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Computers Rant
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Mon, 03/10/2005
Urbandoc.net preliminary notes

There are times when I hate being ahead of the times as it can be so frustrating. In 1998 I had an idea of connecting various doctors offices over the internet to allow for patients to be redirected to other physicians offices when their primary physicians office was closed and to facilitate making specialist appointments. Finally, in 2005, the urbandoc.net project is starting up and it will perform a subset of the functions I sketched out 7 years ago.

I didn't come up with this latest idea and I don't have the patience to deal with myriad bureaucrats in the local health board which are providing funding for the project. It is a rather strange feeling, though, to be at planning sessions being paid to talk about computers and not having to write any code. I prefer writing code, but being a consultant pays much better.

A doctors office has to be one of the most anachronistic places currently in existence, especially in Canada under socialized medicine. Appointments are made using a pencil on lined pieces of paper with communications occurring solely by telephone. Telephones were marvels 100 years ago, but we've come a long way since then. Information transfer bandwidth over a telephone voice connection is somewhere in the range of 100-300 baud at best, and that is if someone talks really fast. Normal telephone conversations, when converted to text form, comprise surprisingly few bytes considering the amount of time that they occupied. That is why I prefer email. I can breeze through emails at >9600 baud equivalent speed which represents a 32-96 fold temporal efficiency increase over raw voice communication. I don't think my receptionist can read as fast as I do, but even if she read 10X faster than speaking rate, this is a marked improvement in office efficiency.

One of the most common complaints I get from patients is that they can't get through on office telephone lines. We have 3 telephone lines coming in of which 2 are publicly available and it appears that they are busy most of the time. I find it so exasperating to make my own personal doctors appointments that I have my receptionist do this. The line is usually busy, so I redial a number of times and then get put on hold. It would be so much simpler if I could simply send an email message to the effect that I would like an appointment in the time interval (ta,tb) or even better if I could directly access the physicians schedule and make my own appointment bypassing the receptionist.

For an individual earning $100/hour, 5 minutes spent on the phone represents a cost of $8.33 and having to deal with the socialist medical system is prohibitively expensive (that is why all of my high income patients have their secretaries call for appointments). The Canadian medicare system seems to assume that the average user of the system is on welfare as the value of their time is assigned a value of zero. Pierre Lemieux has looked at the economics of socialized medicine, and for the aforementioned individual, a private system with far shorter delays and greater efficiencies is far cheaper than the "free" socialized medical system that supposedly makes up the fundamental core of the Canadian identity, and without which we would merely be impoverished Americans. Sorry, rant mode off for rest of this note.

To get back to urbandoc.net, the project will connect about 20 doctors offices via the internet and provide for a means for doctors to actually take days off now and then knowing that patients of theirs who need to be seen can get appointments with other physicians whose offices are located nearby. The website is still being designed, but it is nice to finally be making some progress on bringing medicine into the 20'th century.

My vision of the system involves electronic medical records (EMR) being made available to physicians who are on call or who will be seeing patients when their regular doctor is away. Right now urbandoc.net is merely a glorified scheduling system and a private physician forum. There is still ongoing debate about whether patients should be allowed to make their own appointments or whether all appointments should go through a receptionist (kind of defeats the purpose of system I think). At least the system design is flexible enough that each doctor can run their own office webserver if they desire and that is what I do already.

One big point in favor of decentralized systems is that they provide far better security of data. Government bureaucrats would like physicians to use an EMR that is centralized in a government server as this would allow them access to all data. I would never want my medical records stored in a government server and most patients, once I explain the problems with such a system, would not want this either. Paper records do have the advantage that they are very cumbersome to access digitally; one has to physically go to where they are stored and read them (I'm not sure if we'll see machine reading of doctors handwriting in this century) and transcribe them into digital form. With electronic records, it is possible to have a computer search all of the records in less time than it would take to go through one thick patient chart. Having EMR's means that I can search patients charts for certain diagnoses to see if they are being managed properly (as management protocols for diseases do change with time) which is really useful in patients who rarely come in to see their doctor. A compromise system that gives the benefits of EMR to physicians but frustrates statist bureaucrats is to have each doctors office have their own self-contained EMR server which will interact with other physicians offices via very highly monitored links. If the government wants to see a one of my patient records, they can do so with a subpoena.

When I'm on call it is frustrating to have no information about other physicians patients. If I get called by a patient of mine, or my partners, I either know their medical history or I can easily look it up in my office. In the case of an intelligent, cognitively intact patient, I can get most of the medical history from the patient, but the most difficult cases are elderly patients living at home with some degree of cognitive impairment. Obviously their cognition can't be too impaired or they would be in a nursing home, but these are the individuals who tend to forget items of their medical history like life-threatening drug allergies. Here access to their EMR would make things so much easier.

More to come RSN. Written 15/8/2005, final recheck 3/10/2005.

by Boris Gimbarzevsky  Comments

Posted at:Mon, 03/10/2005 22:32:11