I blame the AARP for my frustration with doctors.
You know the AARP, formerly the American Association of Retired Persons? It seems that ever since they started sending me invitations to join their fine organization, Father Time has been busily ushering my wife and me into a string of medical offices—surgeons, pulmonologists, allergists, rheumatologists, gastroenterologists, physical therapists and a small gaggle of other folks who poke and prod for a living.
Going to them is frustrating enough, but it’s witnessing grotesque inefficiency that fries my sideburns. It’s my joyful place in life to help clients achieve ever-better streamlining of their businesses, so when I see willful placing of speed bumps in offices, I strain to keep myself from lecturing everyone within earshot.
In every successive medical office—every single one—we have to fill out the very same data, over and over and over again. Name. Occupation. Medical history. Insurance. They always tell us on a first visit to arrive at least 15 minutes early so we can fill out all this stuff. It’s infuriating to me. I can’t help it. Especially when there are solutions to the problem, as we’ll see.
The reason this wheel-spinning goes on is that it doesn’t seem to inconvenience the doctor’s staff at all. It’s the patient who has to fill in the little boxes. But in reality, it does hit the staff, because now they have to squint at all the handwriting and put the data into the computer, where it should have gone in the first place. A general rule of productivity is that if you’re doing something twice that could be done once, you’re doing something wrong.
This kind of data siloing is all too common in medicine. Nothing talks to anything else. Medical records in one office just can’t be viewed in another office, even offices affiliated with the hospital that has the records. Medical devices, even those in critical care, can’t talk to one another. All the little beep-boxes you see in patients’ rooms aren’t all hooked together so the staff can read off your condition in one go. No, they’re all independent contractors, all doing their own little jobs their own little ways, and not talking to one another. If they were employees, we’d brand the entire enterprise as hopelessly dysfunctional.
I once thought the Health Insurance Portability and Accountability Act would promulgate data standards that doctors might use to make records portable. Not a chance, apparently. There are standards, but they apply to electronic communications between practitioner and insurer, not between practitioners. In fact, HIPAA makes it harder for doctors to trade data, because it has specific and scary standards for data privacy. That’s commendable and necessary in a world where humiliation is only one YouTube upload away, but it’s also making life much harder on those of us who need to trot from one medical practitioner to another on a depressingly regular basis.
It doesn’t have to be like this. One frequently criticized health care provider has made extraordinary breakthroughs in data availability: the Veterans Administration. As with most large organizations, the VA has several incompatible databases built over many years, but it has managed to knit them together well enough to make patients’ records available anywhere. A veteran can walk into any VA hospital and find his records waiting for him. Not only is it more efficient, it’s safer. If you’re traveling a thousand miles from home and you’re sick enough to need hospital care, you’re probably not going to be able to give a thorough medical history. No need to for veterans.
Others have taken strong notice of the VA’s work. The VA has created software that facilitates sharing data. Called “VistA”, it allows hospitals to exchange data between incompatible databases. In San Diego, the Kaiser Permanente health care organization recently announced that it was signing on to connect its records with the VA’s for patients they have in common, and the Department of Defense is connecting some of its records into this network soon. The VA has managed to drop its costs dramatically by having fingertip access to medical records, because it can nearly eliminate duplicated tests and procedures.
As several authorities have pointed out, these measures won’t always be directly applicable to the rest of medicine, but a lot can be, as Kaiser has begun to demonstrate.
Don’t expect any of this to reach your local doctor’s office any time soon. The medical profession is notoriously fragmented, which means patients will likely be scribbling away on duplicated forms for years to come. Just be warned that if you’re sitting near me in the doctor’s office, you may hear a lot of agitated mumbling and lectures about avoidable inefficiency. Blame Father Time and AARP. They got me into this mess.•
Altom is a consultant specializing in pairing businesses with appropriate technology. His column appears every other week. He can be reached at firstname.lastname@example.org.