8 ms·

Doctors Slow to Adopt Tech Tools That Might Save Patients Money on Drugs

84 points by realshadow 7y ago

skwb 7y ago
I wonder how burdensome it is to even get the tool fully integrated into the ehr. Like are the doctors not using it because it requires manual input of drugs and insurance? Even then, the doctors aren’t necessarily getting paid more for doing this extra work; it’s the payer (insurance) company that is primarily benefiting. To be clear, I am acutely aware of just how hard it is to get this sort of thing working (MS in health Econ, phd in biomedical and clinical informatics). Just keeping track of all the formularies seems like a pain just to to begin with!
- joe_the_user 7y ago
  I too am aware of hard solutions are in reality (or "reality"). Still, I believe we should be acutely aware that the need for doctors to get "tools" just to deal with drug prices is an indication of how off-kilter our society's approach to health care has become.
- delfinom 7y ago
  Well due to the rise of EHR and other tech complexities, many doctors are just joining mega-groups/networks that handle their IT just so they don't have to deal things such as integration. The era of independent doctors is basically coming to a very fast end. Where I live, there are two competing networks of doctors now that have basically absorbed thousands of doctors in the last 4 years with their signs literally plastered everywhere now. Yay because arguably it's the only way doctor offices are going to keep up with ever changing tech. Nay because Americans are going to get fucked in the ass even more by uncontrollable healthcare when the doctors networks become cartels.
  - ghaff 7y ago
    My long-time primary care doctor recently told me to find a new one. He’s going to continue practicing his specialty. But he said dealing with the computer systems was too much effort for his small office to continue handling primary care patients.
  - skwb 7y ago
    There's a certain chicken or egg among health economists for the role of HITECH requirements resulting in consolidation [1, 2]. On one hand, these HITECH requirements put additional technological reporting, which may be a driver of consolidation (though this was in large part 'paid' for if you adopted early). On the other hand, centralization of IT services can produce economies of scale, especially if you're a small community hospital that has a small community hospital budget (aka narrow). Hell, you even see the trend of inter-UC health hosting the EHR instance for another UC [3]. In either case, the major role of healthcare consolidation has been to keep up with insurance consolidation, which is to keep up with hospital consolidation, and so on [4]. [1]. https://www.hhs.gov/hipaa/for-professionals/special-topics/hitech-act-enforcement-interim-final-rule/index.html https://www.hhs.gov/hipaa/for-professionals/special-topics/h... [2]. https://www.healthaffairs.org/do/10.1377/hblog20190304.998205/full/ https://www.healthaffairs.org/do/10.1377/hblog20190304.99820... [3]. https://cio.ucop.edu/making-epic-history-ucsd-and-uci-health-share-an-electronic-medical-records-system/ https://cio.ucop.edu/making-epic-history-ucsd-and-uci-health... [4]. https://www.healthaffairs.org/doi/full/10.1377/hlthaff.22.6.77 https://www.healthaffairs.org/doi/full/10.1377/hlthaff.22.6....
  - biotech 7y ago
    > Yay because arguably it's the only way doctor offices are going to keep up with ever changing tech. Keeping up with the tech is not the problem, it's keeping up with the ever changing regulations, many of which do relate to EHR. You basically need dedicated staff to handle the bureaucratic processes, which is only affordable for large organizations.
- IG_Semmelweiss 7y ago
  It is not. For example, BlinkHealth created a widget for athena's EMR. The caveaat that it would only show Blink's price, which was actually not the insurance price (they are not insurance but instead a PBM pass thru, cheaper-than-usual cash price). The data point was not comprehensive, of course... But my point still stands
doctorpangloss 7y ago
"Doctors Slow to Use Some Startup's Thing That My New York Party Acquaintance Asked Me To Talk About"
- fenomas 7y ago
  What is this in reference to? There's nothing similar in the article.
  - Ice_cream_suit 7y ago
    Think... Puff pieces are a dime a dozen.
- tomc1985 7y ago
  Agreed, tech-for-the-sake-of-tech needs to end
hereme888 7y ago
"Doctors slow to..." Implies all doctors. Then the article begins with an emotional story about one patient. Statistical facts don't come from an emotional argument. That's what politicians and marketers do. What's more likely: that the hardest working, highest average IQ professionals are slow to adopt something that would help them save their patient's lives? Or that the writer of the article is biased and exaggerating things?
- CharlesW 7y ago
  > "Doctors slow to..." Implies all doctors. This kind of generalization is normally read as "Typically, doctors [as a profession] are slow to…" rather than "Literally every doctor is slow to…". TFA supports that statement with a metric and some reasons why. > What's more likely: that the hardest working, highest average IQ professionals are slow to adopt something that would help them save their patient's lives? Or that the writer of the article is biased and exaggerating things? The former. Most doctors work within systems, and can't just start using new tools they think look neat. Instead, they use approved (often mandated) tools.
  - geezerjay 7y ago
    > This kind of generalization is normally read as "Typically, doctors [as a profession] are slow to…" Medical professionals need to be slow to adopt alternatives because they are required (and expected) to be highly reliable. Just because there's a particular industry where rebuilding the whole infrastructure every 6 months without fear of any consequence is considered normal or even desirable, that does not mean the rest of the world should or even could operate likr that.
- deleted 7y ago
  [deleted]
- robotresearcher 7y ago
  Medicine is currently conservative by design. ‘First, do no harm’. This approach has pros and cons: too slow to adopt surgeon hand-washing, but too fast to adopt Thalidomide. A few thousand years of experience has led us to err on he side of being conservative these days. Combine this culture with lack of spare time for young doctors, lack of immediate incentives to save patient money, and lack of exposure to IT innovations, and I can totally see them being slow to adopt new tech.
DataDrivenMD 7y ago
They lost me at "might." You'd be hard-pressed to find many docs (myself included) who are champing at the bit to adopt an informational resource with knowledge gaps.
- jchw 7y ago
  I don't understand. The article is about a pricing tool. The "might" is that it can't give useful price information for all kinds of insurance. It doesn't seem all that horrific that it might not be able to give useful pricing information for every single patient...?
  - elliekelly 7y ago
    Doctors schedules are already tight as it is and I’m not sure what benefit there is to the doctor to spend the precious extra minutes looking to see whether they might be able to save their patients some money before prescribing a drug.
    - jchw 7y ago
      That is a different point to be made, and would apply even if the tool worked 100% of the time.
    - paganel 7y ago
      Because by saving the patient that sum of money said patient will maybe have enough funds to come visit said doctor for a second time (or a 3rd, or a 4th), instead of postponing the visit for financial reasons. In other words, if a doctor prescribes me a $1000 medicine instead of a $500 one, and a visit to said doctor costs $500, I might not visit him a second time because I've already paid $1000 for the medicine and I don't have enough money for my health anymore. Not visiting your doctor when you need it (for whatever reasons) is bad for the patient.
      - elliekelly 7y ago
        That’s not a very strong incentive. I’m not really sure that’s an incentive at all. Most doctors have more than enough appointments. Their schedules are overbooked. But even if doctors who needed more patient bookings could attract those bookings by saving patients money then logic would follow that doctors who have room in their schedule would consistently use the app from the article. Yet most doctors aren’t using it at all. So even if your premise is correct I think you’re greatly overestimating the surplus supply of doctors appointments and underestimating how steep/inelastic the demand curve is for healthcare. Mostly unrelated, is saying “surplus supply” redundant? I can’t decide.
dsfyu404ed 7y ago
Why would they be fast? It's not their money. The incentive is not there. Meanwhile on the other side switching anything is work. Of course it doesn't get done super quick.
gscott 7y ago
Walmart, Target and some others have lists of low prices drugs for common conditions. https://www.walmart.com/cp/$4-prescriptions/1078664 https://www.walmart.com/cp/$4-prescriptions/1078664
dfeojm-zlib 7y ago
America is slow to adopt collective, independent negotiating of medical, hospital and prescription charges as happens in insurance, Medicare/Medicaid/Tricare. Med4all would solve this, rather than hunting around for big pharma "sales" and "promotions."
- didgeoridoo 7y ago
  The US government is the “single payer” for defense contracts. How has that worked out in terms of cost controls?
  - noir_lord 7y ago
    The NHS in the UK pays much lower prices for most drugs than the insurers do (there are the odd egregious cases where a company take the piss, the interesting thing is that we do actually fine them in a rare case of consequences been applied) because simply put they are negotiating for 65 million consumers in one go, if the NHS price is high enough for them to make a healthy profit per patient it is a no brainer. The system requires numerous feedback loops and clinical overview (ours is called NICE - National Institute of Clinical Excellence). Is it perfect, no, few human things are. Is it massively preferable to the average healthcare situation for Americans - hell yes it is. I pay for my prescriptions which is £9 per drug per month (whatever the cost to the NHS of that drug is), I take 3 drugs so that should be £27 per month except they considered that case and I buy a NHS Pre-Payment Card which costs me about £10 a month and covers me for any number of medications. [1] So for £10 a month I get the routine medications I need to make my life not just bearable but enjoyable which allows me to work. So if costs controls in government are your concern the elect better people with better systems. Lest anyone think I'm all sunshine and roses on the NHS, it requires drastic reformation (and they really really need to get rid of their 'internal market' way of running) but the idea is as sound now as it was in 51 years ago (almost to the day, it was founded July 5th 1948). [1] https://apps.nhsbsa.nhs.uk/ppc-online/patient.do https://apps.nhsbsa.nhs.uk/ppc-online/patient.do
    - didgeoridoo 7y ago
darawk 7y ago
That's because they have no incentive to, and for the most part, neither do their patients.
travisoneill1 7y ago
The industry is medieval. I had to get a CT scan in the ER while traveling once and the only way the medical records office could communicate to get the scan was fax or email, and they sent me the images by mailing a CD (in 2018)!
- geezerjay 7y ago
  What's wrong with using email to communicate with the medical records office? And as CT scans are private information, why would you assume it would be Ok to make them available through a public server and send them over the internet?
  - lotsofpulp 7y ago
    I think they typo’d “mail” and wrote “email” unintentionally. Or at least that’s the only way their post makes sense to me.
    - travisoneill1 7y ago
      yes
  - sgift 7y ago
    > And as CT scans are private information, why would you assume it would be Ok to make them available through a public server and send them over the internet? Encryption. A magical tool to make sure things are not available to anyone just because they are available on the Internet. Email on the other hand is so insecure (and cannot be easily encrypted, because many popular programs/email-providers don't support it) that a server sounds like a far better idea. edit/expanded: I have seen all variants here. Usually you go to another hospital, so they don't have all your things. If this is planned I have all the things I got with me, so the doctors have to filter, sort and scan them (every hospital has to do this again), but at least they have something to start with. Often the other hospital also sent something before you arrive if this is a planned cooperation. Maybe these two things together are enough, sometimes they are not. If it's just a report the current hospital can ask for it from the other and they get it faxed. But maybe it's a CT, MRT or whatever scan. These things are big, so they get send per courier, which takes time. Now you have to maybe wait longer for whatever you are there for. In extreme cases it can go down to "I here have what you want and you need it now, so you ask me questions over the phone and I answer you" which is asking for all kinds of problems. All in all the current process is slow, involves repeating work and leads to not everyone having the whole picture. The need to make sure all these private data are safe is very real, but though is the need to get better than this system, cause it doesn't work well and we know that something better is possible here.
deleted 7y ago
[deleted]
aladoc99 7y ago
My experience with such a system has been that it would quote ridiculously high prices for generic medications, so I'd simply tell patients their drug is on the $4 list at WalMart. An information source that's unreliable is worse than no information at all, since it poisons the well for competing systems.

84 points by realshadow 7y ago

skwb 7y ago

I wonder how burdensome it is to even get the tool fully integrated into the ehr. Like are the doctors not using it because it requires manual input of drugs and insurance? Even then, the doctors aren’t necessarily getting paid more for doing this extra work; it’s the payer (insurance) company that is primarily benefiting. To be clear, I am acutely aware of just how hard it is to get this sort of thing working (MS in health Econ, phd in biomedical and clinical informatics). Just keeping track of all the formularies seems like a pain just to to begin with!

joe_the_user 7y ago
I too am aware of hard solutions are in reality (or "reality"). Still, I believe we should be acutely aware that the need for doctors to get "tools" just to deal with drug prices is an indication of how off-kilter our society's approach to health care has become.
delfinom 7y ago
Well due to the rise of EHR and other tech complexities, many doctors are just joining mega-groups/networks that handle their IT just so they don't have to deal things such as integration. The era of independent doctors is basically coming to a very fast end. Where I live, there are two competing networks of doctors now that have basically absorbed thousands of doctors in the last 4 years with their signs literally plastered everywhere now. Yay because arguably it's the only way doctor offices are going to keep up with ever changing tech. Nay because Americans are going to get fucked in the ass even more by uncontrollable healthcare when the doctors networks become cartels.
- ghaff 7y ago
  My long-time primary care doctor recently told me to find a new one. He’s going to continue practicing his specialty. But he said dealing with the computer systems was too much effort for his small office to continue handling primary care patients.
- skwb 7y ago
  There's a certain chicken or egg among health economists for the role of HITECH requirements resulting in consolidation [1, 2]. On one hand, these HITECH requirements put additional technological reporting, which may be a driver of consolidation (though this was in large part 'paid' for if you adopted early). On the other hand, centralization of IT services can produce economies of scale, especially if you're a small community hospital that has a small community hospital budget (aka narrow). Hell, you even see the trend of inter-UC health hosting the EHR instance for another UC [3]. In either case, the major role of healthcare consolidation has been to keep up with insurance consolidation, which is to keep up with hospital consolidation, and so on [4]. [1]. https://www.hhs.gov/hipaa/for-professionals/special-topics/hitech-act-enforcement-interim-final-rule/index.html https://www.hhs.gov/hipaa/for-professionals/special-topics/h... [2]. https://www.healthaffairs.org/do/10.1377/hblog20190304.998205/full/ https://www.healthaffairs.org/do/10.1377/hblog20190304.99820... [3]. https://cio.ucop.edu/making-epic-history-ucsd-and-uci-health-share-an-electronic-medical-records-system/ https://cio.ucop.edu/making-epic-history-ucsd-and-uci-health... [4]. https://www.healthaffairs.org/doi/full/10.1377/hlthaff.22.6.77 https://www.healthaffairs.org/doi/full/10.1377/hlthaff.22.6....
- biotech 7y ago
  > Yay because arguably it's the only way doctor offices are going to keep up with ever changing tech. Keeping up with the tech is not the problem, it's keeping up with the ever changing regulations, many of which do relate to EHR. You basically need dedicated staff to handle the bureaucratic processes, which is only affordable for large organizations.
IG_Semmelweiss 7y ago
It is not. For example, BlinkHealth created a widget for athena's EMR. The caveaat that it would only show Blink's price, which was actually not the insurance price (they are not insurance but instead a PBM pass thru, cheaper-than-usual cash price). The data point was not comprehensive, of course... But my point still stands

doctorpangloss 7y ago

"Doctors Slow to Use Some Startup's Thing That My New York Party Acquaintance Asked Me To Talk About"

fenomas 7y ago
What is this in reference to? There's nothing similar in the article.
- Ice_cream_suit 7y ago
  Think... Puff pieces are a dime a dozen.
tomc1985 7y ago
Agreed, tech-for-the-sake-of-tech needs to end

hereme888 7y ago

"Doctors slow to..." Implies all doctors. Then the article begins with an emotional story about one patient. Statistical facts don't come from an emotional argument. That's what politicians and marketers do. What's more likely: that the hardest working, highest average IQ professionals are slow to adopt something that would help them save their patient's lives? Or that the writer of the article is biased and exaggerating things?

CharlesW 7y ago
> "Doctors slow to..." Implies all doctors. This kind of generalization is normally read as "Typically, doctors [as a profession] are slow to…" rather than "Literally every doctor is slow to…". TFA supports that statement with a metric and some reasons why. > What's more likely: that the hardest working, highest average IQ professionals are slow to adopt something that would help them save their patient's lives? Or that the writer of the article is biased and exaggerating things? The former. Most doctors work within systems, and can't just start using new tools they think look neat. Instead, they use approved (often mandated) tools.
- geezerjay 7y ago
  > This kind of generalization is normally read as "Typically, doctors [as a profession] are slow to…" Medical professionals need to be slow to adopt alternatives because they are required (and expected) to be highly reliable. Just because there's a particular industry where rebuilding the whole infrastructure every 6 months without fear of any consequence is considered normal or even desirable, that does not mean the rest of the world should or even could operate likr that.
deleted 7y ago
[deleted]
robotresearcher 7y ago
Medicine is currently conservative by design. ‘First, do no harm’. This approach has pros and cons: too slow to adopt surgeon hand-washing, but too fast to adopt Thalidomide. A few thousand years of experience has led us to err on he side of being conservative these days. Combine this culture with lack of spare time for young doctors, lack of immediate incentives to save patient money, and lack of exposure to IT innovations, and I can totally see them being slow to adopt new tech.

DataDrivenMD 7y ago

They lost me at "might." You'd be hard-pressed to find many docs (myself included) who are champing at the bit to adopt an informational resource with knowledge gaps.

jchw 7y ago
I don't understand. The article is about a pricing tool. The "might" is that it can't give useful price information for all kinds of insurance. It doesn't seem all that horrific that it might not be able to give useful pricing information for every single patient...?
- elliekelly 7y ago
  Doctors schedules are already tight as it is and I’m not sure what benefit there is to the doctor to spend the precious extra minutes looking to see whether they might be able to save their patients some money before prescribing a drug.
  - jchw 7y ago
    That is a different point to be made, and would apply even if the tool worked 100% of the time.
  - paganel 7y ago
    Because by saving the patient that sum of money said patient will maybe have enough funds to come visit said doctor for a second time (or a 3rd, or a 4th), instead of postponing the visit for financial reasons. In other words, if a doctor prescribes me a $1000 medicine instead of a $500 one, and a visit to said doctor costs $500, I might not visit him a second time because I've already paid $1000 for the medicine and I don't have enough money for my health anymore. Not visiting your doctor when you need it (for whatever reasons) is bad for the patient.
    - elliekelly 7y ago
      That’s not a very strong incentive. I’m not really sure that’s an incentive at all. Most doctors have more than enough appointments. Their schedules are overbooked. But even if doctors who needed more patient bookings could attract those bookings by saving patients money then logic would follow that doctors who have room in their schedule would consistently use the app from the article. Yet most doctors aren’t using it at all. So even if your premise is correct I think you’re greatly overestimating the surplus supply of doctors appointments and underestimating how steep/inelastic the demand curve is for healthcare. Mostly unrelated, is saying “surplus supply” redundant? I can’t decide.

dsfyu404ed 7y ago

Why would they be fast? It's not their money. The incentive is not there. Meanwhile on the other side switching anything is work. Of course it doesn't get done super quick.

gscott 7y ago

Walmart, Target and some others have lists of low prices drugs for common conditions. https://www.walmart.com/cp/$4-prescriptions/1078664 https://www.walmart.com/cp/$4-prescriptions/1078664

dfeojm-zlib 7y ago

America is slow to adopt collective, independent negotiating of medical, hospital and prescription charges as happens in insurance, Medicare/Medicaid/Tricare. Med4all would solve this, rather than hunting around for big pharma "sales" and "promotions."

didgeoridoo 7y ago
The US government is the “single payer” for defense contracts. How has that worked out in terms of cost controls?
- noir_lord 7y ago
  The NHS in the UK pays much lower prices for most drugs than the insurers do (there are the odd egregious cases where a company take the piss, the interesting thing is that we do actually fine them in a rare case of consequences been applied) because simply put they are negotiating for 65 million consumers in one go, if the NHS price is high enough for them to make a healthy profit per patient it is a no brainer. The system requires numerous feedback loops and clinical overview (ours is called NICE - National Institute of Clinical Excellence). Is it perfect, no, few human things are. Is it massively preferable to the average healthcare situation for Americans - hell yes it is. I pay for my prescriptions which is £9 per drug per month (whatever the cost to the NHS of that drug is), I take 3 drugs so that should be £27 per month except they considered that case and I buy a NHS Pre-Payment Card which costs me about £10 a month and covers me for any number of medications. [1] So for £10 a month I get the routine medications I need to make my life not just bearable but enjoyable which allows me to work. So if costs controls in government are your concern the elect better people with better systems. Lest anyone think I'm all sunshine and roses on the NHS, it requires drastic reformation (and they really really need to get rid of their 'internal market' way of running) but the idea is as sound now as it was in 51 years ago (almost to the day, it was founded July 5th 1948). [1] https://apps.nhsbsa.nhs.uk/ppc-online/patient.do https://apps.nhsbsa.nhs.uk/ppc-online/patient.do
  - didgeoridoo 7y ago

darawk 7y ago

That's because they have no incentive to, and for the most part, neither do their patients.

travisoneill1 7y ago

The industry is medieval. I had to get a CT scan in the ER while traveling once and the only way the medical records office could communicate to get the scan was fax or email, and they sent me the images by mailing a CD (in 2018)!

geezerjay 7y ago
What's wrong with using email to communicate with the medical records office? And as CT scans are private information, why would you assume it would be Ok to make them available through a public server and send them over the internet?
- lotsofpulp 7y ago
  I think they typo’d “mail” and wrote “email” unintentionally. Or at least that’s the only way their post makes sense to me.
  - travisoneill1 7y ago
    yes
- sgift 7y ago
  > And as CT scans are private information, why would you assume it would be Ok to make them available through a public server and send them over the internet? Encryption. A magical tool to make sure things are not available to anyone just because they are available on the Internet. Email on the other hand is so insecure (and cannot be easily encrypted, because many popular programs/email-providers don't support it) that a server sounds like a far better idea. edit/expanded: I have seen all variants here. Usually you go to another hospital, so they don't have all your things. If this is planned I have all the things I got with me, so the doctors have to filter, sort and scan them (every hospital has to do this again), but at least they have something to start with. Often the other hospital also sent something before you arrive if this is a planned cooperation. Maybe these two things together are enough, sometimes they are not. If it's just a report the current hospital can ask for it from the other and they get it faxed. But maybe it's a CT, MRT or whatever scan. These things are big, so they get send per courier, which takes time. Now you have to maybe wait longer for whatever you are there for. In extreme cases it can go down to "I here have what you want and you need it now, so you ask me questions over the phone and I answer you" which is asking for all kinds of problems. All in all the current process is slow, involves repeating work and leads to not everyone having the whole picture. The need to make sure all these private data are safe is very real, but though is the need to get better than this system, cause it doesn't work well and we know that something better is possible here.

deleted 7y ago

[deleted]

aladoc99 7y ago

My experience with such a system has been that it would quote ridiculously high prices for generic medications, so I'd simply tell patients their drug is on the $4 list at WalMart. An information source that's unreliable is worse than no information at all, since it poisons the well for competing systems.