Our Offline Physicians
Journalists and lawyers have been going digital for more than a decade. With a computer, a modem and only a dim recall of content, in seconds they can find and retrieve complete texts of articles, legal briefs or government reports from databases like Lexis-Nexis.
To this day, however, most doctors and medical researchers remain stuck in an earlier era, forced to remember exact authorship and titles, wander the bowels of university libraries to ferret out the hard copies and then photocopy every page they wish to take with them. Most physicians and researchers at the University of California, for instance, still have no means of electronically retrieving complete articles even from leading medical periodicals like the Journal of the American Medical Assn.
In addition to slowing the march of science, medicine’s failure to embrace a wide variety of information technologies needlessly inflates health care costs. Today, when patients get X-rays in rural clinics that lack a qualified radiologist to interpret the results, the X-rays are either mailed to the nearest large hospital or examined by a specialist who drives out from the city. For years, however, “telemedical” technologies have existed that could send those X-rays electronically to urban doctors for fast and relatively cheap examination.
Like many new technologies, telemedicine is hobbled by laws framed before it was invented. One example: Because medical licenses are granted by the states, a doctor licensed in one state cannot offer a telemedical consultation to a patient in another unless he or she is licensed in that state too.
Government and professional associations are not the only roadblocks:
* Medical journals charge more than the market will bear. Pricing plans in the electronic databases used by lawyers and journalists have been relatively stable for years; lawyers can pass those costs along to clients, and newspapers can often gain discounts by offering their own databases in return. In medicine, however, most health insurers wouldn’t dream of reimbursing doctors for online search time, and many of the medical journals that are available online charge cash-starved university libraries the same rates they charge cash-rich biotechnology companies. Even the National Cancer Institute, a federal agency, has teamed up with a commercial publisher to cash in on electronic subscriptions for Cancer, its prestigious journal. Universities should demand special nonprofit rates for electronic subscriptions.
* HMOs have refused to release quality data. In 1993, half a dozen states tried to establish “community health management information systems,” public/private computer networks that employers, researchers and consumers could use to, say, compare the cost-efficiency and medical outcomes of different HMOs in a community. Hospitals, insurers and HMOs defeated those attempts.
More headway is being made in academic fields related to medicine. For instance, the Pew Research Foundation has made a grant to Stanford University to develop a “knowledge environment,” a virtual laboratory allowing cell biologists to communicate and share data.
The dream of open medical information networks was briefly but passionately championed by politicians like House Speaker Newt Gingrich in 1993. It is worth reviving. The sharing of information, none of which would compromise the privacy of individual patients, can only raise the quality of health care, reduce its costs and enable doctors, patients and researchers to make smarter decisions.
