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DOCtalk with Dr. Gregg 12/29/15

December 29, 2015 News 2 Comments

Keeping up with the Tech Joneses

The Joneses have been around a long time. Heck, I’d wager that Mr. and Mrs. Caveman even had their issues with keeping their boulders as polished and their campfire as bright as the those of the next door rock-dwelling clan. Given that, it probably shouldn’t be any real shocker to notice a sense of envy when a high tech-oriented doc (i.e., me) finds himself feeling the pull to get the latest and greatest gadgetry for his office when confronted with the wow and wonder of another office that has just installed the newest techno-marvel system or device.

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It isn’t that we don’t have a pretty gadget-heavy office; we do. But in today’s rapid fire technology advancement world, what once was the best thing since sliced bread pretty quickly becomes crusty and stale, perhaps even a little moldy, when compared with HITland’s most recent baked goods.

Having a cutting-edge office, techno-wise, isn’t easy, especially if you don’t have a multimillion-dollar endowment fund, a clutch of support geeks upon whom to rely, and a research department to keep you up to date on HIT’s breaking trends. Plus, it gets even harder when best laid digital plans don’t deploy as predicted. A few cases in point:

  • Hardware: Faster processors, mucho more memory, higher rez monitors, touchscreens, tablets, better scanners, newer printers, higher bandwidth modems and routers, and on and on. (It wasn’t that long ago when “hardware upgrades” mainly involved newer pens, and those were typically free in bulk from drug reps!)
  • Operating Systems: Windows Server 2003 and 2005, XP, Vista (yes, we used Vista), Windows 7, Windows 8 – lots of updates in a relatively short time. (Thank goodness that Windows 10 is free.) I remember when, less than two decades ago, “operating system upgrades” were newer charts, nicer paper. and maybe sturdier clipboards. The upgrade costs were oh-so-nominal.
  • Associated Software (Server, Security, Productivity, etc.) Versions 1.0 to X.X: Upgrades, upgrades, upgrades. The software does get better, but the verdict is out on whether the seemingly endless cash drain is matched by the “improvements.”
  • Patient Portal, Part 1: Back near the beginning of this century, we bought a not-inexpensive EHR that included a patient portal. (This was at a time when very few folks were even talking about such things, when “patient-centered” medical care was mainly the mantra a few “radicals” trying to change the doctor-as-God healthcare model.) That portal wasn’t very pretty – it was actually butt-ugly – but we were promised that it was “on the dev timeline” for improvement. Considering how lovely the rest of the EHR was, we thought it would advance and so also purchased two touchscreen monitors. (This was back in Windows XP days, when touchscreens were relatively uncommon.) These touchscreens were for patients to use at our reception area to log in and access/update their patient data. Fast-forward some years, and that EHR system was acquired-acquired-acquired-sunsetted without one further tweak to the portal. Purchased, but never used.
  • Patient Portal, Part 2: After moving onto a new EHR, we found ourselves again with an included patient portal that, despite the beauty and remarkable workflow of the main system, was not very attractive and wasn’t very functional for our use. (I think it was lower priority, mostly built to address MU.) Thus, we set about finding an absolutely beautiful standalone patient portal that was perfect for our families. Only a year or two later and this system was also acquired and sunsetted. More time, money, and energy invested on a very brief, short-term return.

Recently having visited a nice, new large-group practice with all the techno bells and whistles, I’ve felt a real pang to purchase and deploy sleek, new gadgets and find a new system with a really good patient portal. But, beside the immediate financial impact, workflow disruption, and time costs involved with such changes, several nagging thoughts continue to halt my “keeping up with the Joneses” ambitions:

  • Does the “latest and greatest” really have a measureable enhancement on patient care? That is, are we not doing something now for those we serve that better tech would then allow?
  • Does there ever come a point where the investment in HIT slows, or at least decreases?
  • How much of my kids’ college funds (or of my retirement!) am I willing to keep giving away to keep up with the techno-Joneses?
  • Having the “most high-tech rural pediatric practice” was great when we started, but just how important is it to maintain the cutting edge …  and is “the cutting edge” cutting anything except my bottom line?

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From the trenches…

“Me? Jealous of you? Bless your little delusional heart.” – Rotten eCards

dr gregg

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, an HIT and marketing consultant, and sits on the board of directors of the Ohio Health Information Partnership.


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JenniferMr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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Comments 2
  • Dr. Gregg,

    This is a great post. I’m hoping that as EHR interoperability improves, we’ll start to see good open-source solutions for patient portals.

    By way of analogy, Zotero is free and open-source reference management software to manage bibliographic data and related research materials. It is user-friendly, powerful, and has more features than expensive and proprietary software products such as EndNote. Now many academic institutions provide Zotero tutorials to their members.

    Zotero’s development was funded by the Andrew W. Mellon Foundation, the Alfred P. Sloan Foundation, and the Institute of Museum and Library services, along with user donations. I would think that non-profit health care foundations would have a similar interest in contributing to the development of free and open-source health care software.

  • Frankly, the most frequent, consistent bragging point I’ve noticed in offices–not just health care–in the past decade? K-cup based coffee centers in the lunch room. Seriously.

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