Wednesday, September 26, 2007

Shocked, But Not Awed

I’ve always been the kind of person who tries to salvage small bits of humor from a crisis. Needless to say, the healthcare industry’s jitters as the new HIPAA regulations went into effect have provided me with a steady source of merriment. Strange side effects pop up in the most unusual settings. My mother, who lives in an assisted care facility in New Jersey, tells me how upset the residents are about what HIPAA has done to their daily routine. What impact, you ask, could HIPAA have on a bunch of little old ladies living in a facility with onsite medical care? It seems that the facility where she lives used to post a list identifying which residents were in the infirmary so that their friends could go visit them. That list can no longer be made public. As a result, the healthy residents don’t always know when to send get-well cards to their friends in sick bay. Those ladies really like to send get-well cards to each other. The natives are getting restless!

Closer to home, it’s been fascinating to witness how some of our clients have responded to the need to accommodate changes in their daily routine. Because our service handles clinics and private practices, we often have a more intimate level of contact with our dictating physicians than MTSOs that handle hospital accounts. As a result, we have to do a lot more coddling and handholding than some other service owners (who rely on a hospital’s information technology staff to troubleshoot technical problems on the client’s end).

After researching several options for switching to a web-based service that would work on any platform while providing encrypted, secured transmission of the files we send to our clients, I very carefully drafted a letter which explained – in purely nontechnical terms – what our clients would have to do to register with this service and how to properly adjust the settings on their account. I explained how the process would work, how their files would download to their computers, and what the experience would feel like when using this new, HIPAA-compliant service as opposed to doing things “the old way.”

If you think that people with advanced medical degrees can follow a simple sheet of instructions, I’d suggest you think again. Many ignored the instructions the first time they arrived (which did not surprise me considering their legendary powers of procrastination). Some needed constant reminders that a deadline was approaching before they would take action. Some, although frustrated by their inability to adjust to a new way of working, were patient and grateful for help, stating that “I’m willing to learn and I remember that you were very patient and helpful when you walked me through something similar three years ago.”

Their ability to transition to a web-based delivery service, however, spoke volumes about the computer skills of some physicians.

  • Several clients who registered with the new service immediately forgot their password and used that as an excuse to say that this just wasn’t going to work. One surgeon dutifully registered an account but forgot to give his secretary the password so she could retrieve his documents.

  • One client registered an account using an email address we had never been told about and then, after waiting 10 days to receive their files, wondered if they ought to contact us to see what the delay was all about.

  • One surgeon (who takes umbrage whenever I suggest that his computer skills are not as strong as he’d like to think they are) had to be walked through the process of copying and pasting a URL into his web browser. He left a frantic voice mail message at 6:30 a.m. in which he stated that “I clicked on the link in their email and it didn’t do anything How am I supposed to know what to do? I’m completely clueless about this stuff!”

  • Another client, who quickly realized that his old machine (on which he was still attempting to run Windows 3.0) was not going to be able to do the job, spoke to the computer consultant we had recommended, immediately panicked, and ran to Circuit City where he pointed to a pretty new computer on the top shelf and said “I’ll take one of those.”

  • One of our ESL doctors copied me on a message he sent to the web service’s tech support. As is to be expected from this particular physician, it was very polite, extremely respectful, and made absolutely no sense.

The fear and loathing of new technology was palpable with certain clients. One afternoon, while crossing a busy intersection, I ran into one of our more “charm-challenged” physicians. He looked up at me and snarled “I’ve got your fucking encryption set up, now don’t even start with me!” The next day at the gym, when said doctor tried to tell me it was my fault that his office staff didn’t know how to use WINZIP, I reminded him that there is an interactive tutorial within the program. “So what? How am I supposed to know that?” he grumbled. “What does it matter, anyway? All this HIPAA garbage is going to cause more and more doctors to retire and leave the profession.”

Some demonstrated a level of “hopelessness and helplessness” not found in the Diagnostic and Statistic Manual of Mental Disorders. One client, who is prone to such behavior, called me and said, “No way. I can’t do this!” In a firm, but reassuring tone, I told him: “You can do it. You can learn this. And you will learn this because everyone else has to learn it and you’re no exception to the rule. If you think this is unfair and you’re being singled out for attention, then you can complain to the Department of Health and Human Services. But don’t get all huffy about it with me.”

Impersonating a Jewish mother with S&M tendencies who doles out heavy portions of guilt may sound inappropriate, but trust me, with some physicians that’s exactly what it takes to get results. A week later, when I arrived in this doctor’s office as a patient, he smiled bashfully when reminded about his panic attack. “Look at all those diplomas that are hanging on your wall. Four of them!” I said. “Do you know how many people didn’t have the opportunity to go to medical school like you did? Much less graduate from college? And yet, by some miracle -- and without the same educational advantages, they were able to figure out how to make this work. Four medical degrees and you’re telling me you can’t do this?”

“Of course I can do it,” he sighed. “And I know that if I applied myself to it I could learn. But I’m just not a computer person. I hate this stuff. It makes no sense to me at all.”

When I was a kid, I remember being chastised with the words “If you’re so smart, how come you’re not running the world?” So would someone please explain to me why, if doctors are supposed to be so smart, they can’t figure out how to download a file?

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