Friday, May 2, 2008

Doctor's offices: Welcome to the 21st century!

Doctor’s office reminders. They’re great for the harried working mom or just those of us with one too many appointments on our calendar. I juggle those little business card sized reminders until I can input them in my planner (yes, I still do paper. Heck, I can lose my blood sugar meter several times a week, and that’s needed to survive!)

Then I get the reminder postcard and/or phone calls in the days or weeks leading up to the appointment. My dentist’s office even wants you to waste your (and their) time by calling back to confirm. Hey, I got the message.

But is this good customer service, or a lot of time, money and paper wasted? (And did I mention the resources expended to ship or pick up the cards from Staples or through the mail.

Walking Green recently wrote on her blog:

Can you imagine how much money the dentist would save if the just had it set up
so that you received an email? Of course, there would be the initial cost.
However, by the time you pay for the post card, the postage (.26 cents), an
employee who is filling out the postcards, the non-recyclable labels that our
address was printed on and stuck to the post card (instead of writing it in),
then for a busy practice, it is quite a chunk of change.

Unfortunately, it’s one part financial laziness on the part of practices and one part our friends at the U.S. government. Yes, I’m talking HIPAA, the legislation that says I can’t talk to anyone, even your spouse or voice mail, about your health without you signing pages and pages of consents. (Let’s talk about that paper waste! Actually many places now state you acknowledge you can get a copy of the privacy policy online if you care.)

Because of this, you’re limited in how you can do reminder cards – often, your name and info must be sealed so your spouse, etc., can’t read it.

It’s worse for e-mail, because people change it so often and theoretically anyone can access it. So offices shy away from it.

According to Healthcare Economist:
Among individuals with Internet access, 90% want to communicate with their
physician over email. In fact, 56% of patients claim that having the ability to
email their doctor would influence their choice of doctor.
Really, it’s stupid that they don’t. My endocrinologist has me fax in blood sugars every two weeks (twice a week when I was pregnant). That involves me printing my sheet and faxing it (generating another sheet of paper.) I asked if I couldn’t just e-mail an Excel document (one less sheet, and with HIPAA I am sending the information, not requiring a response over e-mail), and they didn’t want to change their business practices and remember to check an e-mail address. The office is swamped because the physician is fantastic, so we use old technology to make due. I'd simply phone in my blood sugar readings, which would save that one sheet of paper each time, but it could cause problems in interpreting results if something was written down wrong.

The alternative is secure messaging, and no practice (heck, not even a lot of large medical practices) are up for that kind of investment. Instead, it's cheaper in the short run to do paper, no matter what the long term cost is.


Becky said...

Maybe when your endocrinologist is forced to switch to EMR (electronic medical records), the office may revise their policies. It would be a lot easier to download the file from email than receive the email, scan the fax, each time losing legibility.

RJS said...

Becky, you'd be surprised.

While my endo. is still on the other side of town (love her too much to fire her), many of the physicians at my hospital are being dragged kicking and screaming into the 21st century. EMR adaptation in our hospital is slow at best -- going on a couple of years now -- because doctors are used to doing things the old way and don't want to change their habits! And this is even with a citywide collaboration among the hospitals for information-sharing.

It's truly sad. We can jump on the bandwagon to adapt million-dollar diagnostic and surgical tools but can't adapt the things that would make workflow easier for patients, staff and the physicians in the long run.

Walking Green said...

You are right, it is cheaper in the short to do paper. However, when you you look it from two sides for the long run, there are two different angles from a business and environmental perspective.

1) More expensive business wise to have the security parameters you need put into place. That's a downside economically when medical expenses are already exorbitant for the average joe.

2.) Evironmental perspective. Add up the expense of postage, paper, ink, electricity to print, manpower, etc. and it's just as expensive. More so when you think of the affect it's having on the environment and our forestry.

I wonder what the cost differences would be if you actually broke it down over a 5-10 year time period. Add in all the variables, such as the above items, fuel consumption, etc. to it.

I have a friend who does medical software design, I guess it is time to ask him what the cost of something like this would be...but he's also expecting his first baby anyday, so it may take him awhile to guesstimate it for us.

Love reading your blog. Keep up the great work!

Going Green Mama said...

The key is keeping up with the technology, too. Pre-HIPAA, the technology was in place (if they desired) to write e-mails to their patients. Yet few offices chose to.

Today, you can purchase off-the-shelf software (to load, or even have the company host for you) to conduct transactions - simple things like prescription refills. Yet no one wants to do that, even though the patients do. Part of it is they don't want to change their practice, part is they don't get reimbursed by insurance. Maddening.

I work for a hospital, and one of our services finally contracted to do online pre-registration/intake. I think it's little surprise that their patient load increased significantly that year.

It won't be until enough people demand it that physician offices change.