Today was the day for the annual physical examination. There are certain aspects of the "physical" that are not pleasant for anyone, but the thing I enjoy the least is filling out the paperwork. Step one at the doctor’s office is to be presented with a clipboard and forms with fields that are too small and questions that I don’t know the answer to — like the address of my healthcare provider. I said that I had been a patient of the doctor for years and nothing had changed since the last time I filled out the paperwork. "Yes, but we have a new billing service and they require that all patients fill out the paperwork again". It seems like at every visit there is some reason that I have to write down my name, address, phone number, date of birth, etc. After I wrote down the health insurance information from my insurance card, the office assistant asked for my insurance card and then made a photocopy of the front and back of it to put in the manila folder. This is the 21st century?
Before I continue this story I should say that I feel extremely fortunate to have healthcare coverage. It is very unfortunate that many millions of people have no coverage at all. There are multiple reasons for this, but the biggest is the cost. Healthcare costs are spiraling out of control. One of the reasons for that is the paperwork. Not just the forms at the doctor’s office but also prescriptions that the pharmacy can’t read. Another big cost factor is human error. In part because the various processes and sources of data are on paper and are not integrated, there is an increased administrative cost. When medical errors occur, patients (mainly their attorneys) decide to take legal action. This adds tremendously to the cost of healthcare. It is not uncommon for some doctors to incur a cost of hundreds of thousands of dollars per year for malpractice insurance. I believe the glass is half full, not half empty.
Like other things going on in the world, it is a lot easier to find examples of what is wrong than it is find examples of what is going well. There is a lot going well. Danbury Hospital has a CPOE (computerized physician order entry) system that allows doctors to use an online system to enter orders for tests, procedures, or medications. If a medication is ordered, the system checks the patient database to see if there are any allergies or other medications being taken which would cause a conflict with the new medication being prescribed.
A smart card pilot currently running at the Seoul National University Hospital in Korea, aims to offer improved healthcare services while also reducing the cost. The “HealthOne Card” securely stores personalized medical health data including emergency data, prescriptions and allergies, transit fare to get to a medical facility, debit/credit for payment, and a security key for encryption of the data. All of this is stored on a tiny computer built into the card. I don’t know the status of the pilot, but the potential benefits are obvious. Healthcare providers will have instant access to patient information enabling them to offer a higher quality of care and better support their use of emergency facilities. Patients will receive better, and more secure, care by carrying their personal clinical information in their purse or wallet. Governments will see better management of the healthcare system.
Reducing paperwork is bringing benefits in many areas beyond healthcare. All fifty states are now beginning to issue electronic cards for “food stamp” users. The name is outdated, but the process is getting automated. Tens of millions of people in America use food benefits and now they will be able to do so without having to wave coupons. Food stores will see dramatically less cost for processing and reduced delays in receiving payments. State governments will see reduced fraud and lower overall cost.
If eBay, Amazon, Korea, and the food stamp program can operate without paper, why can’t most industries? Answer? They can — and they are beginning to. Things might go faster if the legal profession would lead by example. More on that another time.