The doctor I've been with since 1998 has refused to adopt the digital system. He's getting older unfortunately and I suspect in another few years he'll be retiring only to be replaced by a doctor who embraces digitalization. It's far and few these days to find paper only offices. Which is a shame, as I feel the more modern the medical system is the less personable, less "family doctor" oriented, heck more often only to be bought up by a network. Quaint is under rated, futurism is over rated.
Dentistry has changed in the last decades. If a dentist refuses to use useful computer things, I instantly wonder if they are also out of date with modern best practices. Better materials for infills and stuff like that.
I'm in the process of having some dental implants done and the process is amazingly high tech - I was particularly impressed at the 3D model they created from CAT scans that they then use to position instruments during work - they attach something to my teeth to tell where my head is and the software guides where the instruments should go based on 3d sensors.
Wouldn't surprise me if they went fully robotic for some things in the not too distant future.
I've been with my dentist for a while and in the last 10 years or so I think they've updated their X-ray machines twice. It used to be a massive machine that was in a special room, which they'd use to take multiple photos of your face by wheeling around. Then they got a smaller one that could be right next to your chair, and they'd make you bite down on some film while they moved an arm around with the source on it. Recently they have a new machine that you put your head in and it just seems to do the whole thing in one pass.
The head thing might not be doing the same x-ray as the bite thing.
I'm impressed they only got the bedside one recently. My dentist just recently upgraded to direct digital sensors for their x-rays (wires to the computer in the room instead of digital plates), but the X-ray source shows decades of battle scars.
I did ask a dentist once about why the roots of my wisdom teeth were so strangely distorted in an X-ray and they carefully explained that there was no distortion and they really were that shape...
>Better materials for infills
My mother is a dentist on the verge of retirement who used to fly to conferences all the time and ran a reasonably successful dental practice with about a dozen employees (and plenty of computers). She would always talk about how the new implant ceramics are not as durable as the old amalgam and they're only popular because they're white instead of gray.
If you're in the US this might be for a specific reason.
If you're a medical facility that isn't digitized then you're not subject to many of the HIPAA privacy and security compliance rules. It's an exception they carved out to grandfather in older practices that weren't digitized.
Many facilities stay "analog" in that way for that explicit reason.
Source: used to be a certified HIPAA Security Officer, this was a topic at the certification seminar I attended.
Then again, paper can't leak as easily as a database
Are the security requirements of HIPAA good? (genuinely wondering: your data goes to tons of organizations, any of them could use a not properly secured database and leak it. And are the requirements good both in the technology and practices, as who's accountable?)
I'd say they're not bad.
Any data processing by a third party must be done under a Business Associate Agreement (BAA), which transfers responsibility under HIPAA with the same rules and regulations to the third party. There's always a chain of liability when processing PII, traceable back to the PCP (primary care provider).
The regulations also leave things open ended in terms of specific ciphers etc, stating "industry standard" encryption at rest and in motion (i.e. transport security) must be used, for whatever definition of industry standard is correct.
As for privacy, exfil of PII even in non-digitized establishments is still covered (hence why there is typically also a Privacy Officer appointed with a HIPAA complaint org, distinct from a Security Officer, both being actual terms and certifications being handed out by certification bodies). That covers general privacy and a much larger scope, and applies to any healthcare establishment - not just those who use computers.
Cryptographic audit trail requirements, third party audits and reviews, a slew of other software certifications (some even from the government, such as Meaningful Use), etc all exist to help with that mission.
As for who's accountable, it's always tied to the processor of the information, and "breaches", which are violations of either privacy or security policy, must be reported all the way back up the chain in a timely matter, and in the event the breach might cause risk of harm or disclosure, must also be reported to a regulatory body (I forget which), in which case the offending party must pay a fine. There's insurance for these scenarios, I forgot if it's compulsory. But it racks up fast, and IIRC you're liable in most cases for damages up to a ceiling, somewhere in the 9 figure range.
What's more is that there's also Qui Tam lawsuits which, as I understand things, can be brought against an offending healthcare establishment by a whistleblower of sorts (i.e. a third party who observes a breach, without being part of the chain of responsibility (the healthcare establishment) nor affected by the breach) on behalf of individuals harmed by said breach. As far as I know, anyone can do this.
IMO, for what it tries to do, I think it does an okay job. It's a really difficult thing to generalize and standardize given not only the flux of technology but also the fact that you still want independent innovation in the space without regulatory overreach.
(This is a massive oversimplification of my slightly outdated knowledge of this as I've been out of the US healthcare field for a while now)
Why would my care be better if a doctor goes through a paper folder instead of a digital one?
It’s not how the records are kept per se.
It’s that the paper-using doctor can spend more time on you, the patient, instead of fighting with a balky UI and inane business rules.
A relative of mine had to go back to their paper-only specialist a couple of months ago to get a prescription reissued because the specialist had omitted a mandatory detail from the (handwritten) prescription form and the pharmacist couldn't fill it.
Meanwhile, I had a similar prescription, from a different specialist, who issues his prescriptions as either e-scripts or computer-generated paper scripts depending on patient preference. I suspect his practice management software would stop him from making this class of mistake entirely.
I get why a doctor might prefer to avoid the computer, but I think my relative would have preferred their doctor not screwing up on something basic and wasting a significant amount of their time over better vibes in a consult.
Ive had so many problems woth e prescribe. Half the time its "just not working right now" the other half they send to the wrong place, or they send to a pharmacy that doesnt have supply and you cant find out that theyre out of stock until they recieve the script. At which point you have to cancel and then contact your doctor to resend. Which can take several days. Whereas with paper prescriptions you just drive to the next pharmamcy.
Theres pros and cons to both
Why would that necessarily be the case? I understand that bad software can get in the way of anything, but I find it hard to imagine there is nothing out there that actually helps any given (and willing) physician to improve their work, and make more time for patients, not less. There are inherent properties to IT that can help make stuff more efficient across any domain I can think of, and physicians work checks a lot of the marks.
I happen to work in the medical field and while a lot of the software involved has its issues, not working with software, at this point, seems like a really bad idea, in terms of error prevention, performance and efficiency.
I'm a physician. To understand why this is true you have to understand that the software is not intended to the make the physicians jobs easier or more efficient. The point of modern EMR's is to take every patient encounter and generate a list of billable codes that maps onto the encounter in such a way that insurance companies are less likely to send it back. The stuff like checking medication interactions is just tacked on as an afterthought. Through this lens everything else makes more sense.
Not necessarily, no, but empirically yes.
Paper-shuffling used to be not a major issue in a doctor's work day. It was merely something that yes, sure you had to log new patient data and whatnot for reference, but you were mostly free to do the paperwork in a way that fit your natural workflow. Based on the doctors I know/knew, it was not a pain point. Yeah, you would sometimes have to fetch physical papers from somewhere instead of clicking yourself to the same information on the computer, but that was not a major issue. I'd say it was similar to a programmer who's waiting for an incremental compilation to finish: a minor moment out of actual work but nothing to fret about.
After doctors' offices got digital then interacting with the computer specifically certainly became an issue which didn't exist before. At best, it was just a clumsy way to do the inevitable and at worst it became a major part of the patient visit, with myriad of odd tricks you had to learn about some particular computer software in order to accomplish your actual goals.
If something that used to be normal part of work nobody thought twice about once become noted as a separate issue of the work day, something did change there. Sure, there are benefits too, but it's the friction points that you feel at work when you're trying to get other things done. Sure, software could be written to serve the user and not the other way around, but software rarely is -- no matter the profession, doctors aren't the only ones!
My old family doctor used to have IBM terminals into the early 2010s, I'm fairly sure there was an AS/400 somewhere in the back rooms where all the serial lines in their practice converged. Very fast system. Meanwhile I was at a specialist some time ago and they had to switch back and forth between notepad and the medical app, because you can't enter more than a few words at once into the app. So he would write everything that's not a drop-down in notepad then copy-paste it.
Well for one thing it's much less likely for someone to steal 36000 therapy files and extort people into suicide when they're stored decentrally on paper in locked cabinets instead of ~~the cloud~~.
https://en.wikipedia.org/wiki/Vastaamo_data_breach
Not sure what being personable has to do with knowing how to use a computer.
This has nothing to do with "knowing how to use a computer."
Looking at a screen while you check through dozens of flags and billing related documentation instead of looking at the patient is much less personable.
could it be that wasted time and added stress make you less empathetic?
I can see that working today in dentistry more so than general practice. I’ve got medication that insurance has dictated that I need to refill a weekly med monthly and it arrives precisely the week I need to take it. I need to time my vacations around this med now.
I get that I’m ranting against healthcare and not doctors, but I’d run far from any doctor that’s paper only these days.
I disagree. It’s wasteful spending your day trying to read doctors hand writing. There are dozens of other issues that come from technical incompetence, but the handwriting one alone is a vast waste of time and money.
My dad practiced dentistry since the 70s and never digitized his office. Every patient had a folder. There was a phone, a typewriter, and a calendar. I don't know how insurance claims worked, maybe by post.
When I moved to New York I was surprised to find a dentist whose practice was much the same, though he did have a few computers around. He retired recently.
Computers no doubt can improve things; a lot of it seems like a no-brainer. But I'm starting to doubt that they're there to improve things.
It's not just filing the X-rays. Back in the day, for a big crown you got yourself a full mouth cast, ship it away, and eventually you got a crown which hopefully fit. Today you get a much less invasive scan before the root canal. one after, and the 3d printer in the back creates a crown that fits. Much faster, cheaper and typically even more accurate.
to quote Wendell Berry, “the more superficial and unsatisfying our lives become, the faster we need to progress"
My dentist uses a software that seems pretty efficient. All the x-rays and other notes are right there. One big plus is that the screen is faced towards me so I can also see what they are doing.
> Computers no doubt can improve things; a lot of it seems like a no-brainer. But I'm starting to doubt that they're there to improve things.
They stopped the improvement around Win 10. Since then, everybody (Microsoft, linux, Apple - Google never had a wheel) is reinventing a worse wheel, regularly.
Dental software is terrible as far as I can tell. I’m at school /practice were the staff cheered loudly when it was announced they were planning to upgrade or change vendors.
I never saw such passion about software.
Eh...I'm all in for doctors who can actually take emails than just phones. I fucking hate talking over phones. I don't need "family" doctor. I need a family "doctor".
HIPAA doesn’t exactly make that illegal, but it comes so close that approximately zero doctors would be willing to skirt that line and risk the enormous penalties if they guess wrong.
All major EHRs now have some sort of patient portal with secure (HIPAA compliant) messaging built in.
Sure, but patients don’t want to sign up for yet another portal. Unfortunately, the methods they want to use may not be practicable options.