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Why Aren't Doctors More Tech-Savvy?

Email access, online scheduling, and electronic records would all make healthcare easier for patients. Here's why some doctors are still reluctant to modernize.
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Whenever I feel like taking a trip back in time, I save myself the trouble of building a time machine and instead just head over to a doctor’s office. For a Millennial, or really anyone who lives a modern lifestyle, getting medical care is a rare departure from an otherwise technology-fueled existence.

First comes making the appointment, which usually requires a phone call. My gynecologist's office, for example, doesn’t use online booking, so scheduling a visit means calling them from my "open plan" office and describing what, if any, "the issue is." Layered on top of this indignity, my last name is basically impossible to spell or pronounce. “Yes, once again that’s K-H-A-Z-as-in-zebra-A-N.”

Filling out forms in triplicate in the waiting room is, for me, relatively painless. By now, I've perfected my ability write my address, insurance ID number, and the words "allergies to most plants and animals" in about 15 seconds or less.

No, the biggest nuisances occur when there's any sort of communication required with or among doctors outside of the appointment. In the past 10 years, I've moved from Texas to Washington to California and back to Washington, but each time, I dragged along a filing cabinet packed with phlebotomy results and shot records. To this day, the trunk of my car contains a sinus x-ray the size of a Renaissance painting because it doesn't exist electronically and it's really expensive to get re-done.

Wikimedia Commons

Few of my doctors use email to communicate with patients, so medication refills, questions about side-effects, or reminders about appointments all require elaborate phone tag. This hassle is exacerbated by the fact that healthcare is one of the few consumer-focused industries where being a few minutes late is a sin so grave that it’s punished with a total cancellation of the appointment, and sometimes even the forfeiture of the fee.

I was ten minutes late to an appointment the other day, and the doctor poked his head out the door to let me know I'd have to reschedule.

"Can I come tomorrow?" I said.

"Give me a call."

I called. He wasn't there so I had to leave a message. He called me back during my yoga class.

As frustrated as I get, I am lucky that (at least for now) I don't have kids, which must be a medical-administrative hell I can't even fathom.

I have vivid memories of my frazzled mom rushing to ferry my brother and me to orthodontists’ offices and spending her free time filling out insurance reimbursement forms for obscure kids' medications. My most common fight with my boyfriend ends with me wailing that he’s not "being the sort of guy who would deal with the pediatrician appointments." Cheat on me? Fine. Require me to remember to fax the kids’ immunization records on my lunch break? It's over.

One problem with American healthcare is that it attempts to staple a simple documentation system favored by doctors, who prefer to focus on patient care, onto an increasingly convoluted payment system favored by insurers. Nothing compares with the agony of losing the paper itemized receipt from an out-of-network doctor that you were planning to file for reimbursement using your insurance website. (Also, be sure you have a scanner at hand! Remember scanners? You bought yours in 1998.)

Usually this vintage record-keeping method is just an inconvenience, but sometimes it can cause some major health and financial trouble. Some people have jobs that discourage using the phone to make personal appointments during the day, so it can be hard to schedule or reschedule in time. And having health records scattered throughout multiple doctors’ offices can lead to dangerous drug interactions, especially if you can’t check in with those doctors electronically.

EHR use among physicians over time (CDC)

With a 2009 law, the federal government created incentive payments that aimed to nudge physicians and hospitals to adopt electronic health records, and increasingly, they are. About 48 percent of office-based doctors now use a “basic” EHR system (those that include functionality like patient history, clinical notes, medications and allergies, prescription orders, and digital lab results) according to new data released by the CDC, up from just 11 percent in 2006. Meanwhile, 78 percent now use “any” type of EHR system, a more loosely defined category. Importantly, though, the rates of adoption vary widely; only about 25 percent of ophthalmologists and 19 percent of psychiatrists use them, but nearly 70 percent of cardiologists do. It also varies by state, from 21 percent in New Jersey to 83 percent in North Dakota.

Physicians with EHRs that meet federal standards, 2011. (CDC)

Starting next year, the federal government will start penalizing physicians who don’t digitize their patients’ files. The 20 to 50 percent of doctors who remain luddites isn’t a huge amount, but it’s a fair number when you consider the impending fine.

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Olga Khazan is a staff writer at The Atlantic, where she covers health.

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