Technology has been moving at a lightning pace the past two decades. Technological advancements have crept into every facet of life, from HD screens that now blare ads at us at gas station pumps to disruptive start-ups like Netflix, Airbnb, and Uber, which have rocked entire industries, the air of change is inescapable. The medical field, on the other hand, remains in many ways the same as it has been for decades. Today’s doctors still link with archaic tools like pagers and fax machines while some outliers still even keep paper records. We must stop and ask why we’re falling so far behind.
As a physician training at a nationally recognized academic hospital, I frequently find myself having to rely on patients with ailing memories or those who can’t even reliably breathe on their own for their medical information. We have no reliable centralized databases or streamlined methods of sharing information between various providers and facilities, and this is the norm all across the nation.
Despite the constant chatter in the medical industry about launching the latest wave of electronic health record (EHR) implementations, the modernization of records and communications in medicine leaves much to be desired. Today when admitting a patient to my team in the hospital, I’m lucky if have access immediate to their records from our own hospital and physicians affiliated, let alone outside facilities or unaffiliated physicians. For that information, I must embark on a drawn-out process involving numerous frustrations involving printers, paper forms, and a most perplexingly trip to the 1980’s to use fax machines. After completing a process that can take up to one or two days (to have the required paperwork filled out and elicit appropriate cooperation from necessary parties), I may or may not have access to the records I need.
Despite all that, this is the preferred method of transmission in modern hospitals, where the aim is to provide efficient and expedient care to save lives. The common answer cited as to why we still use fax machines is for “security” concerns. This despite the fact that fax machines have no inherent security features and are subject to security breaches anywhere from transmission to having someone simply intercept the incoming document at the destination.
Certainly, over the past decade, some technological progress has been made, though at a breathtakingly unhurried pace. Part of the problem lies with the traditional, hierarchical structure of medicine, which makes change inherently slow and difficult. Older, tenured and influential physicians who in the past have set pace and made the rules are now giving way to a new generation of doctors who see themselves less as officers marching down the wards, drilling interns and barking out orders, and more as leaders of an interdisciplinary team of caregivers.
The more significant hurdle we face, one which is perhaps less amenable to change is a burden of outdated regulations resulting in an overly bureaucratic and litigious culture of medicine. Certainly, the vast majority of physician and medical providers just as attached to their mobile devices as anyone else today, yet by hospital and health care organization accrediting bodies we are barred from communicating via these devices.
While there several innovative and useful apps such as Doximity and Spruce have come online in the past several years, offering direct, secure communication and even the ability to send and receive documents securely and instantly, adoption of such apps has been sluggish at best. The reason is undoubtedly at least in part due to fears over violating the important but much feared Health Information Portability and Accountability Act of 1996, or HIPAA as it’s commonly known. That fear is for good reason, given that an accidental violation of the act can result in a fine of up to $50,000 per record, whereas repeated or willful violations can result in fines as high as $1.5 million.
As an example of just how crippling fear of violating this law can be, I recently witnessed an incident in which one of my colleagues was treating in the midst of treating a patient with a life-threatening condition which results in uncontrollable seizures. He was attempting to reach the patient’s primary doctor to get some vital information; a task that one would reasonably expect to be rather straightforward. Straightforward, however, it was not: the manager of that physician’s office who answered the phone refused to allow my colleague to speak to the physician without having him print out a release of information authorization form, track down the patient’s next of kin, have them sign the requested form then have it faxed to their office — all the while the patient awaits, life in jeopardy.
As time goes on, social and technological change will invariably make their way into the field of medicine. Like with all aspects of our society, the social progress will occur inevitably as a new generation of caregivers enters the prime of their career. Nevertheless, we still find ourselves faced with archaic rules, habits, and laws from a time when paper charts ruled, and beepers were the height of telecommunications. While we continue to endlessly think and rethink health care reform and examine differing methods of providing improved access to medical care for all Americans, perhaps we should also spend some time examining this challenge, which presents an inherent barrier to maximizing the efficiency of care being provided. Perhaps by reshaping policies to be more in line with technological advancements, we can make the care we are already delivering more efficient and thereby expand access to care while keeping costs lower for everyone.
Mazen Elkurd is a neurology resident.
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