick out any changes. If he is not available any other doctor in the practice can access the same data and do the same. My doctor insists on a set of blood tests once a year so I make an appointment with the nurse at the practice. She looks at her screen and knows what tests are to be done and takes the samples. Next week at my appointment the doctor knows the results. Because of this system he can quickly tell me if I need any treatment though for years I have stayed healthy and had little need of medication. At the age of 80 I believe that this system has contributed to my health and because of the British National Health Service which is anathema to Americans I pay nothing. That part of the taxes I pay which are used to fund the service are much less than any US Health Insurance.
Posted by irdac (60 comments )
Reply Link Flag
You make a comment about how Americans always boast, yet here you are boasting. Classic! What is it you want us to take away from your comment? That your system is perfect? Spare me.

All I want out of the system is common sense. As pointed out there is a human component to treating patients, balance that out with the IT aspect and I am fine with it. Just make sure medical records receive the same amount of priority geared towards confidentiality.
Posted by admiral100 (13 comments )
Link Flag
It depends on the office.

And here in the backward USA, the doctor looks at your chart when you come in, and can instantly compare how you are with how you were last time. I'm not sure how reading it on a computer screen vs. a piece of paper magically makes your history more relevant.

Now if you are talking about sharing the history with other doctors, that's different. We don't have a nationalized computer system, and many would fight that for privacy reasons. But older people or people with specific diseases often wear a medical alert bracelet or necklace that links to the information about you that would be important to an emergency room before they could contact your doctor.

It's not as backward as you make it out to be.

As for the payment/taxes situation, you can say that all you want to, but you haven't provided any proof that you have, over your life, paid less.
Posted by ikramerica--2008 (2246 comments )
Link Flag
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.
Posted by DONNA WAUNN (1 comment )
Reply Link Flag
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.
Posted by Bill_I (231 comments )
Reply Link Flag
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.
Posted by lowild (4 comments )
Reply Link Flag
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.
Posted by drwam (61 comments )
Reply Link Flag
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.
Posted by toddtee (55 comments )
Reply Link Flag
 

Join the conversation

Add your comment

The posting of advertisements, profanity, or personal attacks is prohibited. Click here to review our Terms of Use.