Why Are Medical Offices in the IT Paleolithic?

by Gene Callahan

As a social theorist, I find it always interesting, and a useful exercise, to try to arrive at a good explanation for some social anomaly. But sometimes I find myself at a loss, and here is such an instance: Why, oh why, when we go to a medical office, do we write the exact same info on three of four different pieces of paper? Why are we even writing on paper? I mean, if there is one thing that computers have unambiguously improved, isn’t it the storage of routine information like this? Why can tiny St. Francis College, where I teach, in about one minute set me up so that I am receiving college e-mails, alerts, and invitations on my iPhone, while a multi-million dollar medical practice has me writing my address on four different pieces of paper?

The ideal: You record your “basic medical profile” (name, dob, address, contact, next-of-kin, insurance, major illnesses, allergies, etc.) on your smart phone once (or upload it from your computer to your smart phone once). Then, when you walk into a medical office and the ask for your information, you say, “To what (e-mail address / web page / phone number) should I send it?” You type that in, push a button, and then ask what special, additional information they need (because they are a podiatrist and want to know about your feet, say). Bing-badda-bing.

So why don’t we see this? Yes, the US medical industry is all foobared, but there still is competition. Hospitals and doctors advertise all the time, so obviously they compete for patients. Why not in this way? Or, again, why is St. Francis College, a small, lightly endowed school in an educational market with all sorts of government interventions, about two decades ahead of any medical institution with which I’ve dealt?

5 thoughts on “Why Are Medical Offices in the IT Paleolithic?

  1. Thank you for this provocative question.

    I would not argue with your assertion, “Hospitals and doctors advertise all the time.” But I propose that most hospitals and most doctors are not competing for patients as we would like.

    About hospitals, I suppose they are licensed and operate only in niches pre-approved by the state. If hospitals advertise it is perhaps mostly in the same sense that any federal agency advertises: Each of these organizations has a budget for public relations and spends it. Look at the homepage of the EPA . Does that look like an advertisement for the EPA? Is the EPA competing for customers?

    About doctors, I suppose those that advertise are just getting established or are operating in fringe market segments. But probably the majority of doctors succeed by coexisting with the government-insurance regulatory complex, and they have surrendered most of the control over the paperwork employed in their practices to the regulatory bureaucracy.

    Also, I believe privacy of patient data gets a lot of attention in government regulation. Each medical office may demand that you give them all your details, but each must also demonstrate to its regulators that your details will be divulged to no one without your permission.

  2. I’m not sure the redundant paperwork occurs with the most competitive doctors.

    I visted an eye doctor this weekend who has an aggressive street level business. It was a pleasant experience. I was asked my name, my address and best number to be reached at. That was it. Not even an SS#.

    Any other info seemed to be recorded by the assistant or the doctor as the examination progressed. They never ended up asking for my SS and asked my age, but not my DOB.

  3. Gene’s observations are on the mark. Whenever I see a “social anomaly,” however, I look to the incentives facing the actors.

    What incentives do medical practioners face? To go electronic, they must incur costs. Could they recover these costs in some way under insurance reimbursements?

    True, they might reduce their operating costs. Would insurance companies (including Medicare/Medicaid) not just reduce their reimbursements?

    In short, can medical providers recover their costs with interest under our third-party payment system?

    Add to this is the fact a large cohort of doctors are nearing retirement, and many others are thinking of early retirement. Why make major investments?

  4. Physicians are notoriously shortsighted when it comes to spending money to make their offices more efficient. Most physician offices are groups of five or fewer. The costs of implementing an integrated practice management system (PMS)and electronic medical/health record (EM/HR) are very high per physician. Physicians are by nature a conservative group, and despite all of the studies showing the advantages of an EMR, they are loathe to move into the 21st century. Larger practices generally are on the forefront of these conversions.

    Another big problem is the difficult nature of the conversion itself. It is incredibly complicated, and despite their best efforts, most EHR implementations are fraught w/ disaster and dysfunction. Physicians here these horror stories and question the worth of making such a substantial change to the way in which they practice. And it is a very substantial change.

    However, in the ARRA there is are stimulus $$ being offererd to physicians, of up to $44,000 per physician, paid out over four years, to purchase adn implement and EMR. There are some significant benchmars that each physician has to meet in order to qualify for the $44,000. Simply presenting a receipt saying you spent the $$ is not sufficient. These $$ are being distributed through participation in the Medicare program. The benchmarks are tied to ePrescribing, “interoperability”, participation in various quality measures, etc.

    Again, these benchmarks impose large costs on all practices, and these costs are higher per physician in the smaller practice.

    However, by 2015, penalties will be assessed against thsoe practices that have NOT purchased and implemented an EMR.

    Ask anyone in a physicain practice or a hospital who has gone through one (or more) of these immplementations and I am sure you will hear more horror stories (that later may have become success stories) than you possibly could imagine.

  5. Gerry is on to something. Call you accountant or lawyer and he’ll talk while the clock ticks away your dollars. Doctors generally don’t give medical advice over the phone because those minutes are not reimbursable expenses given how most insurance works.

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