Disclaimer: The opinions expressed on this site do not necessarily reflect my actual opinions.

May 26, 2004

Me and Newt, up a tree

Disturbing as it may be, it seems I do in fact agree with the loveable, cuddly Newt, the man who once proposed a mandatory death penalty for drug smugglers (and wasn't even joking), the bastion of the conservative right, and the owner of the second-most preposterous name in US politics (first prize goes to Senator Saxby Chambliss, R-GA). At least, I agree with him on one thing: healthcare needs to be reformed, and it needs to be reformed right now.

'Course, Newt's talking about US healthcare, which is an entirely different beast from the Canadian version, but there are issues shared by the two (shared by all "public" health systems, really): it's too expensive, it's too slow, and it's woefully out of date.

You know things are bad when you've got to wait a month to have a suspicious lump biopsied, or months for a hip replacement. It's just not good enough, and it needs to be fixed. Fixing it, if we're realistic, means throwing money at it. But throw money in the right direction, at the right things, treat the problem, don't just stick on a financial band-aid.

Where could money wisely be spent? First, on modernising patient records (and this is where Newt and I agree, as weird as it might feel to type that). In the US and Canada patient records are still in "paper form". You remember paper? It's what we used to use to write stuff on, until Al Gore invented the computer. There are millions of pages of patient information sitting in filing cabinets, in big stacks, propping up wobbly desks, and all other manner of places. If you move house, and change your family doctor (assuming you can find one taking new patients), that doctor has to write (on paper) to your old doctor and request they ship your records over, otherwise the doctor hasn't a clue what medical issues and treatments you've received in the past, and has to rely on your mediocre memory. When your new doctor thinks you need treatment he writes (on paper, and often completely illegibly) a prescription, and you take it to a pharmacist to be filled. The doctor also makes a note of this treatment in your paper records, which he then, once you're safely out of the room, puts back under his desk leg so his coffee doesn't spill.

This is madness, utter madness. There are so many drawbacks to this approach that I hesitate to even begin listing them for fear I shall never finish, but let's cover a few, as they occur to me:

  • Paper is comparatively expensive
  • People need to be paid to organise it all
  • Someone has to pay for shipping your (possibly voluminous) records from one doctor to another
  • Repeat tests are often issued because it's quicker and easier than reading through pages and pages of scribbled notes to find out if you've already had it done
  • What's perfectly legible to one doctor might be indecipherable to another
  • If you go to a walk-in clinic that doctor can't access any of your records, and nor can the staff in the emergency room, without calling your doctor on the telephone
  • Pharmacies dispensing incorrect drugs or doses because of illegible prescriptions is a real and serious problem
  • Interactions between drugs prescribed to the same patient by different doctors (or, in some cases, even the same doctor) cause many deaths and much sickness every year, because there's no easy way to summarise what drugs a patient is currently using

As I said, that's just a brief run-down. There are more disadvantages, but most of them fall into two categories: ease of access, and searchability. If your records aren't accessible to whatever medical professional is trying to treat you, be it a new family doctor or an ER nurse or a paramedic, then your records are completely useless. And if you're not conscious you can't very well tell them you're allergic to penicillin and you'd rather not have any, thanks. If you're wearing a medic alert bracelet, that's because our system sucks. As far as searchability goes, who wants to read through dozens of pages of handwritten notes (and doctors are infamous for having appalling handwriting) in order to figure out what drugs you're currently taking, or when you most recently had a tetanus shot? Not you, and certainly not your doctor, who has a waiting room full of sick people to make healthy.

So what's the solution? I'm sure you've guessed already, you clever thing. Instead of on clunky old envrionmentally unfriendly paper, patient records should be stored... on computer. It's a revolutionary concept, I know, that one should use an automated system to store millions upon millions of records so that they might be accessed by anyone with permission to do so and searched almost instantly for any required information. Why, you'd think there might already be some sort of specialised application to do just that, perhaps a kind of base where one can place one's data.

Sure, there are concerns. Security, for example. These days it's possible, even very easy, to encrypt data with such advanced techniques that it would take {insert name of secretive government agency here} years to crack, let alone anyone else. What's more with modern cryptographic authentication it's possible to restrict access to records in a very secure and fine-grained way. Given enough thought and careful planning, your data would be secure from crackers, lawyers, and other criminals. Another concern is data safety, but is a roomful of flammable paper records really any more safe than if the data were in computer form, properly backed up?

The advantages are manifold. Your records could be retrieved more or less instantly, over a wireless network, by the paramedic who's trying to work out why you're foaming at the mouth and making alarming gurgling noises. The ER nurse, the doctor at the clinic, the pharmacist, can all access the information they need without having to get someone out of bed. Do you need a chest x-ray, or did you have one recently? If you did it's right there, along with a graphic of the x-ray, which could help a doctor make an instant diagnosis. Your doctor thinks you need antidepressants, and starts to fill out an online (legible) prescription, but -- uh oh -- you're already on something else that has known interactions (not even necessarily known to the doctor) with what he was just about to prescribe. That might save your life. If the prescription checks out, it's accessible instantly to the pharmacist without you having to hand over a slip of paper. What's more the pharmacist can actually read it without squinting.

This needs to happen. Not only could it save time and lives but it would also be a lot cheaper than the way we do it right now. It's estimated that up to 15% of medical tests are unnecessary because they've already been done recently. Thousands of people die every year from drug interactions and medical errors, which means a lot of investigations and lawsuits. The financial benefits are clear, and Newt bangs on about them so that I don't have to, bless him.

To sum up, then:

(I intended to rant about a two-tier healthcare system, too, but this has already turned into a novel so I'll leave that for another day...)


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