Who will pressure physicians to join the 21st century?

A Bank of America ATM can figure out who you are and how much money is in your account in seconds. It can spit out cash in virtually any currency from nearly any spot in the world — even if you’re a Chase customer. It’s a technological convenience we’ve all come to expect.

Hospitals and doctors’ offices are starting to replace hard copy patient records with computerized heath systems. Some U.S. doctors, however, continue to resist change.

Why then, in this totally connected world, don’t people hold health care technology to the same standards?

Health information technologies like electronic medical records (EMR) could enable doctors to make faster, more informed clinical decisions and improve the overall quality of patient care. But adoption and use of health IT is still not standard practice. And even among physicians with EMR systems, data-sharing is limited.

Without access to a patient’s full medical record, physicians are forced to make vital decisions without vital information. The result: Millions of people are risking their health and the health of their families. 

Imagine a man with mild chest pain. On Friday morning, his cardiologist performs an electrocardiogram (EKG) in her office. Saturday night, the man experiences further discomfort after dinner. He goes to the emergency room right across the street from the cardiologist’s office. The EKG taken the day before could tell ER physicians a lot. It might even help them detect a possible heart attack (vs. a simple case of heart burn). Yet all too often that original EKG sits on a shelf — out of reach until Monday morning.

We need to acknowledge that physicians and hospitals simply can’t deliver the best care when a patient’s medical record isn’t available. But if banks around the world can implement compatible technologies, why can’t doctors and hospitals access your medical information instantly?

Part of it has to do with the amount of time it takes for doctors and hospitals to embrace change.

According to the Institute of Medicine, it can take 17 years for an innovation in the medical practice to become standard practice. This lag may explain the absence of IT in the medical field.

Today, adoption of electronic medical records is increasing. But a recent HHS release shows that only about half of all physician offices in America have implemented a health IT system or used one for anything other than billing.

Another part of it deals with demographics. According to a survey of American physicians, nearly half of U.S. doctors are at least 50 years old. While some of these doctors use cutting edge health IT, most do not. They may use computers and smartphones at home, but that’s not how many prefer to organize and run their practices.

Another part of the explanation involves culture and economics. Most physicians don’t value information technology in the workplace as much as they value medical technology. For them, adding a health IT system is seen as an added expense. But repeating a lab test or an EKG in their office is seen as a source of revenue. And maybe, sharing patient information so seamlessly could make it easier for patients to switch doctors.

But even if we could solve the demographic, cultural and economic issues, we’d still face issues with compatibility and collaboration. There are dozens of EMR applications available in the U.S. and most of these systems aren’t compatible with one another. Even if the technology was compatible, doctors and hospitals across the country would still need to collaborate to ensure the highest quality of health care. So far, there’s been little evidence of that.

We can explain the behavior of doctors and hospitals. But why do patients continue to tolerate outdated health systems and the lack of coordination — factors that repeatedly result in lower-quality care?

Most patients would never put money in a bank that didn’t offer ATM services. Most wouldn’t stay at a hotel that didn’t offer online booking. Yet almost all patients continue to make doctor’s appointments and obtain lab results by phone – during limited 9-to-5 business hours nonetheless.

It doesn’t have to be this way. Physicians and hospitals will change, but only when they have to. What will force American health care into the 21st century? In a word: pressure. Pressure from businesses that purchase health care. Pressure from consumers who use health care. Pressure from the government that funds more than half of the cost of U.S. health care.

Today, pressure is starting to build with the emergence of accountable care organizations and other key changes being brought about by the Affordable Care Act.

But there still isn’t enough pressure being generated to force universal change. The first step will be admitting the best care can’t be provided without comprehensive patient information. The next step is taking action.

Imagine if every major tech company in Silicon Valley or every investment firm on Wall Street announced that — three years from today — they’d only purchase health care from a doctor or hospital with a computerized health system. I guarantee the physicians and hospitals without electronic medical records would quickly join the 21st century.

Robert Pearl is a physician and CEO, The Permanente Medical Group. This article originally appeared on Forbes.com.

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