Monday, June 08, 2009

Should doctors be using computers?, Part 2
I discussed here the complaint by the New York Times about the administration's "headlong rush" towards the computerization of medical records. That was the Bush administration of course, and we all still have the whiplash to show for it. By contrast, Obama recently held a health-care summit at which "the flagship proposal ... was the national adoption of electronic medical records". This time it is the Wall Street Journal that is concerned. Apparently there is no reason to believe that computers should be used for medical records, any more than they were in the writing of that article. And of course, once mistaken medical decisions are committed to computer, they will tend to propagate. Perhaps we'd be better off if doctors wrote nothing down. (I do agree with the article, however, that this proposal will not yield great savings.) Interestingly, the New York Times is not (or at least was not) completely on board. It appears that some democrats want to make sure that the privacy issues are completely settled first. Right.

A friend of mine also feels that privacy issues must be perfected before we go ahead: "Just think about how bad a person with AIDS would feel if his medical information became public." This is true, of course, but I pointed out that there is another group of people for whom it is absolutely crucial that medical records be computerized: people with AIDS. It all comes down to the fact that there are two types of people in the world: those who think that people with AIDS primarily have a privacy problem, and those who think that people with AIDS primarily have a medical problem.

It should be clear that any system that makes it easier for good guys to access (medical) data will also make it at least somewhat easier for bad guys to access it as well. That is, we will lose at least some privacy when we computerize medical records. Also, in the initial version of the system, there will be horrible bugs; with time these will be decreased, but the system will never be perfect in any sense. I think it's worth it. If you don't, then you should explain just what degree of disorganization and inaccessibility you desire for medical records.

An interesting question is: why has this computerization not happened already? Surely the privacy-mongers are partly to blame, but there are many other reasons as well. Two culprits are the medical profession, and facts of life about how standards come about. I hope to write more about this in the future.

1 comment:

DWallach said...

My GP and my allergist both have computerized records, with a PC (running funky custom software, not just a web browser) in every examining room. The allergist's computer (but not the GP) automatically generates faxes to the pharmacy for prescriptions.

Online records are already here, in one form or another. Trying to get some grand-unified data exchange format would be nice, but I'm not imaging that "solving" the health care cost issue is going to require a whole lot more change than just going paperless.