An editorial in today’s New York Times highlights a sleeper sort of problem with big implications for anyone who goes to see a doctor: American medicine’s stubborn refusal to embrace computer technology when it comes to medical records.The numbers, from a recent survey conducted by researchers at Massachusetts General Hospital, are eye-opening: “a paltry 4 percent of the doctors had a ‘fully functional’ electronic records system that would allow them to view laboratory data, order prescriptions and help them make clinical decisions, while another 13 percent had more basic systems.”
“This,” the editorial continues, “is a startling contrast with other industrialized nations. A 2006 survey by the Commonwealth Fund found that nearly all doctors in the Netherlands and the vast majority in Australia, New Zealand and Britain were using electronic medical records. Denmark has a comprehensive health information exchange that allows doctors to see all medical care and testing provided to a patient. They can even see whether a patient has filled a prescription, which is information that most American doctors lack.”
When I read something like this, I think of the several-inches-thick manila file folder with my name on it at Dr. Lerner’s office. Everything else in that office is shiny and high-tech. Sophisticated machines analyze blood samples in seconds. Medications are stored in a smart refrigerator, to which nurses can gain access only by keying in a security code and a patient I.D. number. Even patient appointments are managed by a computer scheduling program.But patient medical records? That otherwise high-tech office is still in the era of dog-eared, photocopied pieces of paper stuffed into bulging files.
This is in stark contrast to the Memorial Sloan-Kettering Cancer Center, where I go for my second opinions. Most of that hospital’s record-keeping is paperless. When I checked in for my first outpatient visit several years ago, there wasn’t even any insurance paperwork to sign: they had me sign with an electronic pen, on one of those machines they use in department stores for credit-card signatures.
There’s a huge cost to maintaining and archiving paper records. There’s also a significant potential for errors, especially when it comes to prescriptions. Jokes about doctors’ poor handwriting aside, there are computer programs that can flag medication interactions and simple scribal errors, as a back-up check on overworked doctors and pharmacists.
Why is it that American doctors have been so slow to embrace this technology, when they’re on the cutting edge of so many other innovations? The Times editorial writers have a theory: “The chief reasons American doctors cite for not moving into the electronic age is the high cost of buying and maintaining the equipment, the inability to find a system that met their needs and a concern that a system would quickly become obsolete. Other industrialized nations have moved faster because of strong national leadership in setting standards and helping to finance adoption”To these reasons I would add another one: fear of litigation. With medical-malpractice lawyers potentially tracking their every move, doctors are fearful of letting go of every little piece of the paper trail.
It all boils down to the inefficiencies of America’s patchwork quilt of small, independent medical contractors, living in fear of predatory attorneys. Countries with a national health system have a powerful incentive for adopting record-keeping standards and developing computer systems (and backups) that work. They also typically have some limits in place when it comes to medical-malpractice lawsuits.
It’s the patients who pay the price of these inefficiencies, of course – both in financial terms, and in terms of human error.
Time for a change?
