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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  • Ron Smith

    I don’t know Robert. You make it sound like the EMR IS the physician. I think your article simple overstates the issues. A good clinician is a good clinician. The EMR makes some things more convenient, but I somehow doubt that it moves the care metric needle that much farther into the better range.

    For example, I developed what I call the PediKey (Peedeekey, patent pending also). This is a flash drive that patients can, when they walk into the foyer, update ALL their children’s medical records directly with one of our host kiosks at any time and in seconds so that they have PDF versions of everything…vaccine records, exam notes, scanned reports, labs, etc. The PDFs are protected by a simple password that the parents will always know.

    I can’t tell you how many times they have presented the PediKey with this information to ER personnel who promptly IGNORED it! All they have to do is plug it into their computer! PDF is readable by practically every computer platform in the world!

    Even when I fax records to patients that I need to have evaluated in the ER, most of the time, they are NEVER READ!

    What you think is better is if you live in the cloud…and I’m not talking about the digital cloud either. It doesn’t happen that way in practicality in my experience.

    Warmest regards,

    Ron Smith, MD
    www (adot) ronsmithmd (adot) com

    • LeoHolmMD

      Your method easily solved interoperability, portability, ownership, and is dirt cheap. But without the ability to data mine and snoop in general, CorpMed will have nothing to do with it. Sad.

      • guest

        well said!

  • http://onhealthtech.blogspot.com Margalit Gur-Arie

    I have to wonder how long will it take folks to figure out that the magic of ATMs, consists of the computerization of 4th grade arithmetic operations, or that an EKG costs less than 10 bucks and the ER doc would repeat it no matter what.

    I also have to wonder about the importance of something that neither doctors nor patients seem to care about very much. So who is this solution in search of a problem important to? Do we need to buy this stuff (and fund it with tax revenues) just to make “every major tech company in Silicon Valley or every investment firm on Wall Street” happy and prosperous?

  • azmd

    This is a pretty easy question to answer, and the answer is even easier than how can we “pressure physicians to join the 21st century.”

    We are already in the 21st century, and the vast majority of us use technology in every aspect of our lives, especially in those areas where the technology makes it easier for us to be more efficient or more effective.

    If someone can come up with an EMR platform with a seamless user interface and good functionality for clinical care, I am very confident that physicians will be clamoring for it. No pressure whatsoever will be required. However, physicians are not dummies. Continue to present us with EMR systems which are clunky to use and make clinical care more cumbersome, and we will continue to be unenthusiastic.

  • goonerdoc

    Is this for real?

  • Steven Reznick

    Information isnt exchanged because physicians are short on time and do not make the effort to get the information. Last year I had a patient on a cruise off Vietnam who went into atrial fibrillation. Using computer screens and fax machines and the telephone everything including imaging, old EKGs. real time rhythm strips was exchanged. I spoke with her cruise ship physician and her wonderfully well trained cardiologist in a hospital in Ho Chi Minh City. It required time, desire and effort.
    I have had electronic medical records since beta testing a system twenty years ago. I am fortunate and able to touch type easily. They make my job MORE DIFFICULT. Meaningful use adds time and tasks to my day to document the requirements even though i perform them routinely before they were listed by EMR and the feds as being meaningful and more than just solid good medicine. The major benefit i see to them is that they eliminate the difficulty of reading difficult handwriting. Beyond that they are a tool for billers, coders, government regulators, insurance company regulators and other non medical players who have made a small fortune reaching into physican and patient’s pockets and picking them clean over the last twenty years. Add to this the mega computer manufacturers and their vendors.
    It is amazing how many resources I must use regularly to get answers wondering if I and my EMR are hitting the triggers for meaningful use and PQRS
    You want us to move into the 21 st century well the government should have held the computer manufacturers and vendors financially responsible for getting our staffs and providers trained before they got paid. If the burden was on them the systems would be far more user friendly and the training would be superior , more hands on with help far easier to obtain than it is now.
    This is an other example of a well paid non practicing executive in a very large practice group trying to tell the 1-5 provider practices what they should be doing.

  • Marian P

    I believe in the EMR in theory and have used several over the last decade or so. BUT they don’t save time-far from it. They improve billing and coding, certainly, and allow third parties to collect data. And in my experience patients DON”T like them-they hate that you are looking at the screen instead of them ( I hate that too) and they think it’s creepy and the government could get a hold of their records ( which is probably true,especially if you have Medicare or Medicaid, and is also true of handwritten records but somehow it’s not as salient.) I would not want to go back to paper because of the handwriting issues and the need to flip through charts to find data-labs, X-Rays, etc that is nicely organized by a good system. But it’s no panacea and adopting an EMR is torture at the outset, and no one is going to pay you for it.

  • azmd

    And actually, I would be perfectly delighted to not have to treat Silicon Valley executives or Wall Street bankers, thank you very much. But there’s an interesting level of arrogance in the assumption that that would make a difference to me and the decisions I made about my practice.

  • LeoHolmMD

    CEO, plastic surgeon. Have you ever touched an EMR? You type in your OR notes and click all the meaningful use buttons? Adoption of health IT has not produced data on saving time, money, lives, repeat testing or anything else. But perhaps that can be forced into existence as well.

  • Lemmethink101

    When can I START to comprehend written medical records without assistance of “specialists”?

  • buzzkillerjsmith

    So this guy wags his finger at us in the first few paragraphs for resisting EHRs and then goes on to tell us what pieces of junk they are. He then tells others to pressure us to use these crappy EHRs.

    What’s his game here? Kaiser has EHR, forcing docs to stay late to jockey it of course. If he can fool the masses with this stuff he might get extra business. He also might be trying to put small practices out of business. Very slippery of you, Dr. P.

  • Anthony D

    A typical rant no doubt!

  • Thomas D Guastavino

    I currently drive a 12 year old because it is reliable and runs well. Why should I be bribed into buying a new car that I know is a lemon? It is clear that the current EMR systems were rushed because the government needed a tapable database in place before the full implementation of the ACA, including accountable care.
    When one is a big fan of technology one tell the difference between good and bad tecnology. To call the current EMR systems simply bad would be being too kind.

  • Marian P

    The doctor really isn’t trying to avoid eye contact! I try to spend a few minutes talking without the computer, then announce I’m going to start using it, then strategically look up if the patient seems upset or something. Also, most systems have places that are marked “confidential” and the secretaries etc can’t look there. And if it’s really private and not absolutely essential to your medical care ask the doctor not to include it.

    • Disqus_37216b4O

      “Also, most systems have places that are marked “confidential” and the secretaries etc can’t look there.”

      Post-IRS, NSA, Wikileaks, etc, plus every all the other “inadvertent disclosures” of info that people have thought was private but which ended up going viral on the internet, you expect patients to believe that when you enter /their/ private information on a computer, it has even half a chance in hell of /staying/ private?

      A doctor might need to know that one of their patients had an abortion as a teen. The IRS, the NSA, Big Pharma datamining apps, and that patient’s nosy sister-in-law whose best friend happens to be temping in the doctor’s office this week do NOT need to know.