Why are doctors offices so low tech? I recently went to a new doctor and had to fill in over 10 pages of paper forms. Listing all of my allergies, past medical history, etc. I can’t think of any other place in life where I have to write so much down with pen and paper. The doctor insisted I get there 15 minutes early to the appointment so I’d have time to fill out the form. It seems ridiculous that every time I go to a doctor I have to go through this tedious and error prone process of ransacking my memory for what things I’m allergic too, etc. Writing down my date of birth as well as how old I am (can’t they do math?). They also insist I write down my insurance information and also photocopy the insurance card. I really feel like they will be treating me with leeches after such a medieval check-in procedure.
It’s been years where at least I have not been offered a chance to do this before I get to office via an app? if you don’t do that then you are handed the papers in office. Seems like most are using some version of the mychart app.
from the doctor’s perspective going into more IT raises their cost (IT staff of questionable skills that need managing by doctors who have other things to do and do not know IT anyway) and added risk of non conformance with complex privacy laws.
as they say on the telly “Ask your doctor” as their response will be better than above as i am just speculating. as so many others will be same.
That is a topic near and dear to me as an engineer and former software dev (more years ago than I will confess) who has run a solo medical practice for almost 30 years.
There are a few reasons which result in this.
First, systems in a doctor’s office need to work with a diverse group of patients. You might be surprised how many patients are technology averse or even illiterate or have no access to internet at home so are are still unfamiliar using the web. Combining both digital and paper options is possible but can also get cumbersome.
Second, the time to achieve a return of money spent on software can be substantial and the cost to transition systems can be even more substantial. For a small practice it can be most efficient to have paper as a primary means of collecting data from patients; the advantages of a digital system come mostly to large practices. And while there are “free” cloud-based offerings, the doc cannot necessarily count on those staying free forever and there can be a very real cost exporting such digitally siloed data into another system in the future.
Third and most notable by far - there are very important rules on protection of privacy which are required in medicine for both legal and moral reasons. Particularly for docs who are not highly tech savvy, it is not as simple as buying off-shelf consumer software and installing it in their office; it may be necessary either to work only with softare vendors who sell HIPAA-compliant versions of software or to hire a consultant to assure the office IT systems are HIPAA compliant.
A related issue is the extreme importance of being sure no digital records are lost and thus how to set up a totally bulletproof backup system while at the same time not violating patient privacy. This may not be a big deal for a doc who is a techie but can take quite a bit of money (with minimal ROI) for docs who have to outsource this to a consultant.
You are quite correct @rms - you just said very concisely what it took me a lot longer to say in my post that I wrote simultaneously with you.
One of the specialist doctors that I use joined the health care organization where my PCP works a few years back. That means that this doctor’s office now has access to all of my electronic records. His office still wanted me to fill out paper forms when I last visited. New patient forms because it had been a few years. This stuff is all in my electronic records. That’s all been set up for them and they have terminals with access to the system in the office. I still had to copy it out onto their forms. Forms that they neglected to send me and then had the nerve to call and complain about not receiving. That they then sent to my PO Box so late that I had to make a special trip to pick them up. It was all so, so annoying.
In this case I’m absolutely sure that it’s his staff. They’ve been doing things the same way for a long, long time. Nothing has changed there in the many years I’ve been using him.
I’d switch to another specialist if he wasn’t the only one in this small town.
I wish it were that simple. The amount of times I’ve pre Filled out paper work online to then have to refill out paperwork at the office is way more than I would like.
I will say though, that usually happens with more private or smaller practices.
It’s been years since my doctor first walked in to my examination room with an iPad. And I still need to come in 20 minutes early to verify my insurance, etc. and answer some routine questions - on an iPad. But since Covid we do it over the phone while I’m in my car waiting my turn to enter the waiting room.
“Perhaps none of the initiative’s former boosters is quite as frustrated as former Vice President Joe Biden. At a 2017 meeting with health care leaders in Washington, he railed against the infuriating challenge of getting his son Beau’s medical records from one hospital to another. “I was stunned when my son for a year was battling Stage 4 glioblastoma,” said Biden. “I couldn’t get his records. I’m the Vice President of the United States of America … It was an absolute nightmare. It was ridiculous, absolutely ridiculous, that we’re in that circumstance.””
- Death by a Thousand Clicks, Fortune 2019
Be careful what you ask for.
A self-employed doc in a small town may not have the tech advantages of a big practice but he also has the independence to run his practice as he sees fit. The same big practice manager employers who provide office computers systems may mandate only 12 minutes per patient or other similarly inefficient rules.
The doc with the confidence and personality to run a small practice in a small town because he values his professional autonomy may also be the doc with the perseverance and ability to spend as much time as needed with you solving a complex medical problem. That’s way more important than a computerized medical record.
Your comment about government funding of medical records in 2009 (“Meaningful Use”) brings up a related issue which is way, way more important than whether you fill in information online or your doc scans in paper… interoperability of medical records.
It is stunning how so many industries have learned to integrate information - but not medicine. If you come to me as a new patient your prior medical records are so immensely important - but despite government promises, there is no way for me to get those online. You have to sign a form which is then faxed to each of your prior doctors, who in turn fax back records. How much better medical treatment would be - both in terms of increased quality and reduced cost - if you could enter a password authorizing me to access your records online immediately. That would be infinitely superior to the disinction of whether you fill out forms in paper or digitally.
Sadly one of the biggest obstacles to interoperability of records is not technology or law - it is economics. Big hospital systems want to keep you in their system - and the harder it is to transfer your records elsewhere, the less likely you are to go for a second opinion elsewhere or add a new consulting physician outside of their system.
Ive read that some of the friction is intentional. For example, you walk into an Urgent Care. The desk lady directs you to a triage nurse. That nurse gets everything from you, and you go into a room. The doctor comes in and manifestly has the notes from the triage nurse, but they make you repeat everything.
Apparently it has to do with people omitting things unintentionally, remembering other useful info, etc.
Not saying that explains all the duplicate paperwork and such - but sometimes some duplication is intentional.
We have a national electronic platform based on HL7. Health Level 7 - Wikipedia
From X-rays to invoices, no paper. Unless wanted.
I will just tell them give me the print of my existing file and I will update if anything is missing. Else it’s all the same.
I even tell the front office you are supposed to hold on to my records. So have it ready before my appointment.
True but it is a bit more naunced than that.
To a large extent, doctors are paid by insurance based on what they document, not what they do. If I see you as a new patient and review all your records, I cannot just document “Read old chart.” I have to list the details; otherwise insurance will not pay me for the visit or will downcode the reimbursement significantly.
Equally important is malpractice risk. I cannot simply document “Agree with Nurse X” or “Agree with prior records”; I need to document it myself to show I reviewed it.
With regard to either of the above, there is some real danger to simply agreeing with other providers or copying/pasting blindly - the effects can be humorous, legally risky, or outright dangerous to the patient. Imagine being sued for malpractice in what would otherwise be a defensible case but the cross-examining attorney points out that you documented “Symmetrical pedal pulses” in an amputee missing one or both legs; “I just copied that from the other doctor” would not be a very good defense, and even if your treatment were otherwise spot-on, your credibility just went unrecoverably down with the jury.
@rkaplan Has done an excellent job explaining the issues around your frustration. I have a slightly different perspective, I own a healthcare consulting business. We consult with offices on the non-clinical side of their practices. Tech is a huge subject.
The reality is costs, knowledge, and compliance are the big reasons a provider might not have made the transition to digital everything, but for our billing practice we have only begun accepting digital signatures in lieu of actual ink on paper since the pandemic began. Everyone was forced to move this direction because there weren’t face to face interactions very often.
Our industry is certainly behind the times in some areas of tech. But way out front in other areas. It is an incredibly complex business and tracking huge amounts of data and keeping it all secure is a much larger challenge than most people understand.
A great example is text messaging. Almost everyone communicates this way. Most people are comfortable with this method of communication. Our favorite fruit company has encryption on their message app. None of that matters because no matter how safe the communication is, and I believe messages to be a pretty secure method, it is not compliant and never will be unless Apple decides they will sign Business Associate Agreements with doctor offices. Without a BAA signed Apple is not acknowledging the presence of PHI (health info) and therefore is not accepting responsibility to protect that data. Even with all of that said, so many providers text message patients on platforms that they don’t have a BAA signed with it is unbelievable, but it is convenient for both patient and doctor.
I just recently saw a Facebook comment thread about how a huge company got hit with a ransomware attack and was offline for an extended period of time.
There were - no joke - people who were talking about how simple it would be for the company to just plug in an external hard drive to get a backup of their data, and how with that they could’ve been back up and running right away.
But if I have surgery for such and such condition on such and such date, that shouldn’t be a matter of interpretation or dispute. Those are facts that should be recorded in a digital record that I can share with doctors. I know designing such a system is complex and has lots of tough issues I’m sure, but how can it be considered a good system if you rely on the patients memory filling out a paper form?
If I want to transfer stock from one brokerage to another, there is a system setup called ACATS. TD Ameritrade doesn’t just take my word for it that I have 100 shares of Apple. There is an official record that gets transferred from brokerage X to brokerage Y. Why not have a similar setup for medical records? Aren’t they just important as a financial account?
I would imagine medical records are a far more complex thing than stock ownership, and something like a stock exchange or a consortium of large banks is in a good position to centrally dictate how those records are formatted.
I know that records can be transferred from provider to provider, but it’s far from an instant process.
@webwalrus We are a long, long way from transfer of structured data from one electronic records system to another; we may never achieve that.
But we do not need that. 95% of the usefulnes of transferring records can be obtained simply by exporting the record to PDF and then importing that PDF as a scanned document into the receipient doctor’s records system.
The delay in transferring records is notable - typically days to weeks. Technologically it should be possible to happen in minutes - while you wait in your new doctor’s office. But for reasons discussed above that degree of interoperability of records does not exist.
A point I was trying to make (badly, I guess) is that he’s now part of a larger organization and his office still won’t use the digital tools that are available through that organization.
I respect independent providers. But he does everything else through the local health care group now (billing, scheduling, his web presence, …) so it’s hard to see him as one. It mystifies me that his office is still so stubborn about using the old paper forms when they have an alternative that easier for both them and for the patients.
All I got when I asked if I could fill them out digitally was “We don’t have those available there.” That wasn’t quite true (the most generic one was attached to the appointment reminder from that health care group), but it mostly was. Sigh…