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It's time for doctors to welcome computer era

By Carl Heintze

Now and then for reasons of health, I have to see a doctor. Or rather I should say I have to see doctors, since no one doctor takes care of all that's wrong with me these days.

Some of my doctors are in what is called private practice (although a goodly number of their patients like me are Medicare patients and hence only partly private). Some of my doctors also are members of the staff of the Palo Alto Veterans Hospital because I am a veteran of World War II.

That care isn't private at all. It's paid for by taxes on the assumption that veterans, having served their country at risk of life and limb, are entitled to care for their wounds and other ills. In my case, because I was wounded in World War II, most of my care is figuratively speaking on you, the taxpayers. Most, but not all.

I've noticed a difference in the care I get in the two different places. The difference isn't in the quality. So far as I am concerned, all my doctors are excellent and know what they are doing. Rather, it is in the way the two systems of care keep records.

When I go to my private doctor, he greets me, pulls out his pen, laboriously takes out a sheet of blank white paper and questions me about my ills. He writes my answers and his observations down on the paper.

I'm not sure what he does with the paper after I leave. Presumably it goes into a manila folder with my name on it for future reference.

When I go to the VA, my doctor there never takes out any paper. He, or sometimes she, sits down at a computer console and types all my answers and his or her observations into the machine. They're stored there in a central repository, along with all my prescriptions and other information.

Given the right access (my Social Security number), anyone can look at my records anywhere there is a VA terminal. I can even look at them myself on the Internet.

The computer age has arrived at Veterans Affairs, even if it hasn't in a lot of private physicians' offices.

That's because medical practice is a cottage industry. Every doctor has his own set of records. Records don't often get passed on to other practitioners, even though sometimes this is necessary. The records really aren't the doctor's, anyway. They are the property of the patient and if he wants, he can ask for his records when he moves on to another doctor.

Doctors, though, are loath to share records. They cite problems of privacy. They also--because medical care still is a cottage industry in many ways--want their fair share of the patient care dollar.

The VA doesn't have to worry about this. Once a patient gets into the VA system, he is just like everyone else, and his records are a part of the system, too. While there has been some concern about VA records, particularly when someone stole a laptop computer with a lot of veterans' Social Security numbers on it, so far the system seems to work pretty well. (The computer eventually was recovered and with it all the missing numbers.)

But in private medicine, the computer age has yet to arrive.

In an effort to get around this, a consortium of companies led by Intel has been working on software that would make possible a grander coalition of medical records. The other members of the consortium are all large employers such as Wal-Mart, for instance.

The idea is that at least the members of the consortium would pool their health records, presumably because the employers pay some or all of the cost of health care, but the records would remain the property of the employee-patients.

Intel foresees a time when it would be possible to have such health records available through the internet. One would have a screen name and password, as is now the case for online banking, for instance. You would not have to carry your records from doctor to doctor. All you have to do is give your doctor access to your records on the Internet.

There are, of course, a few problems to be ironed out, not the least of them the lack of enthusiasm on the part of many in the medical profession, for the reasons cited above.

But it may eventually dawn on private physicians that the computer is really here and that it offers a much more efficient way to handle the tedious business of record- keeping.

No one wants to give up keeping medical records, but by using the computer it well might be cheaper in the long run if doctors did.

And that might make them more money in the long run, too.