Doctor No

I am sitting in the doctor's office waiting for my eyes to dilate, wildly searching the room for something to read or do. Of course there is no open wireless network for patients, and there are only half a dozen dog-eared magazines. Four of them are issues of either "Outdoor Life" or "Field and Stream." The other two are "Elle," a magazine I never read, but happened to find at the spa last week while I was getting a pedicure. So I had read the two-month-old issue at the doctor's office. Same thing with "Entertainment Weekly," the September issue about "Nip/Tuck." And the TV monitor wasn't connected to cable, and was there only to play patient education films.

Why isn't there more customer service, I always ask myself? Why don't they visualize themselves in these aptly named waiting rooms and make something interesting out of them? Why? Because doctors feel that they have it tougher than their patients do, seeing high volumes of patients with low reimbursements in an unfulfilling rat-on-a-treadmill fashion, and they are awash in self-pity (if they can't afford to retire). This is not why they went to medical school: they went to medical school to help people. But all they do is shuffle paper.

It has taken me an inordinately long time to figure out that doctors are unproductive and inefficient about the way they run their offices, and it trickles down to their patients in a kind of misery-loves-company way.

For the last year or so, I've been meeting with a group of people who are trying to break the cycle of inefficiency in Arizona through the better use of information technology in small physician practices-- which make up the bulk of the health care delivery system in the state. After thinking about it, we formed a not-for-profit called AHITA -- Arizona Health Information Technology Accelerator. That was about three months ago. We spent the next three months gathering information on national models, early adopters, vendors, case studies, white papers, ROI to the practice, ROI to the patient, ROI to the insurer, etc. We are knee deep in national initiatives, local committees, and partnerships. We know that in most cases, after plunging into the icy water of automation, early-adopting docs who have gone to EMRs, or EHRs, have increased their revenues, lowered their expenses, and saved themselves a wad of time.

The evidence is all there. And we don't want to make money from this. All we want to do is mak everyone's life a little easier -- ours and our doctors'. We want to help physicians navigate the myriad of funding, vendor selection, data migration, work flow changes, and psychological barriers that keep them from adopting products are not only ready, but have been ready for years. Dozens of medical software companies have gone broke trying to leap across the chasm from early adopters to the mass market.

It's the original chicken-and-egg problem, however. Because the offices are so inefficient, the doctors are crushingly busy, especially in Arizona, where there is a real shortage of doctors to service a rapidly growing (and aging) population. It's tough to get to see a doctor when you want to pay him, much less when you want to sell him something -- or even sell him ON something, like why to risk automating his health records rather than paying for the extra room of real estate necessary to house the paper records of some 4000 patients (at least).

So there I sat, entering my name, social security number, date of birth, and family history on probably the twentieth paper form attached to the twentieth clipboard of the year. And there sat the front office person, scanning my insurance card for the twentieth time.

I realize I've written about this before, but it never ceases to amaze me. You can have LASIK surgery in less time than it takes to fill out the form in the surgeon's office.

technorati tags: EHR, health care, electronic health records, medical informatics