Ask Your Doctor ... About Computers

Do you ever get the feeling that your healthcare providers are decades behind the times when it comes to information technology? Does it trouble you that your credit score is instantly accessible around the country but your health record cannot even follow you around the block? If the answer to these questions is “yes,” then the time may be right to ask your doctor about computers. How might a chat with your doctor about computers go? What you hear will likely be mostly negative. “Doctors say electronic records waste time,” ran one US News & World Report headline, which was followed by the claim that “technology has slowed doctors’ work.”¹

As historians of computing, we have the resources not only to help the general public think more constructively about the roles of computers in medicine, but also to see how what is happening in medicine lays bare the great and small changes the use of information technology has brought to everyday life. More specifically, we can answer an important question that lies, in part, behind primary care physicians’ dislike of electronic records: How did we wind up with computers in most doctors’ offices but little communication between these computers?

Toward Electronic Health Records

Your physician’s chief complaint will likely include mention of the HITECH (Health Information Technology for Economic and Clinical Health) Act and of Epic Systems. The HITECH Act, a major part of the American Recovery and Reinvestment Act of 2009 (aka The Recovery Act), mandated that the US Department of Health and Human Services (HHS) spend on the order of $25 to $45 billion to create a national, electronic network for medical records. American healthcare providers, ranging from large hospital systems to small private practices, were granted these HHS funds to start using computers to create an electronic health record (EHR) for each patient. For proponents of President Obama’s plan to provide health coverage for all Americans, an effective EHR was hailed as a means to cut costs while at the same time improving the quality of care. With the HITECH Act in place, Americans had, in principle, a mechanism to encourage (via generous grants) healthcare providers to go digital and punish (via steep fines) those who would not. Proving compliance, particularly to electronic security and privacy measures mandated by the act, can be a nightmarish process.

The most widespread EHR software the HITECH Act encouraged—or forced—physicians to adopt are products of the privately held Epic Systems Corporation, which developed software that manages the health records of most Americans (approximately 170 million people). For the purpose of bringing a given institution into compliance with the HITECH Act, Epic’s products have a reputation for getting the job done. Nevertheless, they are also notoriously expensive and ineffective when it comes to sending heath records from one institution to another, even when both are using Epic software.² Epic’s interoperability problems, coupled with the theme-park atmosphere at Epic’s “Intergalactic Headquarters,” generated fierce criticism of the company across the political spectrum and widespread mockery of its slogan “Do good. Have fun. Make money.”³

By some measures, the carrot-and-stick approach of the HITECH Act worked. In 2008, less than one in five doctors in the US kept some form of electronic records. By late 2015 that proportion had risen to more than four in five.⁴ Hospitals have seen an even more dramatic rate of EHR adoption. In 2009, just 9 percent of hospitals used EHRs, whereas today that figure exceeds 75 percent.⁵ The clinic may have become home to a “strange tribe” of compulsive computer users who manufacture database records, but there is an odd limit to this activity.⁶ Health records, even if they are kept locally in entirely digital format, still are generally faxed or mailed between clinics. Furthermore, American patients simply do not have a centralized health record any care provider could access.

MUMPS in Your Medical History

The origins of this situation is not just or even mainly about protecting patients’ privacy—by 2016 most American adults have become accustomed to handling private personal information online. Instead, the...