Where should Technology be Directed

I do not have access to millions (or billions) in health care dollars. Nor do I think anyone will give me access to it any time soon. So when I read about connecting labs and radiologists with doctors offices I can only think of it on my own small scale.


In our office, do I appreciate being able to see a patient x-ray from the office? Damn right I do, it saves me waiting 12 hours for a courier to bring up a CD with the results (or having an admin assistant go get it if I need it fast). But what is the cost?


In this blog entry the author makes statement that wait times are being reduced by improving a network. But how much does it really help? My own family doctor is connected to the labs digitally. When I go see my doctor here are the steps I go through:


1. Contact/making appointment 30-60min on phone (frequently busy)

2. Waiting for appointment (10-30 days depending on urgency)

3. Drive to appointment 60min total (my family doc is 1/2 hour away)

4. Appointment in Office (min 1 hour - occasionally quicker)

5. Lab Work (right next door if they're open 45min waiting for blood work)

6. Call from my doctors receptionist 7-14 days later (he doesn't call himself, they reley the message through the office administrator. Last time she told me my triglycerides were too high and maybe I should consider some exercise)


So to get my cholesterol checked I could wait approximately 17 days if I get in quickly and they call back soon after results are received. At worst I'm looking at 44 days wait and about 4 hours of my own time. And, I don't think this is atypical. The quick transmission of results is nice, it's great infrastructure but it is not the panacea that everyone is making it out to be.


In my own practice, we have to allot a certain amount of money to infra-structure maintenance (including IT projects like this) and strictly calculate the return on investment. On a larger scale, the ROI isn't always so easy to calculate but I think we've over done it. It's not that the technology is bad or useless but that the return on investment is not fantastic. When we value these types of projects in a clinic, we look very hard at how it will improve efficiency. When I look at digital transmission of lab results, ROI is almost nil. In the case of Muskoka they've increased bandwidth and put in a private network specifically to accommodate it. What would happen if we put 2.0 billion in this country towards new physicians, nurses or training staff on efficiency (and giving them the tools to make it happen)?


A poorly implemented EMR will actually worsen wait times so having the end-providers deeply involved in the implementation is paramount. There is a fantastic blog at Health Care Renewal about why EMR's fail. As we progress to Health 2.0 and 3.0 building IT infrastructure is important to our medical system but the massive layout for network and EMR is not adding to the value of care the way it's being touted. As we've said before, a new project must not only make things more efficient it must also increase quality. Without one or the other, the implementation is likely to fail. Without both, it's doomed.