Now it is impossible to obtain a graphical trend line for my results (ie, glucose, HDLP, LDL, etc.) as related to medications. I did my own data base (excel workbook) with manual entry of the data and showed that some drugs were totally (statistically significant results) ineffective for me. I also showed that other drugs helped on parameter of concern while harming another factor of concern.

These are some of the advantages of a digital data system. However, MD's aren't the most progressive individuals around. I had (past tense) one comment to me "don't you have something better to do than keep track of data", when my statistical analysis showed that his recommended drug was ineffective, in my case. He has forgotten that drug approval is a statistical problem where they have been shown to work for the average, but that there is a statistical distribution of individuals where it works much better than average or doesn't work at all. It is my health, not his ego that is important.

"No the answer as a practicing physician who's career has now spanned from complete paper charts to a fully integrated medical records system is an absolute YES."

No, you're wrong. As someone "in the game" I can tell you, unequivocally, that the number of those favoring electronic records versus paper records is in not a overwhelming majority.

Max

Our problem isn't lack of electronic medical records. Our problem is connecting them all and doing something useful with them while still maintaining patient confidentiality. But, installing more electronic medical record systems is easier, so that's what will happen. The data will still sit idle.

When Palin was announced as running candidate for McCain, how long did it take the little socialist squirrel in Tennesee to hack into her e-mail to find any dirt he could find to give to the news agencies. Imagine how neat it would have made him feel to be able to hand over details on every Palin medical visit, diagnosis, and treatment at the same time, not only for her but her entire family as well.

And don't think for a moment he would have hesitated, nor that the media would have hiccuped over printing and broadcasting it.

My thought while watching the doctors stepping through the program asking the questions as prompted was that this is CYA medicine. But data entry is also a problem. What I saw was very time consuming.

Due to the relatively small transaction sizes and need for detailed scheduling and billing records, even small companies in this industry were eager to computerize.

It did not require a government mandate or subsidy to get it done. These companies saw it as an essential business expense, just like a truck or other piece of equipment.

The idea that doctors and hospitals, a richly rewarded and highly compensated industry, needs a government subsidy to computerize is ludicrous.

Every doctor or hospital I have had any business with in recent years has handled their billing electronically.

So the issue must be the doctor's notes and treatment recommendations. Obviously those would have to be entered by the doctor directly or transcribed from notes. Either takes extra time compared to the current system with no ability to bill extra to the patient.

So the medical industry has already largely decided that additional computerization is not cost effective. Why is that a problem?

It is like someone with an iphone or other PDA saying, "Everyone should have one of these. Look at all the time and money you will save using your time waiting in line at the grocery store to do your banking, check movie listings, etc, etc. Everyone should have one. Let's make it a law!"

If I write software by writ of some statutory decree, then I haven't necessarily added a valuable good to the economy, so my consumption decreases the stock of valuable goods without increasing it commensurately. Maybe the software is a "public good" in some sense, but then again, maybe it's not.

Simply creating "demand" without creating more stuff to demand doesn't simulate the economy usefully. A market economy is not a zero sum game, but simply entitling people to consume regardless of any productivity is zero sum.

Muirgeo

Did I read this correctly – you are a physician?

What might they have spent that money on otherwise? Is the economy somehow better stimulated by the programmer's spending? I don't think so. I think it's safe to assume that you don't either.

Let me put this another way, and relate it to the broken window fallacy a little more clearly: Doctors currently have a system that they, ostensibly, prefer. We break or destroy that system to replace it with a different(electronic) one. Are we economic benefactors for destroying the system? Or have we vandalized the doctor's practice?

Well, the programmers certainly benefit (like the glass maker in the parable of the broken window). And certainly whatever he spends his money on will profit the producers of his consumption.

However, the doctor his harmed by the destruction of his property (like the butcher and his window in the parable). Had his property not been destroyed, what would he have spent his money on? Would those producers have benefited from this consumption just as well as they would from consumption of the programmer?

I think so. I'm also sure that you do too. If other producers benefit just as well from the doctor's consumption as they do from the programmer's, what is the sense in imposing costs on the doctor? After all, if there is no difference in the the consumption of each actor, the cost is simply dead-weight loss.

In encourage you to read the link I provided above. There is a lot of wisdom to be gleamed from understanding it.

You're correct. It is a benefit to the computer company, the folks who work there, and folks who serve them. However, that's half the story. You have to look at what purpose that dollar was taken from.

You've missed the other side of the equation. That is, the cost.

We could, of course, simply break windows and we'd kickstart the economy, right?

It takes a lot of time to key in the new information too. I've sat in appointments with doctors who do use electronic systems. It takes them several minutes just to bring up my record, and then they spend more time typing in the discussion and all the required entries associated with the discussion than they do actually discussing the problem.

I troubleshoot a computer based system for a living, and I wouldn't want to use such a system while troubleshooting a system that is far less complex than the human body. There's a flow, and these systems destroy the flow. I think that in real life the doctors may be forced to use them, but in time their entries will become so cryptic as to be useless to anyone else.

Would electronic documents – in lieu of handwritten notes and signatures – be as acceptable in legal proceedings? It's hard to top the credibility of notes in a doctor's or nurse's handwriting.

I guess we have to redefine the term "market failure" as: "Stuff muirgeo doesn't like."