Thursday, January 06, 2005

Some Thoughts on Healthcare in 2005 

So, I went to see my doctor yesterday, and some things struck me. This is my first doctor apart from my previous life-long doctor back home, or going to student health. Some things surprised me.

For example, there was a constant stream of vendors or salesmen or something, men with large bags emblazoned with some drug-sounding name. They'd come in, say hi to the receptionist, and help themselves to go right on back. I don't know what they did back there, I just thought it was interesting. It seemed like every simple object you could think of was covered in a drug-sounding logo. Here, wipe your nose with these Zanaflex tissues. Fill out this form with your choice of pen: Imitrex, Zyprexa, or Cerumenex. Find useful women's health information in this pamphlet, presented by Ortho TricyclenLo.

The thing that most disturbed me was what I saw behind the receptionist. It was a row of gigantic shelves, stuffed with folders, little letters hanging out. The entire office was entirely paper-based! My god, this is 2005. How many of these receptionists are really needed if we were using a computer-based database? How much more office space would there be? How many medical mistakes might be prevented because someone didn't misread someone else's handwriting? Could we see more patients in a given doctor's day? When I had to go upstairs to get a blood test, the doctor filled out this 1950's-era carbon copy sheet and gave it to me to take up to them, and they had to separately confirm my insurance information upstairs. With computers and networking, looking me up in a database would have been instantaneous. How much are we wasting here, across this entire system?

There were some computers around, but they were all DOS-era dinosaurs running in text-mode. I knew that the health industry is notorious for being slow to adopt IT, but this was a shocking sight to me. Except for the cell phones, the entire experience would have looked much the same as in the 80s. I have no idea what they were being used for, but it could only have been a fraction of what is possible. The shame of it is, despite the lousy decor and all that, I thought this was a decent doctor, and the nurses were all attentive and professional.

I think the problem is that doctors traditionally run their own companies, making them into managers as well. I suspect most doctors don't have much interest in the management problems of their organizations, and would rather spend the time seeing patients. That would certainly explain why they seem to do such a lousy job on the management side.

Hey, every problem is an opportunity. Why doesn't some young entrepreneur go out and figure out how to take these management problems off the doctors' hands? Perhaps they can take advantage of the idea that most of the suites in a given medicine-oriented building are taken up with doctors or dentists, and can rent space for a small, shared IT division in one of the suites that runs around and keeps all their systems upgraded and running smoothly. Or they could rent some space in a building that has many other doctors nearby, if the area is more urban. Doctors could pay a monthly IT services fee to get that whole hassle taken care of; doctors can then concentrate on what they'd rather be doing, specialists would keep their IT operations running smoothly, and they would probably wind up lowering costs or increasing their quality of care (hopefully both).

How do you know the men with the large logo bags weren't just employees, who recieved the bags free earlier? "Here Karl, they just sent me another bag, you want it?" It's like how at Sun the distinguished engineer would have these giveaways of all of the free stuff he's been given but doesn't want.

Anyway, it's an interesting post. In San Diego, I went to the Scripps Center for Dental Care, which is where Mother Terresa went when she had an emergency while in the area. (There's a picture of her sitting in the chair on the while.) Anyway, this Scripps place is really advanced:

Instead of separate rooms to see the patients, it's more in a cubicle style. There aren't even sinks at the cubes... I had to spit into a little cup for the mouthwash (while getting the filling, it was that suction thing instead). Each cube had a PC stationed that would have my records. The xrays were digital instead of film. When the hygentist was measuring my gum line, she'd speak into a microphone for the computer to record everything she said (voice recognition). This was more efficient than her having to drop her instruments to type in the result for each tooth, and probably far cheaper than hiring someone to type it in for her. (She had a headphone, to hear what the computer thought she said, but she only needed to correct it once.)

Anyway, as I went from one station, like the xray to the next, my record would follow me. It was like Star Trek.

There still was a large set of paper files, which included a polaroid picture of me so the staff could recognize my face. I presume all of the receptionists look over the photos of everyone who is coming in that day, because they've always recognized me in the times I've gone in.

As for payment, you have to pay the full amount (write a check, whatnot) before you leave. They would always know the exact price of every procedure.

To me, it was just about all you could hope for. I'm not sure how they do it, but their model seems explary.
what really needs to happen is to have a standardized software implementation arranged for the medical world. the problem with setting up a computerized system for one particular doctor's office is that anytime a patient transfers to a different medical practioner, there is no clearly defined method of passing along a digital record if the new doctor doesn't support the same software platform to be able to make any use of the patient's documentation. instead, that convenient new digital record would have to be printed out and subjected to the shortcomings that paper documents suffer from.

people have actually lost portions or the entirity of their medical records due to the current and lousy system of keeping track of all pertinent information on paper and storing such information in filing cabinets.

what ideally should be setup is a centralized digital medical database that can be accessed via any doctor's office, with several backups of the data made on a regular basis. that way, nobody loses their records, and any doctor can dial up the system to find out what allergies a vacationing tourist who requires immediately surgery may have to prevent any malpractice incidents.

however, this would obviously have to be a network that was completely independent of the internet, and non-accessible from standard computer terminals in order to ensure patient confidentiality and to prevent any would be hackers from wreaking havoc on citizens medical histories.
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