Technology Is Not Magic

Giant-Sawbones


From The Mystery Of Ezra Klein by Mickey Kaus:

The Education of Ezra Klein (and Barack Obama) continues: In 2007, Young Ezra Klein was full of enthusiasm about the cost-saving potential of electronic record keeping in the health industry. The failure to rapidly adopt this new technology was nothing less than an indictment of the American Way of Medicine:

I’ve never read a compelling explanation of why the nation’s doctors and hospitals haven’t broadly adopted electronic medical records. It’s not as if they’re allergic to technology. At this point, cardiovascular care employs every strategy but astral projection to keep our in rhythm. It’s not as if it wouldn’t be cheaper and easier for them. …

That all these factors haven’t spurred our private providers to incorporate such broadly appreciated technology should be one of our first signs that American medicine is not responding to the incentives we’d expect.

[...]

Comes now the RAND corporation to tell us that the projected cost-saving benefits of electronic medical records have not materialized. From the NYT‘s report:

But evidence of significant savings is scant, and there is increasing concern that electronic records have actually added to costs by making it easier to bill more for some services.

It turns out that electronic records allow hospitals to easily “upcode” procedures, charging more for them, while removing some of the hassle of ordering expensive tests. As Groopman and Hartzband note, the most common kind of costly medical error is misdiagnosis–and those misdiagnoses are now spread far and wide at the speed of electricity rather than carbon paper. Doctors may also be discovering something Microsoft employees discovered long ago: computers allow the exponential proliferation of bureaucratic paperwork. You don’t even need the paper.


This is one of those “I don’t get it” things. I have been hearing for years how computers and the internet would revolutionize medicine, and I guess it has in some ways. But I never understood exactly how electronic record keeping could really save a whole lot of money.

Doctors still have to examine patients. They still order tests. Old tests might be useful for comparison but new tests will still be necessary. There will still be record keeping, and I would expect most doctors to keep hard copies of all their records. But even if doctors went completely paperless how much could that really save?

No matter how you store records someone still has to read them. Even worse, the potential for a misdiagnosis (or a mis-keyed diagnosis) to come back to haunt the patient at a later date increases.

You cannot accurately predict the effect of new technologies. Computers and the internet revolutionized the legal profession, especially in regard to research and writing. But lawyers didn’t get any cheaper.

Technology is not magic.


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31 Responses to Technology Is Not Magic

  1. votermom says:

    But even if doctors went completely paperless how much could that really save?

    OT, but supposedly one of the incentives to go paperless is that it saves trees and therefore the atmosphere.
    Guess what happens when the demand for paper goes down? Tree farms lose money and their owners start to sell to developers who pave the land.
    Congratulations, green movement, you have again self-perpetuated your bogey man.

  2. elliesmom says:

    And what happens when the computer network goes down? It happened to my doctor the last time I was there. She had nothing. She couldn’t even write refills for my prescriptions. We both knew what I took, but all of their prescriptions are forwarded electronically to the pharmacy. We went out for coffee together until the system came back up.

  3. HELENK says:

    computers are useful tools only. garbage in = garbage out.
    what bothers me a lot is people are forgetting they have the first computer in their head. It is called a brain.
    I have had to teach many people how to do the job without a computer so that things do not stop when the computer goes down. Always did things on paper along with input. seems like double work but you would be surprised how many times it came in handy and saved money

    • myiq2xu says:

      Ever watch people trying to do math without a calculator?

      • HELENK says:

        I was the wicked mom who would not buy her kids the calculator until they could recite the times tables by heart.
        also had a business math teacher that made us answer 60 math question in a minute. The were simple math but it did teach us to add and subtract quickly

  4. HELENK says:

    http://pjmedia.com/lifestyle/2013/01/10/grown-men-dont-read-comic-books-heres-an-alternative-that-might-just-save-america/?singlepage=true

    one bad product of the technilogical age. bad manners and not much get up and go.

    BTW

    does anyone else wish they would publish “classic comics” again?

    a lot of kids did learn the classics that way

  5. SHV says:

    It is interesting that the Daily Caller story and others on the same topic usually omit the key piece of information in the NYT article:

    “RAND’s 2005 report was paid for by a group of companies, including General Electric and Cerner Corporation, that have profited by developing and selling electronic records systems to hospitals and physician practices. Cerner’s revenue has nearly tripled since the report was released, to a projected $3 billion in 2013, from $1 billion in 2005.”

  6. myiq2xu says:

    Tina Fey tired of Palin comparisons

    Tina Fey isn’t thrilled that she’s constantly associated with former Alaska Gov. Sarah Palin, whom she famously impersonated during the 2008 presidential election. From Rolling Stone:

    As the late-middle-aged couple at the table next to us get up, the male half approaches, grinning: “Excuse me, aren’t you Governor Sarah Palin?” It’s so lame that Fey can barely manage a quarter of a fake smile. “Not for, like, three years now,” she says, looking as if she’d like to dive under the table.

    The guy has his gag, though, and he’s going to run with it. “I so enjoy watching you on Fox,” he says.

    “Thank you, have a nice day,” she replies. As he walks away, she murmurs, “Until the day I die. Until the day I die.”

    Karma is a you-know-what.

  7. Somebody says:

    There are some good points to electronic records, but it’s not the panacea that was promised. A lot also depends on what software is being employed and yes it is true garbage in = garbage out.

    I happen to have a lot of experience with both methods. My father had ALS and I was his caregiver. The facility he went to was way ahead of the curve and had all electronic records. A couple of years later my daughter was diagnosed with leukemia and the facility she went to used old fashioned paper charts and records, then they transitioned to electronic records half way through her treatment.

    So I saw situations with my dad where if it wasn’t in the computer it didn’t exist, when I knew damn well it did or it had happened. Conversely my daughter had so many issues and complications they had to start a second chart for her and the first chart was filed away somewhere………which could have been to her detriment in a few cases, except I was there insisting I knew what was what.

    On the up side electronic records of X-rays, MRI’s, etc., are really convenient for a myriad of purposes. Another nice thing is some of the pharmacological software that automatically catches allergies and potential adverse interactions. Of course, once again it could be a case of garbage in = garbage out.

    Every doctor we deal with now has electronic records. I find that doctors typically don’t tend to read too far back into your records. Usually it’s the equivalent of reading the last page in the chart, so besides “saving” trees where’s the beef? I guess eventually once everybody is connected if you happen to be 3,000 miles away from home and have an emergency then whatever attending doctor is caring for you should be able to get your medical history.

  8. Karma says:

    Another reason I wanted Romney to win. So this type of stuff would end.

    • DeniseVB says:

      Didn’t print media, cough, Newsweek “die” on Dec 31, 2012? Is this from their “paperless” new beginnings? Screw’em.

      • Karma says:

        Yup. And it looks like they still haven’t learned why the print version tanked.

        • foxyladi14 says:

          poor things :)

        • Constance says:

          And if we could get some consumer rights regarding Tv all of the networks and news channels would go out of business just like Newsweek did. They are all worthless as far as news goes and I am sick of subsidizing them so I can get PBS and my Ancient Aliens fix on H2.

  9. swanspirit says:

    There is nothing like being involved in a complicated procedure ,treatment , or intervention , and then having to sit down and document precisely everything that happened ,all details of what was done ,what the results were etc etc , knowing you are creating a legal document , and that if you leave anything it out ; legally it did not happen .
    There is nothing like doing an initial complete assessment on someone who has an extensive medical history , making an accurate list of all their current medications , and documenting all of it accurately by handwriting it all out.
    Computers help . They allow for much faster input of information , decrease errors , and “remember ” previous notes .They help with continuity of care , accuracy of documentation , and save enormous amounts of time. The difference between having a lab tech read you the results over the phone while you record it ; and grabbing the print out and sticking it in the chart , is incalculable , not to mention not having to repeat reading it to the MD, because he already has a copy.
    I could go into much greater detail , regarding innumerable instances of increased efficiency provided by improvements in technology in medical documentation, but I am used to using check off sheets that communicate all of this much more compactly ;)

  10. DandyTiger says:

    Technology is not magic.

    Dude, you’re going to blow my cover. How am I going to charge all this money if the clients find out it’s not magic.

Comments are closed.