So easy a child can do it

Tags: fiesinger, president's letter, electronic, technology, health information technology, ehr

By Troy Fiesinger, M.D.
TAFP President, 2012-2013

When we walked into the dentist’s office, my kids ran straight up to the computer to check in for their appointments. This was my first time to take them to the dentist, as my wife usually drives them. My son and daughter quickly entered their names on the touch screen, grabbed books, and took their seats. Freed from manually registering patients, the front-desk clerk monitored patient flow and welcomed everyone to the clinic with freshly-baked chocolate chip cookies.

Later that day, I went to my doctor’s office where I signed my name on a clipboard and patiently waited in the lobby as patients have done for decades. His office has the same electronic medical record as mine, but his clipboard system has not changed in decades. My clinic has an electronic medical record with a web portal and secure patient e-mail, but our patients still queue at the front desk to give their information to a clerk. At the gas station, I swipe my credit card and fill my gas tank without talking to another human being. At the airport, I walk up to the kiosk, insert a credit card, and print the boarding pass for the flight I checked in to the night before. We expect businesses to adopt the latest customer service technology and embrace their use while we keep our clinics in the technological dark ages, suspiciously questioning each new innovation. We complain about the inefficiencies of our EMRs but are slow to adopt innovations to improve the efficiency and ease of our patients’ visits to our offices. Are we so focused on our frustrations that we forget our patients?

Some of this skepticism is well founded. For the past four years I have used the same EMR software I helped implement in my own residency 14 years ago. I can do work but do not save time. It still cannot talk to the hospital system so I do not have to look up the results of lab tests drawn five miles away. Although the computer file format that allows EMRs to communicate with each other has existed for years, I recently read another editorial lamenting the lack of interoperability between competing software products. While I firmly believe that such technology can improve patient care, these benefits are far from inevitable. In the United States, we believe in the goodness of technology like an article of faith. If you don’t think that technology will make your life better, you must be old-fashioned, or tragically unhip. Too often, however, we fail to adequately question whether the benefits the vendor promised are as good as advertised.

In a recent discussion thread, colleagues compared the latest fitness apps for their smart phones and GPS-based devices. I have tried similar devices but have found an “old-fashioned” running watch to be far more reliable. While I enjoy my smart phone, tablet, and laptop, I think we must still channel our inner Luddite by asking: Is this technology really improving our lives as much as we think? Are there unintended consequences we will regret in years to come?

On the other hand, we shouldn’t simply disregard potential benefits based on such concerns. If my children can check in to their own appointments, why don’t we make this available for all our patients? If my 80-year-old patient can learn to use secure e-mail to communicate with me, why can’t you? If my 50-year-old patient on Coumadin can check his own INR at home, e-mail me the results, and adjust his medicine based on my e-mailed response, why don’t more patients adopt this technology?

My father learned engineering with a slide rule, was one of the first to use the “revolutionary” Hewlett Packard desktop calculator, taught himself DOS and Windows a decade later, and now is mastering the iPad. While he is not sure he likes how the screen orientation changes when he turns it, I doubt he would give up his iPad for a slide rule. Such technological changes are inevitable, but our responsibility is to ensure they benefit our patients. The genie is out of the bottle and it’s too late to put him back.

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