November 18, 2012
Healthcare Joins the Growing Paperless Society
By Hawai‘i Island Beacon Community
HILO, Hawai‘i – You haven’t been to your Doctor’s office for a while, and when you arrive, you notice a subtle but definite difference—it doesn’t seem quite so crowded. There are still the same number of patients…oh, you know what it is…all those paper files are gone! There used to be wall-to-wall shelves of patients’ records, and one of them was yours. Now, when the nurse takes your blood pressure and temperature, she doesn’t “write down” the “information,” she “enters” the “data” into a machine. And when the Doctor comes in, he isn’t carrying a paper file with your name on it; he’s carrying an iPad or a laptop. What’s going on? Are you even in the right place?
The change you’re noticing is just another aspect of the digital revolution. For years, we have been doing our banking online. Our groceries are scanned at the checkout counter. A machine checks us in at the airport and issues our boarding pass. Now one of the last holdouts in a growing paperless society has given in—computers have become mainstream in the practice of medicine.
Of course, advanced technology has long been available in healthcare, from MRIs and CAT Scans to the miracles of modern surgery. But it is relatively recent that doctors have been able to throw away all those paper charts and convert to electronic records. And the federal government, which wants to modernize medicine as a way of both improving healthcare, and saving money, by making the practice of medicine more efficient, has offered to help reimburse part of a doctor’s cost of investing in the new technology, figuring that financial incentives will make the transition quicker and less painful, and save money in the long run.
These “incentive payments” are necessary because converting from paper to an electronic system may be seen as desirable, but that does not make it a simple decision. First, doctors and their staff can spend endless hours dealing with endless sales people who are offering endless options. Then once a choice is made, the system has to be installed and everyone needs to be trained on how to use it. The hours, and the dollars, add up. Meanwhile there are patients who are in the waiting room and require care. So some doctors are slower to convert than others, and some probably never will. But the trend is clearly in the direction of less paper and more computerized records.
Should you, the patient, care? To some extent it doesn’t matter; whether the doctor takes notes on paper or on an iPad, she will still use her professional skills and still provide the quality of care that you have come to expect. On the other hand, computers are a great way to organize a lot of information, and if the computer enables the doctor to more easily review your medical history and list of medications, and compare how your lab and test results have changed over time, she will likely be more efficient and accurate in diagnosing your problem and offering solutions. And then, with the push of a button, she can order your medicines at the pharmacy of your choice, there is less chance that the pharmacist will be unable to decipher the doctor’s writing and make an error, and the pills will be ready for pick-up when you arrive. That’s a pretty good deal.
Is there a downside? The most common concern is confidentiality. Health information is very personal, and if computers can be hacked, and we seem to read about that every day, isn’t your most sensitive health information at risk of being broadcast to the world? The answer has to be, “It’s possible.” But if we’re talking about security, we also have to ask “Compared to what?” After all, doctors and hospitals always have had to record information, and if they keep paper files, those files may be seen by other people. With computer records, there are important safeguards required by federal law that are not possible in a paper system, not the least of which is that there is a requirement that the electronic system must keep track of every person who looks at any file. The system is not fool-proof; no system is. But whereas a paper file can be opened and looked at without anyone ever knowing, the electronic file is password protected, the identity of people using the file is recorded, and there are big penalties in the law for violating someone’s confidentiality. A patient can feel confident that privacy and security have been given very high priority when it comes to electronic medical records.
Next time: “I don’t have just one doctor. He’s referred me to a specialist, and I’ve seen a couple of other doctors in the hospital, and every office I go to, I’m asked the same questions over and over again. Don’t these people talk to each other?”
This column is provided by the Hawaii Island Beacon Community, www.hibeacon.org. Special thanks to the Hawaii Tribune-Herald for its courtesy.