By Bill Reid, SVP of Product Management and Partners, SCI Solutions
It makes no sense to me.
I have been dealing lately with a potential joint surgery due to osteoarthritis and a lifetime of sports. I have been hard on this body of mine. As a result, I have had lots of experiences with the health care system and it is just not where it needs to be given all the recent spend on health IT – meanwhile, other industries outside of health care have learned how to use technology for business model innovation and operational improvements.
To illustrate how out of touch health care is with technology, consider the recent experiences I’ve had while trying to schedule appointments with new doctors:
- I had to call, on the phone. I can book a flight, reserve a table and track a package online. Why, for a simple consult, did I need to call? There were no questions asked of me on the phone that could not be answered online.
- I was handed a set of paper forms to complete prior to my visit. Not one form was designed for hand-entry even though that was the only way to complete them. There was nothing on the form that could not have been on a web form accessed via SSL and writing to an encrypted database to later be pulled into the EMR. In all the cases, providers had a patient portal, but it was not used for this. Why?
- The paper forms got put into a file. Forms, I am convinced, are time-occupying make-work for patients to distract us from the waiting. Despite taking the time to complete them prior to the visit, as instructed, I began the visit with a medical assistant asking me the same or similar questions, which he typed into the EMR. At one point, I was asked how to spell something. I suggested he copy it from the forms I had filled out.
- Both of the providers I saw use the same EMR, an EMR that touts interoperability. The providers, though, are in competing health care systems. They cannot exchange data despite the same nameplate on the box. That is why the paper forms and the duplication and scanning were necessary.
- I routinely had to correct my insurance information. I was actually told that “sometimes it glitches and pulls up the old insurance.”
- Everything is scanned and stored somewhere. I am doubtful it is ever referenced. I have had my insurance card and license scanned in numerous business card scanners or photocopied. I suspect the next time it is accessed is when they are doing forensics on a suspected breach.
This is just some of the journey. There are more stories, and I am sure you all have your own.
What is really at the core here, I believe, is the fact that we have not really tackled interoperability. I am not talking the technical issue of vocabulary standards and use of FHIR vs. whatever. I am talking about the true understanding of the experiences we want for patients who get care across the community, who create lots of information and then recreate it, and likely introduce subtle changes into the record each time. I am talking about the interoperability that is prevented by thinking about competition through informational lock-in vs. superior customer experience. I don’t keep using OpenTable because it has locked me in – I use it over and over because it is easy and reliable. Banks trust me to deposit money through a smartphone camera and they validate it later. I get to go into the TSA pre-check line because of a number I entered once on an airline site – not each time I want to fly. Once.
If we want to apply technology to health, we have to make it work for us – professionals and patients alike. It has to support us, not frustrate us, or block us, or cost us time. We can do better and we need to begin by making what we do work together, in service of the client. Let’s think a bit more broadly about what interoperability really means.