Survey shows many in high-tech healthcare prefer paper to PCs (and are fools)

Self-interested survey of Dunning-Kruger victims shows destructive instinct in health industry

In 2009, when the Obama administration signed the $800 billion American Recovery and Reinvestment Act (ARRA) into law, it also signed the death warrant for hard-core luddites within the power structure of U.S. healthcare.

Though it was primarily aimed at stimulating the recessed economy, ARRA gave $27 billion to the U.S. healthcare industry to fund a large-scale conversion from a 19th-century management structure that depended on paper records and couriers to one that requires patient records be kept, transmitted and stored electronically.

The funding came with specific requirements and deadlines designed to ensure everything from giant hospital conglomerates to local doctors' offices had an upgrade path, a set of goals and deadlines to hit and financial penalties for not modernizing quickly enough.

Evidently it didn't clear away the Luddite attitude that kept medical records in the Dickensian era, or the tendency of those with ulterior motives to fan the embers of anti-technological resentment.

Anoto – a Swedish company that sells digital pen-and-paper systems aimed at doctors who wish the whole PC thing never happened – today released results of a survey of healthcare workers implying that the counterrevolutionary opinions of end users prove the healthcare industry doesn't need to be modernized.

Specifically, according to the survey, wholesale conversion from paper records to digital is unnecessary because:

Paper is King:

  • Paper records are too important to the existing culture and workflow;
  • Technology to replace paper is too expensive;
  • Switching requires too much training because all anyone knows how to use is paper.

Anoto's survey has numbers to back up the conclusions, of course:

  • 63 percent of respondents said they spend 25 percent to 75 percent of their time on paperwork (red flag No. 1 that paper records are the problem, not the solution);
  • 80 percent still use paper records despite having or building a digital records system (red flag No. 2: a compulsion that requires you to double your work in order to avoid losing a system you already understand to one whose value you can not yet judge is a clinical symptom, not a positive characteristic of a clinician's work);
  • 78 percent believe the upcoming reforms in healthcare regulation will not reduce the volume of their paperwork (not so much a red flag as ignorant pessimism; the regulations aren't final yet, so it's impossible to know what the implementation will look like, especially when hordes of buzz kill are dragging their feet on the digital systems that might make their lives a little easier if they could ever be finished).

I won't be pedantic enough to point out that Anoto sells digital-paper systems designed to let clinicians work under the illusion that they haven't modernized while adding a completely extraneous set of products designed to convert their quill-and-vellum chickenscratch into something anyone else can read, and maybe store in something other than a long hallway stacked head-high with filing cabinets.

I will mention that even the Anoto survey included a question that allowed 90 percent of the change-resistant tribe of clinicians to admit that (scientific data eventually being too thick to deny) that digital patient records do ultimately improve patient care.

Almost 50 percent said their interest in digital pen-and-paper systems – that is, being able to benefit from the conversion to digital records without the trouble of doing it themselves – was an 8 or higher on a scale of 1 to 10.

And that, in brief, is the internally conflicted U.S. healthcare industry: so heavily technologized that, amid the welter of test results and insurer "recommended" best-practices, there's no time to ask patients how they're doing or what's wrong.

But the doctors and administrators who make the system move invested so much time and effort in learning the intricacies of the paperwork maze that learning the business of medicine was nearly as much work as learning how to practice it. Giving up a familiarly arcane system for a simpler one is such a huge personal conversion many will do almost anything do avoid it.

For decades, they did just that.

So did the rest of us, though only because we had no choice.

The U.S. medical industry is finally dragging itself into the 21 st century, though just barely.

If there are a few luddites left who are willing to spend extra money and time of their own to squeeze paper records into a system that doesn't need them, fine, let them do it.

It will add cost, add latency, add complexity and contribute to more errors at every level, just as any new layer of technology would in any complex IT system.

In this case digital pen-and-paper is Physician Middleware – an awkward, expensive, error-prone kludge designed to let cranky, mistaken know-it-alls stick to their own self-destructive compulsions while the rest of us move to something that might actually be tolerable.

Anuto's little survey seems like an inconsequential little human-interest piece. It tries to portray all those pen-obsessed clinicians as being coerced into modernizing when they don't have to.

That's not even vaguely what it is.

Whether Anoto intended it or not, the survey plays up the worst tendencies of the U.S. healthcare system: resistance to change, denial of its own weaknesses and near-fatal levels of the Dunning-Kruger Effect.

Dunning-Kruger is a cognitive bias that keeps the incompetent from realizing just how bad they are at something. In medicine it expands to the arrogant belief that success in one difficult field is evidence of genius in all the others. Like, say, deciding whether pens and clipboards are more efficient ways to manage the high-tech care plan for a single patient, let alone a multibillion-dollar industry.

When it comes right down to it, it's not possible to those august personages that they're wrong – denial affects their hearing as well as their decisions.

It would probably be easier to email them. Then phone the office see if there's someone who can print it out and put it in an envelope so boss can read it.

Read more of Kevin Fogarty's CoreIT blog and follow the latest IT news at ITworld. Follow Kevin on Twitter at @KevinFogarty. For the latest IT news, analysis and how-tos, follow ITworld on Twitter and Facebook.

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