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Can High Tech Happen on a Low Budget?

August 31, 2009
by root
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Dear Mr. Guerra:

In May, you noted that HITECH is going to render the solo or small group medical practice extinct. Maybe. On the other hand, there is not enough capacity in larger groups and in hospital-based groups in the U.S. to make up for those losses. I work in Western Massachusetts. We do not have a region that can take care of patients according to your paradigm. We have a semi-rural, distributed care network that will go “high tech” at its own pace, with the need for someone to infuse the capital to allow every office to do its conversion to all-computer.

I want to indict your industry overall as a major impediment. The high tech mavens and IT administrators say that everything is good and wonderful, confetti and balloons, when at the grass roots level, they do not know what they are talking about.

Does anyone care whether the new and better computer systems make my work as a physician less efficient? For example, we are going to start using e-scription (a Dictaphone product) next month. With the need to put patient identifiers into the system, at normal pace, and with the prompts that actually slow me down, I will lose an average of 7.5 minutes each day for just the task of getting to the point of dictating. With the need to log onto the hospital system and stand around waiting for it to get its act together, I will be wasting nearly 20 minutes each day overall. That is one to two office visits that can't be seen. Where is the immediate payback? Does the IT industry expect me to work longer hours? My staff certainly does not want to support more hours; they do not want overtime! It is the patient who loses immediately, as access suffers.

You can successfully argue that having my records in a centralized repository is the benefit. Sure, a boon to a point. However, the system is predicated on the $200/hr doctor doing clerical work that normally costs around $12/hr. This is totally stupid!

Oh, let's discuss another abject failure of the IT industry: regional integration of information. All of your articles are focused on systems that are fundamentally based on single hospitals or their corporate networks. Yes, you have written about RHIOs, but they are vaporware. What happens when I need to refer a patient 90 miles away to Boston? We drop to paper. The images go to CDs and everything goes by USPS, just as it did ages ago. If I get a doctor on the phone with a referral, and he/she is not in my immediate area, that doc can't look at my hospital's records. There is no way for the Cerner system we have, or Meditech for that matter, to have me issue a temporary password for that information to be shared while we discuss the case. I can't do data dumps, either. If the patient is being sent away for care, I can't burn a CD with the information in a manner that will allow the away doc to see what is going on before the patient arrives.

My indictment is that the IT industry is not thinking outside of its corporate boxes, and they are not sufficiently asking doctors what is wrong with their solutions.

Sorry for the J'accuse letter to start your week, but your note from May really struck me as one of those “throwing the baby out with the bath water” sorts of expositions. We are headed for a real doctor shortage in this country overall, and we have a current shortage in numerous areas, such as primary care, exactly the docs who are not sufficiently rapidly adopting the IT solutions your advertisers tout. You are wrong in your editorial. We can't afford to lose those docs. If the IT industry does not realize that it is not getting its solutions to the grass roots physician, then it has become the problem, and it will fail its mission to improve the healthcare of the United States.

Jeffrey Kaufman M.D. F.A.C.S.

Baystate Vascular Services

Springfield, Mass.

Healthcare Informatics 2009 September;26(9):12