In 2018, the Centers for Medicare and Medicaid Services (CMS) announced a vision for "the free flow of information between patient, provider and payer." Posts on this blog have advocated for greater transparency as part of improving the delivery of medical care in America. See Transparency for Efficacy and Medical Charges and Challenges.
CMS perceives technology as the path to this information flow, as reported by Healthcare IT News. The particular tool in which it is interested will be web-based, likely as "consumer-friendly applications for Medicare beneficiaries to connect." Thus, the drive is toward new technology and through it transparency for those who use Medicare. The critics, at this stage, will point out that us boomers are perhaps less app-savvy than other generations, and we are a larger part of the current and certainly near future Medicare beneficiaries.
In that, there may be a disconnect between the technology and (some of) us users. Intertwined in this drive for applications to share information is less-favorable news for older, some would say antiquated, technology that remains ubiquitous. After announcing the app plans, the CMS Administrator also suggested that these efforts could help us "make doctors' offices a fax free zone by 2020." Apparently, that proposition drew applause from Administrator Verma's audience.
What is the point of transparency through technology? A patient is seen by a primary care physician, who recommends a consultation with some specialist. Or, a patient is seen in the emergency room or after-hours facility, treated, and told to follow-up with the primary care or a specialist. Each of the care providers is interested in delivery, interpretation, and evaluation of care, including that of ancillary providers such as a radiologist or laboratory.
In the age of paper, each participant on the care team obtained information about and perhaps from the patient, recorded it, and filed it away. When the patient presented elsewhere, physicians and facilities shared that information through the use of correspondence, facsimile, and the telephone. Each of which consumes time. Even the facsimile, though quicker than the mail, still requires contacting the possessor of the record in question, the retrieval of that physical record, and the transmission back.
The age of electronic medical records has dawned. However, some may say that sunrise is proceeding more slowly than it should. Systems exist to both record and store medical information. Sharing that information within an office or facility has been greatly enhanced, doctor to doctor, treatment to billing, and more. But, there remain challenges to sharing that information, seamlessly, with others that are more detached from the particular facility that created the record.
The IT News says that some healthcare providers contend "data can't be shared," when in fact they mean they choose not to share. The story quotes CMS Administrator Verma's contention that this refusal choice is because "of the fear the patient will be poached." There is thus a business reason for declining to share. Administrator Verma plans to counter that with another business factor, reducing physician and hospital payments for those that decline to afford patients record access electronically.
Vox reports that in medical practice, records currently are virtually always transmitted by facsimile or mail. It reports that clinics have progressed to use of electronic records, but some say their "electronic system can’t connect with other clinics’ records."
This is a portability issue that has been mentioned periodically in workers' compensation. However, with an even broader scope. Attorneys lament that they can, using a prospective client's identification and password, review medical records within the Social Security system. Thus, when discussing the potential of representation, an attorney may be informed in real time from the actual records rather than only the best recollection of the potential client. There is value in such real-time information.
That opportunity does not exist widely in the workers' compensation world. Certainly, there are medical providers that provide patients with each office visit note. There are patients who assiduously catalog and maintain those records. But, the vast majority of us are not consistently that organized. We find ourselves in that familiar position of clearly remembering having some piece of paper but being utterly unable to recall what we have done with it. Thus, an interview with a prospective client may be a bit challenging at times.
Understanding the drive for portability, and the view that the Internet is the platform with the most promise, why the disdain for the facsimile machine? A later Healthcare IT News describes the risks that facsimile presents. It asserts that "75 percent of all healthcare communications are still processed by fax." Those communications are vulnerable to hacking. It concludes that "the antiquated devices pose real privacy issues when it comes to transmitting patient data." While that is an issue for stand-alone machines, it could apparently be a larger issue for facsimile machines that are connected to computer networks.
"Most industries abandoned the fax machine in the 1990s, and for good reason. Fax machines are terrible at sending data. Busy signals interfere. Printouts are blurry. And sometimes faxes go to the wrong place entirely."
It says that the "Obama administration spent upward of $30 billion encouraging American hospitals and doctor offices to switch from paper to electronic records." That effort brought about significant change in terms of having electronic records, but "didn’t account for a critical need: sharing."
Despite the criticism of facsimile, Vox says that "in the medical sector, the fax is as dominant as ever. It is the cockroach of American medicine." Popular Science reports that "its continued use among doctors, lawyers, and governments" means that the machines will remain "in one form or another, for years to come."
I have discussed elimination of facsimile machines in the practice of workers' compensation repeatedly. Each time, the suggestion is met with objections. There are those who remain convinced that the law cannot be practiced without such machines. About a year ago, the facsimile machine in the Pensacola District office ceased to function and was removed. The world did not stop, there was no hue or cry. In fact, it seems that no one noticed that the "cockroach" was gone. Life went on, cases were filed, mediated, and adjudicated, without the antiquated technology.
I will be curious to hear from readers. I wonder how many lawyers out there remain convinced that the fax machine is an indispensable part of the practice of law in the 21st century. I wonder how many lawyers have calculated what their facsimile line costs them each month, and compared that to the number of actual faxes she/he has sent or received. How many of those lawyers have investigated the Internet-based alternatives to that old, dusty, fax machine. Are lawyers clinging because medical providers are, or is this a co-dependency based in fear of progress or change?
Progress comes for us all. Some of us are merely better prepared to greet it.