Commentary: Bingeing on infotech is easy, but just try finding the follow-through

February 26, 2004

I've been to several of these healthcare meetings in the past few years. At the very least, they're good for one's physical health. I get more aerobic marching in five days of medical meetings than I do in a season of angry golf. This is my fourth

I've been to several of these healthcare meetings in the past few years. At the very least, they're good for one's physical health. I get more aerobic marching in five days of medical meetings than I do in a season of angry golf.

This is my fourth HIMSS, and I've been to the last five SCAR and RSNA gatherings. In one sense, all these congregations are alike - retreats where the medical community covets a collective vision of its future, usually seen unfolding in the latest electronic messiah.

Meetings that forecast the future with such certainty can also be a spiritual tonic. It's hard to walk through exhibition halls at these revival meetings without coming out the other end feeling buoyant, certain once again that healthcare's technological temple will somehow shelter us all in the end.

It's the same exuberance that emerges when a new medication is discovered, or a new surgical procedure evolves beyond experimentation and becomes mainstream medicine.

This week in Orlando, like other weeks in other cities, hundreds of vendors have erected glittering altars to convert the digital agnostic. The aisles of the Orange County Convention Center are adorned with the latest electronic medical solutions from nearly 800 merchants: EMR, CPOE, HIS, RIS, PACS, PDAs, telehealth, telemedicine, bar coding, smart cards - all noble, elaborate examples of modern science put to work addressing something important.

Why is it, then, that my banker and mechanic still know more about me than my doctors?

I can go anywhere in the country and find an ATM that knows how much money is left in my checking account, and I can take my Cherokee to any Jeep dealer and every one of them knows the last time the oil was changed and where.

Sometimes it seems the digital miracles lined up in exhibition halls show few signs of flourishing far from the conference. Just about the only place you see these gadgets is on the exhibit floor.

The military, largely unconstrained by cultural and financial resistance, has done a much better job of creating an electronic medical record than the private sector. It's easier to decree than propose change.

Kaiser Permanente has made a reasonably good start at an EMR, and other HMOs will no doubt soon be up to speed. But none of them are likely to talk to each other, or to the miliary's system, in the foreseeable future.

It's true that Toyota doesn't share information with Ford, and Bank of America doesn't communicate with Wells Fargo. But healthcare is not about bank balances or tire rotations, it's about people, and while people may change banks or automakers, they never change their medical history.

Every time I change jobs, spouses, or insurance carriers I'm likely to end up with a new set of doctors, and the first thing they want is a complete medical history - the same one I provided their golf partner last year, or last week.

Meanwhile, I still can't present at any emergency department with an expectation that the medics will know my blood type, current medications, or allergies unless I tell them. Lord only knows what happens to unconscious patients.

In the end, medical meetings are like bingeing on apple juice. It may be good for you but you can wish you hadn't done it.