The Book of Trickle Down Technology

In Michael Savage’s new book Trickle Down Tyranny he writes that that we are living in an American economic nightmare.  That may be true.  When the Social Security fund is running out of cash and millions of homeowners are either underwater with their mortgages or facing foreclosure, it certainly looks like another Greek tragedy.  For doctors, it is a crucial time as well.  Many have been forced to take a long look at what the future holds when it comes to updating their practice to conform to the requirements set forth by the U.S.government.  These “technology” changes come at time when the healthcare industry is under immense pressure to conform to a system which they are unfamiliar.

For decades medical practices have been struggling with the prospect of moving from paper-based records to electronic medical record (EMR) systems.  Now that this has become a reality, there are still factors that are limiting some practices from moving forward, whether it is the cost of the systems or fear of change.   There are obvious benefits and significant operational, clinical and administrative areas that should be examined while taking the next step in healthcare technology.

There were very good reasons for a low rate of adoption of EMRs five years ago.  The concerns were obvious; the cost of buying and implementing, the potential disruption to daily operations and the reliability of the technology. With the regulatory mandates that have been set forth, these concerns have increased.  But with the emergence of financial incentives many physician practices have come out of the cold to embrace these changes and are finally making the transition.

A practice that is moving from physical to digital recordkeeping will understandably have concerns about the reliability of systems designed to support electronic records. If a computer goes down while making clinical notes during a patient visit, many questions arise.  When a system crashes and takes all the electronic records with it, what are the consequences?  A diligent evaluation of different systems will be required to address these concerns.

The hope for the future is that these technologies will save us from inefficient, redundant and disconnected healthcare.  But a recent article published in the Journal of American Medical Association (JAMA) suggests that high EMR adoption will not necessarily lead to increased data exchange.  Because of the lack of interoperability and privacy concerns, many physicians have voiced their displeasure with meaningful use standards.

Julia Adler-Milstein who wrote the JAMA articles says patients who take their health information with them to another provider create a competitive disadvantage to some physicians.  Using data from past encounters to make treatment and diagnosis decisions is a new issue that many doctors may resist.  The article goes on to point out the inability currently to facilitate information exchange between physicians.

Stage 2 of meaningful use rules set a higher bar for physicians to transfer patient data upon referrals.  This could encourage physicians to loosen their grip on patient health data.  Stage 3 might go even further with respect to data transfer.  There is a trend toward team inspired treatment.  Healthcare can change for the better if there were greater incentives for physicians to share information with the other doctors and really make patient-centered care the attitude of the industry.




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