The other day, I went to see a new physiatrist for my chronic back problems. She came highly recommended by my former physiatrist, who retired. I found her (the new one) to be lovely and helpful, as was her staff. No problem with the people.
The technology was concerning, though.
Some things they got right. The doctor typed on a computer while we talked, but she had the monitor and keyboard raised and next to the examining table, so that she wasn't constantly looking down or away. I didn't find that off-putting at all, surprisigly. And when I first registered, the receptionist asked for my email address. I declined, because I don't want to be spammed by the hospital she's affiliated with. The receptionist told me that it's for something called, "My Charts", where I can look up my results and summaries of my visits, and where I can easily communicate with my doctor. I still declined.
Later, the physiatrist encouraged me to sign up for My Charts. She didn't know I had refused. She obviously uses it regularly, so I decided to do it, and I sheepishly told the receptionist that the doctor had convinced me, and gave her my email.
What I didn't like about the technological aspect was the initial forms. Well, "forms". I was handed a tablet, and asked to fill out privacy and insurance forms that way.
Problem 1: The thing is a fomite. There are typical hospital-type signs in the office about properly wiping down all shared equipment with cleaning products, but you can't really do that with a tablet, and dude, this thing was not clean.
Problem 2: The user interface was crappy, but that's no surprise.
Problem 3: The software was less sophisticated than paper forms. When you're handed a paper HIPAA form, you can decline to sign it, and the doctor simply has to document that she made a good faith effort to give you the forms. Your lack of signature does not in any way prevent the sharing of information that HIPAA allows. In other words, your information can get tossed around publicly, whether you agree to it or not. If you don't believe me, see my post, What, Exactly, Is HIPAA?
The electronic version had no option for not signing. With paper forms, I generally refuse, because even if I have no say in what happens to my information, I don't have to jump on board that bandwagon by obsequiously signing. But I couldn't finish the electronic form without signing.
There were 4 different documents I had to sign. One said that if I didn't agree to the terms, I wouldn't be treated. At least I think that's what it said. The lack of clarity is another problem.
A second form was a standard, "I agree to share this info with my insurance," which I know I have to sign if I want coverage. And I was pleased that this doctor, who came so highly recommended, happened to be in my network. This is part of the upside of technology, which, if done well, can make it possible to manage a high volume practice that takes insurance but still makes money, and also treats patients well. And this practice, unlike my own, is high volume.
Another form gave me two final options. I could either agree to share all information with other providers, or I could refuse to share any information with other providers, including in an emergency. It specified that part. Then there was a line below the options that said if I didn't choose one or the other, it would be assumed that I wanted to share no information, except in an emergency. I thought, "Oh, good. I won't choose." Naturally, the software wouldn't let me do that. So I refused the sharing of any information, on the assumption that in an actual emergency, any intelligent doctor would just go ahead and get the necessary history.
There was one other form, and I can't remember what it did.
Like I said, paper forms would have made more sense. It was galling that there was a big sign in the office touting the use of these tablet forms, and how they would allow for better patient care.
I'm not comfortable having my health information readily available to pretty much everyone. In an article in yesterday's NY Times, Why Health Care Tech Is Still So Bad, Robert Wachter describes a lot of what I just did, but with the hope that today's tech is really version 1.0, and that it'll get better. He points out the flight industry wouldn't dream of using new software until it was tested extensively by pilots in simulation. Not so in health care. Go figure. And Apple interface, especially with iPhones and iPads, is a pleasure in large part because Steve Jobs was a tyrant who wouldn't market a product until it worked the way he wanted it to. Not so in health care. Maybe we need a Steve Jobs.
But the line that struck me from the Wachter piece was, "Big-data techniques will guide the treatment of individual patients, as well as the best ways to organize our systems of care. (Of course, we need to keep such data out of the hands of hackers, a problem that we have clearly not yet licked.)"
Personally, I'm far less concerned about hackers getting my health information than about insurance companies and the government getting my health information. Who else would hackers sell it to?