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Mad Medicine

by John Ogle, MD, MPH, FACEP

Published in Colorado Medicine, Vol 102, No. 4, pp 206-207 Aug/Sep 2005

A metastatic malaise malingers throughout medical networks. Why are we healthcare professionals so slow to adopt data automation? Today I sit at a computer in Guam retrieving lab data for a patient seen earlier today. This software is 15 years old, but its power far exceeds what I use back in my civilian practice. Inspired by Jim Cramer’s show, the words “Mad Medicine” flash across my neurons.

My impatience did not develop overnight. In the 1990’s, our dawdling embrace of healthcare information technology (HIT) was justified by many pundits:

Modern medical curricula are packed, there’s no room for teaching computers The Internet has not fully matured Medical graduates are old--Today’s doctors just didn’t grow up with the Internet.

Hogwash—I don’t buy any of it! The Internet will always be evolving, how much of a lag do we need? My late father was quick to point out in 1990 that my Macintosh II should make medicine very easy. He believed I could simply input symptoms into an omniscient computer program and read the diagnostic output. Machines won’t replace human diagnosticians, but much of the tedium persisting in our profession can be automated.

While using the VA computer network in 1993, I recall a smooth, user-friendly interface that provided secure electronic health information to any authorized provider. The VA database has millions of patients. In 1993, I relished a bright future. Back then I reasoned it could be no longer than a year or two before all of us would have such simple luxuries as comparison data at the stroke of a key. The Internet was up and running the following year. Efficient electronic health records (EHRs) would be here soon. Won’t be long now…

Twelve years later…the “dot com” hypertrophy has leveled off. While that era should have left an irreversible sequela of boundless opportunity, few of us are realizing that promised efficiency. We resemble the fearfully ignorant Mother who desperately wants a healthy child but is afraid of vaccinations.

My last Emergency Department shift was typical and illustrative. I was presented a 52-year-old man with semi-suspicious chest pain and cardiac risk factors. That night’s EKG was nonspecific, and he claimed he’d had a recent work-up at a nearby hospital. I needed his old EKG. After many attempts, we contacted the patient’s former hospital. The staffer politely informed us that his records and old EKG “were in archives;” therefore, they were unavailable until the Monday morning crew came in. It was Saturday at 2:00 AM. The words “mad medicine” revisited my neurons.

My second patient was a serious trauma victim requiring air transfer to another hospital for surgical repair. CT images acquired at our facility would help the receiving hospital with surgical planning. My grandmother figured out how to send me email pictures years ago. Surely we can transmit high-resolution CT images to the receiving hospital with a modicum of data integrity, speed and security. I’m told such technology is unavailable. The two hospitals have incompatible systems…mad medicine—getting madder.

Today’s public private key infrastructure (PKI in techno-speak) is mature. People confidently buy cars on the Internet with only a credit card. Most Americans with rudimentary common “cyber-sense” transact e-commerce safely despite incomplete technical understanding. We don’t need to micro-analyze the vast complexity behind these trusted transactions. I am comfortably ignorant but confident in the years of standards research that yielded our sophisticated yet largely transparent ecommerce-worthy Internet. Transactions are simple, safe and secure.

Why are we so timid when it comes to medical records? Incomplete national standards partly explain our “Wait and See” stagnation. Software companies compete fiercely, and consumer confusion reigns. Obsolescence and incompatibility are scary realities. We’ve seen this before with TV signals, VHS, and now DVD standards. I think we can deal.

My colleagues mutter things about HIPAA, implementation cost, mal-ware, pending obsolescence, but I believe these issues are peripheral. Adequate off-the-shelf technology and security solutions have existed for years. Perfection must not be the enemy of the good. We will remain vigilant and continually improve our HIT, but common sense precautions are not valid excuses for inaction.

I’m a capitalist and accept that money and market share are driving forces, but disinterested (noncommercial) parties must steer this train. The June CMS Tech Fair was a good start with big attendance and lots of committed curiosity. However, one, day-long event is not enough.

So what is a poor doc to do? As we say in the military, “follow, lead or get out of the way!” Support and participate in Colorado’s organized medicine as we lead the nationwide charge. Your medical society will partner with government, commerce and private health care providers to help build a cooperative infrastructure. I believe we should start shallow, broad and scalable. Building trust will be essential. As the national leaders at Colorado Health Information Exchange (COHIE) design a federated network, CMS can support a statewide initiative to connect all of the state’s emergency departments with the humble but critical EKG (COEKG.org). A scalable prototype project will get people thinking cooperatively.

Lessons learned from a functional pilot project will directly apply to COHIE’s laudable endeavor. Patients, doctors, insurance companies, HIPAA regulators, software vendors, and network watchdogs independently acknowledge theoretical benefits of HIT. Yet, tomorrow I will still struggle to get a midnight fax of an old EKG from the hospital up the street. Ten years into the Internet era and I remain unable to view a simple “comparison EKG” off the Internet. Our children and our parents shouldn’t wait another decade. Independently, we claim blamelessness, but collectively there is no excuse for inaction. Mad medicine can become motivated medicine. Visit COEKG.org  

Doctor Ogle is an Internet authority and practicing Emergency Physician. He is also a Lieutenant Colonel and Senior Flight Surgeon in the Air National Guard. He is currently deployed to the Western Pacific with the Air Force in Operation Enduring Freedom, a part of the Global War on Terror. He has operated an Internet Company, FlightPhysical.com, for the last six years and maintains an Internet presence for over 4,000 US Physicians.

Published in Colorado Medicine, Vol 102, No. 4, pp 206-207 Aug/Sep 2005

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