Pediatrician Describes Efforts At Computerization

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One of the big hopes of health care overhaul is that the U.S. will get its health care system computerized. A Maryland pediatrician, who last March described her concerns about computerization, discusses how things are going now that her practice has switched from paper to bits and bytes.


One change the Obama administration would like to see in health care has to do with the way that doctors practice medicine. The administration would like to see the doctors' offices keeping medical records on computers. To help, there is $19 billion in stimulus money. NPR's Joanne Silberner has been following the efforts of one doctor in suburban Maryland and, as she's found, making the switch is not easy.

JOANNE SILBERNER: Today in a speech at the Brookings Institutions, Vice President Joe Biden made a vow.

Vice President JOE BIDEN: What we're talking about, if we did nothing else, and we're going to do a great deal more in health care, you've got to modernize the system that allows for the transfer of information. It is archaic. It is absolutely archaic.

SILBERNER: Doctors have been resistant. According to a survey last year in the New England Journal of Medicine, only four percent of physicians had total electronic record systems. Five months ago in Rockville, Maryland, pediatrician Cynthia Fishman decided to plow ahead with trepidation. Here's what she said then.

Dr. CYNTHIA FISHMAN (Pediatrician): I'm nervous about technology today. For instance, I walked in and we're now transitioning our computers to the new system and they were down.

SILBERNER: Fishman worried that she'd focus on the computer and not the child. That computerization would be expensive. Her nine-doctor practice completed the transition to computers last April, a few weeks ahead of schedule. But sure enough in the first week, there was an electrical failure and for a day, they were back to paper. Now Fishman totes around a tablet computer with a pen for the touch screen and a keyboard for typing in information. She shows me her day.

Dr. FISHMAN: So in this instance, my first patient of the morning was a three-year-old. And I would click in here and I would wait...

(Soundbite of laughter)

Dr. FISHMAN: ...because sometimes the computer is slower than I would like it to be.

SILBERNER: The computer holds her patients' histories, her schedule, phone messages and a prescription pad. But as for the promise that computerizing would make health care more efficient, not for Cynthia Fishman.

Dr. FISHMAN: I will spend another couple of hours tonight at home, after my children go to bed, documenting in the computer what went on.

SILBERNER: Information she didn't have time to type in during the day. As for costs, no money saved yet. Fishman's practice isn't receiving any of the stimulus money. They computerized too early. The big benefit for Cynthia Fishman would be if specialists and hospitals who've treated her patients were able to send records that would go straight to her patients' charts, but no.

Dr. FISHMAN: Right now, computers don't talk to each other.

SILBERNER: Still Fishman figured computerization was inevitable. She's made a conscious effort not to focus on the computer during examinations and she's a good sport about the whole thing.

(Soundbite of laughter)

Dr. FISHMAN: It's been going better now than it was the first month. So we're at least getting used to the system and there's not as much griping. Yeah, it's better but it's still - you have to come back to me in probably nine months.

SILBERNER: She's hopeful. She says colleagues who've been computerized for years tell her that they're happy. Meanwhile, the administration is hoping that computerized medical records will save on the nation's health care bill by wiping out inefficiencies like repeated medical testing. But that remains to be proven.

Joanne Silberner, NPR News.

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