Eh, Something's Up, Doc

If you've been to a doctor's office recently, you may have noticed a room off to one side crammed with file cabinets, file boxes, and piles of loose manila folders from floor to ceiling, wall to wall. No, these aren't the doc's letters from Mom, college files, or copies of old Daily Racing Forms. They're patient records. Untold hundreds of millions of these folders containing patient records exist in America, the land of milk, honey, and high technology. You can find them piled high in nearly every physician's office, clinic, and hospital from Bangor to Tulsa to Berkeley. I know one physicians' group that rents an entire building at another location just to house their patients' records. They have to send out -- like ordering a pizza -- when they want to access your file. While UPS, IRS, Hertz, American Airlines, and just about every business in the modern world was going digital over the last two decades, the health-care system in America was sliding deeper into a paper-filled quagmire. Where were these people when they passed out the computers? Or the Internet? Well, for one thing, they were busy. In fairness, most physicians -- both internists and specialists -- are more pressed for time than ever. HMOs have put the squeeze on them so that they're forced to see many more patients today than in the recent past, usually spending less time with each than they would like. When you're that busy, it's hard to find time to sit down and learn how Windows 2000 works. Another reason is that doctors by tradition tend to do things the old-fashioned way, which means on paper. They write each diagnosis on a piece of paper that goes into your personal manila file folder. They write your drug prescription on a small slip of paper. They ask you to sign paper forms to be mailed to your health plan for reimbursement. When you see a PC in a doctor's office, there's a good chance it's used primarily for one task: billing. If you didn't know better, you might think that getting paid is the most important part of the health-care system. Okay, so health care is behind in using technology. Why should anyone care? The reasons are simple: As patients, we pay in terms of lost or misplaced records -- a common problem in the health-care industry -- as well as for the inefficiency and waste inherent in largely manual processes. Ill patients get stuck on hold waiting for their doctor's receptionist or, worse, they get a constant busy signal when trying to schedule an appointment. Automation could bring speedier response times, while reducing the cost of storage space, and appointments could be made online a lot faster. There are other benefits, but those are a few of the key advantages if the nation's fragmented health-care industry were to adopt a comprehensive plan to go digital. Several national firms are attempting to enlist the Web to bring digital efficiencies to the medical field. Healtheon/WebMD, an electronic processor of medical claims, wants to link the various players in the health care industry via the Internet. DiabetesWell serves as an e-clinic, helping physicians monitor and treat hundreds of diabetic patients online. Medical-equipment manufacturers are doing their part to digitize or Web-enable particular aspects of the industry. In the X-ray area, Lumisys Inc. makes a system for physicians to view and store X-rays in digital format. Imagine -- wow, what a revolutionary idea! -- having the lab transmit your X-ray results directly to your physician's PC, instead of hearing, "Well, we haven't received the X-ray results yet." Medical-device maker Medtronic Inc. is trying out a cardiac implant capable of monitoring heart performance and sending that data to a computer, and ultimately, over the Internet. Despite the e-revolution, physicians and patients are only beginning to interact over the Internet. According to a recent survey by Cyber Dialogue in New York, only about one out of 10 patients knows his or her doctors' e-mail addresses. Some observers surmise that doctors are wary of expending hours of unpaid time responding to piles of e-mail from patients describing their aches and pains. My guess is that will change. Before long, if only to remain competitive, physicians may be forced to give patients their e-mail addresses. If that happens, the once-common house call, last seen when there were tail fins on Cadillacs, could make a comeback in cyberspace.