Dr. Michael Koriwchak, www.wiredemrdoctor.com
Despite the success of information technology (IT) in transforming many parts of the economy, the health care sector has proven itself immune to the seduction of smart phones and iPads. This is puzzling at first glance. It is certainly not due to any shortage of health IT products. The problem appears to be on the demand side.
A recent article by Olga Khazan in The Washington Post provides some explanation. She reports on the third annual mHealth Summit, held earlier this month in Washington D.C. The event has attracted such notables as Bill Gates and Ted Turner, according to the mHealth website. The piece laments the “enthusiasm gap” between Health IT startup companies offering dozens of miracle products and those darn stick-in-the-mud physicians who just can’t get with the program. But meetings like the mHealth Summit actually hurt the movement of Health IT that they profess to support.
The poster child for Ms. Khazan’s article is Dr. Eric Topol, one of the Summit’s keynote speakers. HHS Secretary Kathleen Sebelius joined Dr. Topol behind the podium. Together they offered Health IT Utopia – where “you can take a video of a rash on your foot and get a diagnosis…without making a doctor’s appointment.” Then they criticized practicing physicians using the same old Obamacare propaganda. Ms. Sebelius continued, “Americans still live sicker and die sooner than many of the people in other nations…Healthcare has stubbornly held on to its cabinet and hanging files.” Dr. Topol called the medical community “ossified” regarding the adoption of health information technology. The author starts the online post-article comment thread herself with the question, “How do we encourage doctors to be more open to these technologies?”
This kind of meeting is common in the Health IT (HIT) community. A bunch of self-described HIT experts get together, pump each other up about the absolute perfection of their products, and then start bashing physicians because - literally and figuratively – we aren’t buying it. At similar meetings I have heard HIT people brag about walking out on their doctor the minute he pulled out a paper prescription pad. Doctors are called fearful, stupid, or rich fat-cats protecting their turf. Now thanks to our “colleague” Dr. Topol we can add, “ossified” to the list of unflattering terms. It comes as no surprise that the government is happy to join in the sing-along. It is a free opportunity to serve Obamacare Kool-Aid.
I am a dedicated supporter of HIT. Our practice’s EMR implementation reached a reasonable level of maturity long before Obamacare, HITECH incentives, and Ms. Sebelius came along. We became Meaningful Use – compliant the first of October. I believe in the potential of HIT to revolutionize the practice of medicine by reducing costs and improving efficiency and quality of care. But I do not believe the HIT community is on a course that will take us to that vision.
The IT community has indeed done great things for other parts of the economy – without government incentives. They have yet to offer similar value to practicing physicians. Health care is different from banks, grocery stores, and airlines. It would take an entire book to fully explain the differences, but for now consider 2 indisputable facts that distinguish health care: 1) In health care there is no tolerance for errors and unexpected outcomes, and 2) In health care the beneficiary of a service is not the one who pays for it.
Consider Ms. Sebelius’ example of a rash on the foot. In her utopian world you don’t need to see the doctor. Instead you just take a picture of your rash, send it via the Internet (oops, I meant “The Cloud”) to a provider who looks at your photo, makes a diagnosis and sends you the treatment. The job is done for less cost and with more efficiency…right?
Well, maybe…but what if the patient with an apparently simple rash is a brittle diabetic…and right next to the rash, beyond the photograph, is a near gangrenous toe? Or perhaps this patient recently changed laundry detergents, or maybe went camping and had a tick bite. Of course the clinician (who is probably not a doctor, in Sebelius-utopia) has no way of knowing; in this example the picture is the only information available. Will we expect clinicians to make a diagnosis with so little data? If not, then what additional information should be made available? How will it be made available? How should the standard of care for remote service be defined? Doctors cannot be expected to spend precious dollars on IT products until we establish how they should be used.
Then comes the daunting task of paying the provider. If patients paid for their own care they would be glad to pay a fair price for remote service in order to avoid losing time at work and save on gas, parking, etc. This in turn would make it attractive for doctors to offer the service, and everyone would quickly buy in. But third party payers have no incentive to give doctors more ways to provide service and get paid. And in the health care regulatory environment doctors would take a huge legal risk if they attempted to bill insured patients directly for remote services. Ms. Khazan mistakenly lays the blame at the doctor’s feet, accusing us of having no interest in saving money. She also brings out the same old propaganda regarding the quantity-not-quality payment system. Those arguments are complete nonsense. Neither the HIT community nor the government knows the first thing about how to provide quality health care while at the same time making payroll for staff, getting the office rent paid, and still putting bread on your own table.
To address Ms. Khazan’s question, here are some ideas for the HIT community that will make doctors more receptive towards HIT:
First, stop insulting your target audience. It’s hard for us doctors to do business with folks that call us fearful, stupid, greedy, “set in our ways,” “stubborn,” or “ossified.” If you think so little of us physicians, why should we work with you? Why should we trust our patients’ welfare to your products? As the saying goes, you get more bees with honey.
Second, through your success digitizing other parts of the economy you have earned our respect. But you need to admit that doctors know more about patient care than you do. To us your health care products are the technological equivalent of black-and-white vacuum tube TV sets and brick-sized cell phones. They reflect your lack of understanding of how to practice medicine. Physicians will not get interested until you spend less time rubbing elbows with famous people and globetrotting academicians and spend more time working in the clinic with regular docs to learn how patient care works in the real world.
We docs are indeed set in our ways to some extent, and with good reason. In our years of training we were repeatedly taught that even small changes in patient care could adversely affect treatment outcomes in unpredictable ways. You don’t make changes in a cavalier fashion when patients’ lives are at stake. There is more to lose than there is to gain.
Third, stop letting Kathleen Sebelius and her Obamacare cronies play you for fools. They are giving you the time of day for only one reason – to make you dependent on government for survival. Getting in bed with them may feel great now, but the morning after will be ugly. Their goal is not to jump start your industry, but to control you forever. Meaningful Use incentives were the first step. Witness the fate of the American Medical Association. For decades they have financially benefited from government support of the AMA-copyrighted CPT coding system. But, faced with the prospect of Obamacare “reforming” CPT out of existence, the AMA chose to abandon its physician constituency, supporting Obamacare to preserve its CPT revenue stream. The government owns the AMA. Now they want to own you.
The government should not be your customer. Doctors and patients should be. It is not too late to change strategy. Among regular docs there are plenty of early adopters willing to work with you. Let’s talk.