Why Doctors (Practices) Hate Computers (Still)...

[Midpack]

It has always seemed healthcare is always behind on integrating computers into their practices, and I have always wondered why. The paperwork at most doctors is frustrating at best, and you can tell the younger folks that work there are just as dissatisfied as any remotely tech savvy customers, but can't do anything about it. This article doesn't help much.

My anecdotes:

• We moved here couple years ago, so we've had to reestablish with new docs across the board.
• I still find myself confronted with 4 page paper questionnaires at many doctors offices. That's ridiculous in 2022.
• The last two offered the opportunity to fill out the questionnaire online in advance of the appt - great!
• The first one an ortho - the surly woman at the counter told me they didn't have it when I arrived and handed me the stupid paper questionaire again.
• Today I went to an eye doc, and they handed us questionnaires in the tiniest font ever, but we told them we'd submitted them online the day before - and they said, we'll try to find them and didn't make us do paperwork. However, the first tech asked me many of the same questions, when I said I answered these questions already, she said that system doesn't sync with their medical records system. Is this 1992?
• OTOH, our GP is no more than 30 yo, and she can make computer tech dance - so it's entirely possible. We get results, consults and questions answered from her online very quickly!
• A good friend, an accomplished orthopedic surgeon, is the least tech savvy person I know of any age (my 93 yo Mom was better). The doc is totally bewildered by his latest model iPhone, he may/not be able to handle a text, or make a phone call.

https://www.newyorker.com/magazine/2018/11/12/why-doctors-hate-their-computers

The surgeons at the training session ranged in age from thirty to seventy, I estimated—about sixty per cent male, and one hundred per cent irritated at having to be there instead of seeing patients.

Something's gone terribly wrong. Doctors are among the most technology-avid people in society; computerization has simplified tasks in many industries. Yet somehow we’ve reached a point where people in the medical profession actively, viscerally, volubly hate their computers.

 

[momoftwo]

I worked in hospitals/laboratories/healthcare for 40+ years. Can't remember how many new installations and "upgrades" I lived through. Some better than others.

Now, a retired medical consumer of various specialty practices, unfortunately. Each with their own patient 'portal'. BUT the portals don't talk to each other. It would be great if all my docs were in one network/system, but they're not. My rheumatologist cant see my labs ordered by my GI doc Really?

I had six weeks of PT appts for a hip rehab. That system required me to pre-register online before EACH session.
Enter insurance, meds, health history, symptoms, allergies, etc, etc.
Very absurd.

I'm trying hard to resolve some health issues so I can avoid further visits anywhere.

 

[MRG]

My career was in technology, things like imaging, security, business process management and some dabbling into EMR systems. To say doctors don't embrace technology isn't accurate; perhaps it's the individual practitioner's technology skills. I see many people who embrace it, sometimes they make me remember when two of my co-workers were trying to scanning in a printed alphabet and display it on a monitor. Now they can say with certainly what my cervical spine is like. [emoji848]

To many IT's model of continuous integration isn't acceptable and they can get fried over constant changes. The front office is a great example of what should be done and isn't. I should never be asked to fill out initial forms after the initial visit but that happens. Probably due to a total lack of discipline during upgrades and backups.

As far as sharing your medical records that's never going to happen in my lifetime. Technically doable but individuals create systems that don't integrate in standard methods and security systems that are designed to keep outsiders outside. Additionally the vendors really don't want to make it too easy for their data to be shared with others. Removing vendor lockin is a big fear amongst them.

 

[Sarah S]

My patient portal from the neurologist and former pcp allowed me to give access to my records to my new pcp It was very easy- a few clicks. My pcp can see any updates too. They both use epic but are in different healthcare systems.

 

[momoftwo]

Ah yes, EPIC. Used it at my last position.
But I'm not so lucky to have my docs all on EPIC.

 

[OldShooter]

We are fortunate that the two major health providers locally use "Epic" software. We have each signed one-time, one-page releases allowing the two providers to share our information. So all our docs are working from the same databases and our PCP can easily monitor our status if one of us is in the hospital. The exception seems to be ophthalmology, which locally seems to wandered off the reservation, using less-popular systems.

A little Googling tells me that Epic is the US share leader with just under 1/3 of hospitals and 55% of patients, and that the industry is consolidating. So there is some hope for seamless communications. IIRC the feds have their fingers in this pie, too, so that may force vendor interoperability even if the industry wants to drag its feet..

 

[FindingForward]

It has always seemed healthcare is always behind on integrating computers into their practices, and I have always wondered why. The paperwork at most doctors is frustrating at best, and you can tell the younger folks that work there are just as dissatisfied as any remotely tech savvy customers, but can't do anything about it. This article doesn't help much.

My anecdotes:

• We moved here couple years ago, so we've had to reestablish with new docs across the board.
• I still find myself confronted with 4 page paper questionnaires at many doctors offices. That's ridiculous in 2022.
• The last two offered the opportunity to fill out the questionnaire online in advance of the appt - great!
• The first one an ortho - the surly woman at the counter told me they didn't have it when I arrived and handed me the stupid paper questionaire again.
• Today I went to an eye doc, and they handed us questionnaires in the tiniest font ever, but we told them we'd submitted them online the day before - and they said, we'll try to find them and didn't make us do paperwork. However, the first tech asked me many of the same questions, when I said I answered these questions already, she said that system doesn't sync with their medical records system. Is this 1992?
• OTOH, our GP is no more than 30 yo, and she can make computer tech dance - so it's entirely possible. We get results, consults and questions answered from her online very quickly!
• A good friend, an accomplished orthopedic surgeon, is the least tech savvy person I know of any age (my 93 yo Mom was better). The doc is totally bewildered by his latest model iPhone, he may/not be able to handle a text, or make a phone call.

https://www.newyorker.com/magazine/2018/11/12/why-doctors-hate-their-computers

HA! I just said this - practically word for word - in the pet peeve thread. I don't understand it either. I keep getting nagged to join portals that the office staff and doc themselves don't use! Half the time the portals have bugs and don't even work well - I'm dealing with one now that doesn't allow me to send messages - I get error screens every time, even though that's supposed to be a main benefit. The software tech support confirmed my issue and told me it's "a bug we haven't fixed yet...we'll let you know when we do". That was 3 months ago, lol.

Meanwhile the office is on a "different system" and tells me they never see messages or use that portal themselves! Then stop wasting my time by telling me to register. I prefill paperwork online, then must redo it at the office because "we don't see it" or "our system doesn't sync with that portal" or any other number of lame excuses. I bring paper copies because the ones I upload never seem to find their way into the doc's hands.

Ok..rant over

 

[disneysteve]

This issue is largely the government's fault. Years ago, they mandated that medical practices needed to switch to electronic records. As a result, literally hundreds of different electronic medical record companies popped up, none of which could communicate with the others, so it became a complete mess. Then, as smaller companies closed down or got bought out, practices had to keep switching to new EMR providers, learning new systems, and doing their best to convert their records again and again which is a slow tedious expensive process each time.


What should have happened is that when the government said we needed to switch, they should have handed us all the software to use so that every doctor, every practice in the country, would have been on the same system. It could have all been seamlessly interconnected and been a one-time conversion process.


My former family practice, a small independent office, is still on paper charts to this day. It's the big groups that really forced the issue with EMR so that the higher ups could harvest all of the data they wanted and better track everything being done for billing purposes. In a smaller private practice, there's no need for that.


The sales pitch back then was that EMR would eliminate medical errors. That's a load of BS. EMR does reduce certain types of errors but it introduces a whole crop of new errors that can't possibly happen on paper charts. Trust me, I speak from experience. I've made mistakes in electronic charts myself that I couldn't have made in a paper chart.


EMR does have advantages, like never having to search the office for a misfiled paper chart, but it also has a bunch of disadvantages, so introducing technology doesn't always make everything better and more efficient. It definitely takes me longer to record a patient visit in Epic than it ever did on paper.


One big issue with EMR systems, which is common with technology in general, is that they don't involved the users in the design of the system so they aren't user-friendly or intuitive. Also, every practice is different. The workflow in Dr. Jones' office is different than in Dr. Smith's office. The workflow in a dermatology office is different than in a cardiology office. The workflow in a 7-provider family practice is different than in a solo provider practice. It's impossible to design a system that can be all things to all people.

 

[mn54]

I worked in hospitals/laboratories/healthcare for 40+ years. Can't remember how many new installations and "upgrades" I lived through. Some better than others.

Now, a retired medical consumer of various specialty practices, unfortunately. Each with their own patient 'portal'. BUT the portals don't talk to each other. It would be great if all my docs were in one network/system, but they're not. My rheumatologist cant see my labs ordered by my GI doc Really?

I had six weeks of PT appts for a hip rehab. That system required me to pre-register online before EACH session.
Enter insurance, meds, health history, symptoms, allergies, etc, etc.
Very absurd.

I'm trying hard to resolve some health issues so I can avoid further visits anywhere.

one of the main reasons why the mayo clinic is good is that all the doctors in all the different departments are all on the same computer system and they all can see your entire file so everyone is on the same page. makes things so much easier.

 

[Midpack]

This issue is largely the government's fault. Years ago, they mandated that medical practices needed to switch to electronic records. As a result, literally hundreds of different electronic medical record companies popped up, none of which could communicate with the others, so it became a complete mess. Then, as smaller companies closed down or got bought out, practices had to keep switching to new EMR providers, learning new systems, and doing their best to convert their records again and again which is a slow tedious expensive process each time.


What should have happened is that when the government said we needed to switch, they should have handed us all the software to use so that every doctor, every practice in the country, would have been on the same system. It could have all been seamlessly interconnected and been a one-time conversion process.

I can’t think of any industry that had a universal system “handed to them.” They’ve all had to find their way to what works, and most industries have had to work through consolidations including computer systems. It’s painful, but I went through it several times with enterprise and process control systems. From personal experience I can say manufacturing and finance are light years ahead of healthcare in terms of productive digitization. I would guess retail (especially online), transportation/logistics, scientific community, technology, and others are also from my more limited experience. Legal is the only other profession I can think of that seems to be way behind using computers, and proud of it.

Not to harp on it too much, but I can’t think of any good reason patients should have to sit and fill out a 4 page paper questionnaire, especially after completing same online days before only to be told “we didn’t get it.” And then be told to repeat the process annually thereafter when NOTHING has changed. That’s just ridiculous in 2022.

[edit: OTOH it wouldn’t surprise me if many (older) patients are against anything online, and they may prefer paper & pencil. ]

 

[disneysteve]

I can’t think of any industry that had a universal system “handed to them.”

Maybe not, but if the government is stepping in and saying you must switch to an electronic system so we can harvest all of the data we need from you, then they should provide that system. The government is the single largest insurer by a huge margin covering about 41% of the population. They could have at least offered an option without forcing it to be used. Then providers could have decided if they wanted to go with that system or choose one on their own.

There should have also been standards established so that all systems were compatible with one another and could freely communicate across platforms.

 

[Freedom56]

I guess we live in different worlds. All our medical history is online and the two providers we use, Cedars-Sinai and UCLA Health are interlinked for data sharing. Any prescription medication is also available and the healthcare providers are linked to the pharmacies. Patient questionnaires are competed online prior to your appointment. Text messages are sent to our phones to confirm the appointment and updated texts are sent if the doctor is running behind schedule. At the doctor's office everything is automated. The doctors are always entering information into the terminal located in every exam room. Blood and other test results are normally available the same day or one day after. You can view your current results and past results and graph the trends. The level of automation has improved considerably.

 

[disneysteve]

I guess we live in different worlds. All our medical history is online and the two providers we use, Cedars-Sinai and UCLA Health are interlinked for data sharing. Any prescription medication is also available and the healthcare providers are linked to the pharmacies. Patient questionnaires are competed online prior to your appointment. Text messages are sent to our phones to confirm the appointment and updated texts are sent if the doctor is running behind schedule. At the doctor's office everything is automated. The doctors are always entering information into the terminal located in every exam room. Blood and other test results are normally available the same day or one day after. You can view your current results and past results and graph the trends. The level of automation has improved considerably.

This is true in our system here in NJ also (Virtua Health). All providers can see everything and we can see everything through the portal. We do e-check in before visits. We get texts and emails and app notifications about everything. It's very efficient. The problem is if we see any providers not in the system because they may use an entirely different set up.

 

[Jerry1]

I guess we live in different worlds. All our medical history is online and the two providers we use, Cedars-Sinai and UCLA Health are interlinked for data sharing. Any prescription medication is also available and the healthcare providers are linked to the pharmacies. Patient questionnaires are competed online prior to your appointment. Text messages are sent to our phones to confirm the appointment and updated texts are sent if the doctor is running behind schedule. At the doctor's office everything is automated. The doctors are always entering information into the terminal located in every exam room. Blood and other test results are normally available the same day or one day after. You can view your current results and past results and graph the trends. The level of automation has improved considerably.

My experience is similar. I’ve gone to three different hospital systems but they are all on EPIC and they all can see everything. In my most recent hospitalization, while they were trying to figure out what was going on, the doctor asked me about an issue I was having several years ago where I saw a doctor in on of the other systems.

The portal has worked out very well for keeping track of my appointments and communicating with my providers. What doesn’t work well is if you see a provider that’s not on EPIC. It’s possible to give them limited (time limited) but there’s a dance you have to do. One thing I really like is getting my lab results right away. As soon as they’re complete, they’re posted.

 

[pacergal]

The EPIC system, used by many health systems around the US has several "packages" that health care companies can buy. They will speak to each other, but only if the right combo is used.
Where I worked, they cheapened out and only purchased some, and then instead of adopting the EPIC system/reports ,etc, tried to create "workarounds" forcing it to fit around what they wanted.
Serious failure to communicate! and created so many "do this, instead of that". Each update created more work, instead of stream lining.
Luckily, the medical entities we have personally used in the past, and now Kaiser, are very much into EPIC and our docs can get records, etc without too much trouble.

 

[foxfirev5]

I guess we live in different worlds. All our medical history is online and the two providers we use, Cedars-Sinai and UCLA Health are interlinked for data sharing. Any prescription medication is also available and the healthcare providers are linked to the pharmacies. Patient questionnaires are competed online prior to your appointment. Text messages are sent to our phones to confirm the appointment and updated texts are sent if the doctor is running behind schedule. At the doctor's office everything is automated. The doctors are always entering information into the terminal located in every exam room. Blood and other test results are normally available the same day or one day after. You can view your current results and past results and graph the trends. The level of automation has improved considerably.

+1 My 80 yo PCP retired at the same time I went on Medicare. The transition to MyChart was great. Fortunately I had my own PSA history. They manually entered all data and took an active interest in my care. It really is a mix of tech and real people.

Now I'm all in on my 6 providers participation on the platform. During my last visit to my Urologist she commented that she wished most of her patients where as tech involved as I am. While no tech wizard I realize it's a two way street.

 

[Midpack]

I guess we live in different worlds. All our medical history is online and the two providers we use, Cedars-Sinai and UCLA Health are interlinked for data sharing. Any prescription medication is also available and the healthcare providers are linked to the pharmacies. Patient questionnaires are competed online prior to your appointment. Text messages are sent to our phones to confirm the appointment and updated texts are sent if the doctor is running behind schedule. At the doctor's office everything is automated. The doctors are always entering information into the terminal located in every exam room. Blood and other test results are normally available the same day or one day after. You can view your current results and past results and graph the trends. The level of automation has improved considerably.

I’m jealous. Although parts of medical records and doctors data entry seem to be highly automated, not so with all the admin stuff. Again, our GP and her office is on top of things, but other specialists mostly aren’t IME near two different large metro areas. Some day…

 

[aja8888]

I guess we live in different worlds. All our medical history is online and the two providers we use, Cedars-Sinai and UCLA Health are interlinked for data sharing. Any prescription medication is also available and the healthcare providers are linked to the pharmacies. Patient questionnaires are competed online prior to your appointment. Text messages are sent to our phones to confirm the appointment and updated texts are sent if the doctor is running behind schedule. At the doctor's office everything is automated. The doctors are always entering information into the terminal located in every exam room. Blood and other test results are normally available the same day or one day after. You can view your current results and past results and graph the trends. The level of automation has improved considerably.

This is how things are around here in Houston which is one of the most advanced areas in the U.S. for medical care. Everything seems to be connected and data is at my fingertips. And I log into multiple health portals.

 

[disneysteve]

I’ve gone to three different hospital systems but they are all on EPIC and they all can see everything.

EPIC is a fine system. That's what we use. Another big medical system in our area uses it also. It's great being able to see most or all of a patient's medical stuff when I go into their chart even if it isn't from our system. Patients love that I walk into the room knowing that they were in the ER 2 weeks ago, what meds they got, what their PCP said at their follow up, etc.

One thing I really like is getting my lab results right away. As soon as they’re complete, they’re posted.

This is very much a double-edged sword. As a patient, I love this too. As a provider, it leads to a lot of problems as the patient often sees their results before their provider has had a chance to review them and discuss them with the person. This can cause a lot of confusion and unnecessary worry or misunderstanding as many patients don't know how to properly read and interpret the reports. Transparency is great, but transparency of complex data can be not so great at times.

 

[Jerry1]

One thing I really like is getting my lab results right away. As soon as they’re complete, they’re posted.

This is very much a double-edged sword. As a patient, I love this too. As a provider, it leads to a lot of problems as the patient often sees their results before their provider has had a chance to review them and discuss them with the person. This can cause a lot of confusion and unnecessary worry or misunderstanding as many patients don't know how to properly read and interpret the reports. Transparency is great, but transparency of complex data can be not so great at times.

I'm a good patient. I ignore most of the labs unless/until I have an understanding of what I'm looking at. This year, I had a medical issue (first major issue in my life) and my hemoglobin was down around 4. After a couple transfusions, I was discharged but my blood was drawn frequently. It was good and reassuring to be able to see my hemoglobin inch up as the weeks went by. Me and DW couldn't wait to see the lab results after each blood draw. Of course, there were other tests they did, but I only focused on the hemoglobin - something I understood.

 

[sengsational]

What should have happened is that when the government said we needed to switch, they should have handed us all the software to use so that every doctor, every practice in the country, would have been on the same system. It could have all been seamlessly interconnected and been a one-time conversion process.

Yes. They did such a great job with the simple task of offering PPACA health insurance, I think they should have been given the task of building a much more complex system to manage health records

 

[6miths]

This issue is largely the government's fault. Years ago, they mandated that medical practices needed to switch to electronic records. As a result, literally hundreds of different electronic medical record companies popped up, none of which could communicate with the others, so it became a complete mess. Then, as smaller companies closed down or got bought out, practices had to keep switching to new EMR providers, learning new systems, and doing their best to convert their records again and again which is a slow tedious expensive process each time.


What should have happened is that when the government said we needed to switch, they should have handed us all the software to use so that every doctor, every practice in the country, would have been on the same system. It could have all been seamlessly interconnected and been a one-time conversion process.


My former family practice, a small independent office, is still on paper charts to this day. It's the big groups that really forced the issue with EMR so that the higher ups could harvest all of the data they wanted and better track everything being done for billing purposes. In a smaller private practice, there's no need for that.


The sales pitch back then was that EMR would eliminate medical errors. That's a load of BS. EMR does reduce certain types of errors but it introduces a whole crop of new errors that can't possibly happen on paper charts. Trust me, I speak from experience. I've made mistakes in electronic charts myself that I couldn't have made in a paper chart.


EMR does have advantages, like never having to search the office for a misfiled paper chart, but it also has a bunch of disadvantages, so introducing technology doesn't always make everything better and more efficient. It definitely takes me longer to record a patient visit in Epic than it ever did on paper.


One big issue with EMR systems, which is common with technology in general, is that they don't involved the users in the design of the system so they aren't user-friendly or intuitive. Also, every practice is different. The workflow in Dr. Jones' office is different than in Dr. Smith's office. The workflow in a dermatology office is different than in a cardiology office. The workflow in a 7-provider family practice is different than in a solo provider practice. It's impossible to design a system that can be all things to all people.

+1

An excellent motivator to RE!