Modern Medicine is in a state of technical antiquity

Over the past week I’ve interacted with our healthcare system in 2 ways:

1. Drug test for a new employer at Quest Diagnostics
2. Internal Medicine Appointment (Nashville, TN)

I’ve begun to realize just how far we HITmen have to go.

Question Diagnostics:

Though much work has been done by Quest to modernize their offering – integrating with Google Health & Microsoft HealthVault as well as Keas.com, little of that work is “sold” at the point of care offices. All of the technical effort is shoved aside, relegated to office corners, standing up as cardboard kiosks offering colorful brochures.

Like autumnal leaves scattered about the office, the brochures add color to an otherwise drab office but garner little attention beyond a few glances.

I came with a paper receipt, pre-filled out, in carbon-copy triplicate. The Quest tech dutifully tore the sheets apart, filed them in overfilled drawers and shuffled me to the back. I did my duty and was escorted out of the office without any mention of Quest’s technical offerings. Frankly I’m not sure she even had a computer, but I am sure she didn’t know anything about Quest’s many high-tech offerings.

As a technologist, I’m saddened to see so much effort ignored – so much value lost.

Internal Medicine Appointment : Baptist Hospital

I had a 3:00 PM appointment, I arrived at 3:05 PM was called to the back at 3:25 and finally met a doctor at 3:45 PM. Sadly typical, but what amazed me was the state of modern medicine. This is Baptist Hospital in Nashville, TN. The doctor’s office was on the top floor of a well designed, aesthetically pleasant 9 story building that towered over the Emergency Room where my father worked for 25 years as a E.R. Physician. But after my appointment, I wondered if much had changed since my father saw his first patient all those years ago.

The waiting room had modern touches: dark, wood flooring, subtle, ambient lighting, appropriately upholstered and fairly plush seating, but true to my past experience with doctors I received the age old wooden clipboard filled with a small stack of papers asking the same tired questions I had answered over the past thirty years. Age, Sex, Name, Medications, Medical History…

I asked the nurse if they had PHR, EHR or EMR – then I saw the phosphorous green screened machine she punched my credit card into, I was amazed to hear the dot matrix printer produce a double ply receipt -- I received the carbon copy. I shook my head – definitely no EHR or PHR. I explained the difference between the three, the nurse said they had some new software called NextGen (http://www.nextgen.com/), but she couldn’t tell me anything beyond that.

She drew her hand over her head, meaning she didn’t get any of the technical points I was trying to make. So I sat down with everyone else and filled out the forms with a blue, ballpoint pen.

The Technician

Once I got past the waiting room, I was led around by a unenthusiastic technician. I asked how her day was, “okay I guess.” I noticed the Fuji Lifebook she carried, and as she entered my weight (195 lbs – about ten pounds too heavy) I asked her how she liked the software she was using.

She turned the book around and showed it to me. A Windows based application with straight forward forms – 2 ways to enter data: 1) Stylus or 2) Keyboard. Though she used the software without a hitch, she hated it.

“It’s slow. Too complicated. Pens and paper are faster.”

I didn’t try to change her mind; she must have been having a bad day. I kept looking at the software. Hard to say what software package they were using, but I’d imagine it was Enterprise Practice Management:

NextGen EPM can centralize appointment scheduling, billing, collections, and other business processes for group practices, while preference settings allow different locations, and in some cases staff, to operate according to their own workflow.

Workflow flexibility is the key to productivity. Yet, management can control business processes across practices because data is collected and centrally stored in a standardized, discrete format.

This gives practices real-time access to patient records from any location, to reduce redundancy and errors – and to provide patients with better service. At the same time, managers have instant access to reports, for financial and operational analysis, that are built into the system.

NextGen EPM features other practice-configured automation tools for increased productivity and management control, such as WorkLog Manager and Autoflow, a computer-guided check-in/check-out process.

NextGen is more than vendor – we are your partners in the development and growth of your group practice. When you collaborate with NextGen, you benefit from our:

• Customized workflow that is uninterrupted, as standardized, discrete data is collected for pay-for-performance, business analysis, audits, outcomes analysis, and more.
• Single-vendor solution for integrating your administrative and clinical processes on one system for streamlined, consistent patient care.
• Stability as the most financially secure, publicly traded (NASDAQ:QSII), company in our market space, with over a thousand employees and growing.

Waiting for the Doctor

I waited in a patient room for twenty minutes. Frankly I could have used a bit longer to take in the sheer antiquity of the place. The walls were brown with a dark brown trim and dark oak doors. A mercury filled blood pressure cuff hung from the wall like a historical relic, but the technician used it ( 120 / 80 – good I was told ). A white melamine storage cube stood over an old, worn gray bed with crisp white paper covering the creased and cracking plastic cover.

The whole room felt old and out of place. The clean white linoleum floor looked sterile, the room out of some forgotten time. There were no modern amenities. Everything in that room could have come from the 80’s or 90’s – nothing hinted at the 21st century. Even the off white, plastic phone that hung on the wall communicated one thing: Modern Medicine lived in a strange reality unaffected by technical change.

In Healthcare IT we obsess over security and privacy, but those ideas were as absent as interior design. The walls were paper thin, and even the leaky faucet with its persistent drips couldn’t compete with the candid discussion going on in the next room.

The conversation was morbid, depressing – literally. The doctor advised his patient that Valium could not be used to solve anxiety in the long term. The patient discussed her bouts of depression. The doctor asked if she’d considered suicide, and she indicated there were episodes of depression in her family but that’s as far as it had ever gone.

I wasn’t prying. The conversation was loud, for a moment I thought amplified. I couldn’t ignore the conversation, they might as well have been in my room. Thankfully my doctor came in before the prognosis next door got any worse.

Meet My Internal Medicine Doctor

He was older, in his sixties, he had the same gate and demeanor as my father. He held his Fuji laptop and stylus in the same way that he had held a clip board and pen over the past thirty years. I asked him what he thought about the NextGen software, and he showed it to me with deliberate patience. He picked at the screen and navigated the forms, but he smiled when he said “I’m from the old guard. We don’t get used to computers easily.”

But he liked the software (EMR), not for the reasons that he should – for the value that we in IT should provide. The software didn’t help with the diagnosis or suggest tests or even provide an optimized, world class workflow.

My doctor admitted that this is the way of the future, but I was more interested in why?

1. No more lost charts
2. No illegible notes

To him NextGen was merely the next generation clip board. I smiled looking around that old room, at his well worn, wrinkled fingers as they hunted one key after another. Beyond that laptop, the only thing indicative of the 21st century was the the Sports Illustrated sitting on the windowsill – November 2009 edition. I walked out of that anachronism and into the modern world realizing just how far we HITMen have to go.

In the Media: NY Times { EMR No Measurable Benefit }

http://www.nytimes.com/2009/11/16/business/16records.html?_r=1

A new study comparing 3,000 hospitals at various stages in the adoption of computerized health records has found little difference in the cost and quality of care.