Telemedicine: The State of Telepresence In Healthcare (robohub.org)

Hallie Siegel writes: Telemedicine can let doctors and nurses check in on patients who might be recovering at home, or monitor people in remote locations where it's hard to access physician services. This article gives an overview of the different systems that are out there, what are some of the legal obstacles, and how various countries are investing in the technology. From the article: "The Japanese government has allocated about $23M USD to the core technology market in an effort to develop products for its aging population. Toyota, for example, is focusing on home living assistance robots that will allow those with limited mobility the opportunity to live at home. While Japan might have the largest market in the world of 65+ citizens (over 30 million as of 2014), South Korea is estimated to be allocating nearly $6B USD to their own robotics research. The Koreans are taking a different approach, using robots for mundane tasks of delivering food, allowing humans to provide care."

Comments

Logan's Run had it right

[Anonymous Coward]

Renew!

Maine has been doing this since 1976

[cleara]

Folks: Maine has been doing this since 1976. The Central Maine Medical Center, Saint Marys Hospital, Maine General, and Eastern Main Medical Center got connected together via a terrestrial microwave network that was developed by a Maine television visionary named Robert Cowen. Bob worked with both the University of Maine television network as well as by boss at the time (WCBB TV's chief engineer Roland Disjardins. I was one of the transmission engineers who had helped put this together at the WCBB TV transmitter site in Litchfield, Maine.

It's interesting that just about all of us who worked on this project were also amateur radio operators and much of the technology was born from our skills we gained through the hobby of amateur radio. By the way, I am WA1SEY. If any of you went to WPI, I was active in their ham radio club W1YK.

All this long before the Internet was even a faint dream in our eyes.

Re:Maine has been doing this since 1976

[ColdWetDog]

Which is exactly why this field is so annoying. We've had 'telemedicine' for decades. We have been able to have a remote physician look at and talk to a patient and the local provider ever since closed circuit TV was available. The idiot TFA basically wants to talk about other things - patents and point of care robots, but really does nothing to discuss the lack of ubiquity that evangelists have been promising. Every couple of years, some new company wanders in and tries to demo their 'new'
and invariably proprietary gizmo that is typically a combination of Skype and a fax machine.

Every couple of years somebody gets a grant for these things, uses them for about six months and then stuffs them in a closet.

Telemedicine can work for a simple doctor / patient interview but falls apart for anything more complex because medicine is quite a bit more than simply a doctor / patient interview. The remote site typically doesn't have the diagnostic gear that the consultant needs. The consultant typically doesn't have access to all of the records. And the remote site may not have the staff or equipment to treat the patient, even if the diagnosis is clear.

So at anything other than the most basic level, it has been thrown together technological bits that have long sought out a reasonable use case. Yes, you can have remote teleoporated surgeries and other hi tech stuff if you really want to pay for it. No, that isn't going to make sense for anything other than edge cases for a very long time.

The other stuff TFA briefly mentions are devices to automate point of care - getting vital signs on a home bound patient, saying hi to them, checking on if they are breathing. All well and good but something that isn't exactly earth shattering and isn't going to cure cancer or bad breath.

Not much to see here, move along.

Re:Maine has been doing this since 1976

[Zero__Kelvin]

"Telemedicine can work for a simple doctor / patient interview but falls apart for anything more complex because medicine is quite a bit more than simply a doctor / patient interview. The remote site typically doesn't have the diagnostic gear that the consultant needs. The consultant typically doesn't have access to all of the records. And the remote site may not have the staff or equipment to treat the patient, even if the diagnosis is clear."

I don't see you listing any barriers that can't be overtaken. Get the remote site the equipment needed. Invent some kind of system for allowing access to the records. We could tie two computers together, and call it something new and unique like a "network". Perhaps the staff can't treat the patient for every diagnosed condition, but they can get a better diagnosis, thereby allowing them to decide if the 400 mile trek to the hospital makes sense or if the issue is something that can be handled on the remote site.

"The other stuff TFA briefly mentions are devices to automate point of care - getting vital signs on a home bound patient, saying hi to them, checking on if they are breathing. All well and good but something that isn't exactly earth shattering and isn't going to cure cancer or bad breath."

You seem to imply that because you can list two things it won't help with, the latter of which is actually often a symptom of a disease and is therefore diagnostically significant, that there are no things it can help with. One imagines that you don't realize how complex the human body is, and how many things can be solved remotely.

One thing I will never understand is why neo-luddites like yourself even bother to read slashdot. You are clearly against technological progress.

Re:Maine has been doing this since 1976

[j-turkey]

The idiot TFA basically wants to talk about other things - patents and point of care robots, but really does nothing to discuss the lack of ubiquity that evangelists have been promising.

This is probably the only part of your post that I agree with. Telemedicine is more than telepresence robots, but it's working right now for many people who wouldn't otherwise have access to care. I'm sorry that it's not doing more for you right now.

Telemedicine can work for a simple doctor / patient interview but falls apart for anything more complex because medicine is quite a bit more than simply a doctor / patient interview. The remote site typically doesn't have the diagnostic gear that the consultant needs. The consultant typically doesn't have access to all of the records. And the remote site may not have the staff or equipment to treat the patient, even if the diagnosis is clear.

I don't mean to attack you, but what you're saying suggests that you either don't work in healthcare, or have never worked within a successfully implemented telehealth program. Further, it sounds like you're confusing telehealth with m-health and home care. I'll say this much as a concession: telehealth isn't for everyone, all the time. If the patient site has qualified staff, telemedicine can absolutely increase access to specialist care for people in rural areas. Your medical record argument does not hold much water, as EMR's and EMAR's are very real things that most modern practices have access to. I've also built shadow record systems to provide consultants with images of patient charts as well. Do some patients need to see a specialist in person for many procedures? Most certainly. The technology absolutely has its limitations, and telemedicine will never replace in-person care. Further, for most of us, many procedures require an onsite visit. Does that mean that the technology has not lived up to it's promise? Absolutely not. You're misinformed.

Telemedicine can work for a simple doctor / patient interview but falls apart for anything more complex because medicine is quite a bit more than simply a doctor / patient interview. The remote site typically doesn't have the diagnostic gear that the consultant needs. The consultant typically doesn't have access to all of the records. And the remote site may not have the staff or equipment to treat the patient, even if the diagnosis is clear.

Yes and no, but the basic thesis is incorrect. I've spent the last 8 years building and managing a telemedicine network and my company's providers use the technology to see over 6,000 patients per month. Using fairly basic specialty exam cameras and properly trained presenters, many patients in rural settings can be seen and diagnosed by specialists who are far away - who these patients would have not had access to. Perhaps they will have to travel onsite to have certain procedures performed, but the initial consult and follow-up visit can be performed remotely.

So at anything other than the most basic level, it has been thrown together technological bits that have long sought out a reasonable use case.

Again, yes and no. I completely agree that if you just throw technology at a problem without having healthcare operators be a part of the implementation, it will fail. However, there are quite a few more reasonable use cases. I can name a few low-hanging fruits that are being widely used right now:

• Behavioral health (this is a no-brainer, and productivity is higher than in-person in some clinical settings)
• Dermatology (generals special derm cam, but a general exam camera works, too)
• Radiology (um, teleradiology is radiology now
• Cardiology (tele-EKG was one of the first uses of telemedicine, many decades ago - this tends to do well with a tele-steth, but it works exactly like any other stethoscope - any RN can operate one)
• Nephrology (Nephrolo

Re:Maine has been doing this since 1976

[quintessencesluglord]

Having seen telemedicine in practice over the past 10 years, I can tell you the clear and defining raison d'etre is a CYA mentality that at least some specialist was involved, and of course money. Lots and lots of money.

Of course any proof that patient outcomes were better is sorely lacking, but hey, who needs scientific rigour when there is money to be had selling a bunch of high-tech equipment to people who can barely afford it, let alone an actual doctor.

I don't see you listing any barriers that can't be overtaken

One of the largest obstacles to automated medicine is simple pattern recognition, where even having a wealth of information on tap is meaningless without boots on the ground that can identify subtle pattern changes that even patients might not notice, which often drives having further tests done. That requires having trained medical staff onsite, and that requires money, which in short supply. That is a huge barrier.

You are clearly against technological progress.

Nope, just seen 'technological progress' used as a sales pitch too often, that had very little to offer in terms of actual improvement, but by-golly succeeded splendidly in making some people rich.

Re:Maine has been doing this since 1976

[ColdWetDog]

Yes I work in rural healthcare and no, I have not seen a 'telemedicine' system worth the time, effort and money. In my rant, I'm not including a number of things that you rightly call telemedicine because that isn't how the technology is being pitched to hospitals. But you are quite right that radiology is telemedicine in the truest definition of the word. I'm hard pressed to call faxing EKGs 'telemedicine' because if you go that route, everything since the telephone is telemedicine. The stethoscope recorders are an example of a discrete part of an exam that can be transmitted remotely that has very limited clinical utility. Pretty much any cardiologist is going to ask for a echocardiogram which takes an expensive piece of equipment and a highly trained operator. So off the patient goes. So you can do it but it's really not helping the patient in any sort of coherent fashion.

The stroke protocol is interesting. They have managed to take a simple, six step checklist and create a wonderfully expensive device and system (that can be billed for, natch). Providence Anchorage loves the things but pretty much every neurologist will tell you that it's totally unneeded. Any rural facility that is capable of using clot busting agents is capable of having a trained paramedic / PA / nurse practitioner that can do the exam and then call the neurologist on the phone.

So my rant is devoted to those complex, expensive systems that are trotted out routinely that try to do very simple things (basically your examples) in complicated, typically proprietary fashion.

I actually think we agree more than disagree. As usual, it's semantics (is a video camera really telemedicine?) The low hanging fruit has been harvested and now the industry is trying to get on a rather intellectually shaky ladder.

And anybody who says that you can just 'connect' EHRs to deal with the patient's chart has never seen EHRs. Despite federal law and three decades of work, it takes custom programming, time and angst to get two different EHRs to talk to each other.

Re:Maine has been doing this since 1976

[Zero__Kelvin]

That's all very well and good. Now look at the state of technology in medicine today, compare it to just 30 years ago, and then tell me there hasn't been a vast improvement due in very large part to technological advances. For all your claims it isn't getting better, reality has a counter argument.

Re:Maine has been doing this since 1976

[Kjella]

I think you're right about the discovery phase, basically it's a niche where you have a registered nurse on the remote site that can do blood samples, blood pressure, stethoscope, "say aaaaaah" and all the other really basic examinations but not enough demand to warrant a local doctor. I mean you wouldn't ever treat a patient via telemedicine if the patient was in the next room, it's an inconvenience you do if it's overall easier than getting the patient to the doctor. I think there's far more potential in the monitor/treat phase though where you know what parameters to look for and if the progress is good you don't really need to do much at all, what you're looking for is complications or that the treatment isn't working. Or it's a chronic condition you can't really cure but is just doing surveillance on. Or where you're more giving physical care than medical care, the lines get a bit blurred sometimes. There's a lot of health in good hygiene to avoid infections, for example. Doctors do spend a lot of time following up on your progress and automating some of that could free up better use of their time.

Re:Maine has been doing this since 1976

[quintessencesluglord]

That's all very well and good. Now look at the cost of medicine today, compare it to just 30 years ago, and then tell me it hasn't been driven in very large part by technological advances, which hasn't significantly improved outcomes, but has driven medical care out of reach for many, keeping in mind telemedicine is seen as a cost-saving measure due in part to more spending on the technological aspect of medicine at the expense of the infrastructure.

For all your claims it isn't getting better, reality has a counter argument.

http://ije.oxfordjournals.org/...

Take a look at the reality for yourself then. It is less than clear-cut, except for the fact costs have risen dramatically.

Re:Maine has been doing this since 1976

[Zero__Kelvin]

"That's all very well and good. Now look at the cost of medicine today, compare it to just 30 years ago, and then tell me it hasn't been driven in very large part by technological advances, which hasn't significantly improved outcomes"

OK, the cost of medicine today hasn't been driven in very large part by technological advances (unless you consider HMOs and ObamaCare to be technological advances), and technological advances clearly have drastically improved outcomes. Any claim to the contrary is as absurd as you clearly are, now off you go ...

Re:Maine has been doing this since 1976

[Applehu Akbar]

"a combination of Skype and a fax machine."

Why does our medical system still depend on fax machines? Digital recordkeeping is a much more established technology than robotics or telepresence, and yet we still can't get our medical system to use it globally. We're at the islands-of-automation stage now: large hospitals form systems with local doctors and share information electronically among them, yet when you walk into a new specialist's office, you still see that goddamn wall of paper jackets behind the receptionist's desk that mean you have to fill out another history form that, subject to your possibly incomplete memory, repeats all the information you already have in the hospital's system.

When this mess is cleared up, we will have an indication that the system will not just think of advanced technology as another threat to its existence.

Re:Maine has been doing this since 1976

[j-turkey]

The failures that you have described, I have seen in several places. Telehealth equipment purchased with some sort of rural healthcare grant and dumped on a clinic by technical staff, and left to gather dust because it was not implemented properly. In my experience, it's really easy to get this wrong. As you know, tech people are neither providers nor managed care operators.

You are correct that when I use the term "telemedicine", I tend to use it in the broadest possible way. You alluded to this in your comment - and I'll reiterate that just using the novel terminology (e.g. da Vinci machine and telemed robots) does not do justice to the work that has gone into getting telemedicine where it is now. Telecommunications technology has been used for healthcare since it's inception, and in these broad terms, it certainly counts as telemedicine (early telephone and telegraph use, not to mention NASA's work on remote monitoring for astronauts). We take the low-hanging-fruit solutions where we can, but there is so much regulatory and bureaucratic friction ensuring that telemedicine adoption happens very slowly. (Cross-state physician and nursing licensing is always a problem, CMS regulations prevent billing in many cases, state boards of medical examiners are passing protectionist measures to make it difficult to perform telemedicine - especially across state lines, etc). In building a system, I start small, and take the small victories on the low-hanging-fruit. More often than not, it's the healthcare providers who need to buy into the technology and they are the ones who come up with ideas for how to use the technology. It's very often that I hear something like "I've got a regular ENT clinic, and don't need that scope, but could I use this for after-hours coverage when I only have an RN on duty? I'd bet that with video supervision, we could really reduce the number of ER transports, which is exactly what our client is asking for."

With respect to cardiology, in many cases, a cardiac echo machine and tech are easier (and cheaper) to transport than a cardiologist. It really depends on the circumstance. If it's easy to refer a patient to a clinic with the appropriate equipment down the street, then it makes sense. In a large hospital that already has echo cardio equipment onsite, then it's a no-brainer. In a massive self-contained environment (e.g. native American reservation, prison system, VA network, or university system), this isn't always possible - and this is where we can bring the equipment and tech to the patient. These are the environments where we have seen the greatest successes.

You are also correct in that nobody is going to just "connect" two EHR's overnight. Most of the federal law revolving around these was not really for portability in the charts, but in billing codes. Even that is very complicated and cumbersome. However, getting a partner provider (or a remote employee) access to an EMR is very easy to do.

Yeah, we're closer than it would appear in our opinions on this. It would appear that you've been on the wrong end of more than one bad telemedicine implementation. Throwing technology at a non-problem does nothing for anyone. Pie-in-the-sky promises and deploying poorly implemented systems and walking away moves us backwards on all levels. I've spent the better part of the last decade blowing the dust off of these implementation and making them work. What I do is not bleeding edge robots, but finding small victories wherever possible and then working with stakeholders to identify other opportunities to grow their program (or overcome obstacles that have prevented them from using the technology in the first places). I'm sure that we both totally agree that telemedicine is not a fix-all that will replace in-person care. I've never made this promise to anyone, and never will. However, I've been increasingly surprised by what we've been able to accomplish even with older equipment.

Nerds, the tech you develope today

[deodiaus2]

The tech you develop today is going to be tending to you ass in 25 years.
I have been thinking on the side, what can I devise to make life later on easier for me. I was giving thought to natural buoyancy chambers. If I become so weak and feeble, would it not make sense to design a water tank in which to live. I got this idea years ago (1975), when sensory deprivation chambers were receiving a lot of attention

I just can't see it.

[EzInKy]

Robots are seen as cold and detached, humans are seen as warm and empathetic. Which would you rather have caring for you?

Re:I just can't see it.

[Anonymous Coward]

Robots, obviously. Something I can relate to.

Re:I just can't see it.

[fuzzyfuzzyfungus]

I think that the plan is to keep squeezing the humans, larger caseloads, less training, lower pay and status, until the quality of human-provided care is sufficiently grim that you'll accept the efficient neutrality of the robots as the lesser of two evils.

The process certainly hasn't been completed; but there are some good examples to be found in areas of medicine that are(whether anyone is willing to say it in so many words or not) seen as largely futile cost centers: nursing homes seem to provide a lot of the good horror stories; lots of frail old people, aggressive cost cutting in staff/patient ratios and staff salary and qualifications, and then grandma isn't being checked often enough to keep ghastly bedsores away.

It's not that 'telemedicine' doesn't have potential, or valid use cases, being able to consult with colleagues, even if you are out in the sticks, is obviously helpful; and there isn't much sense in having a country GP also doing his own labs, cultures, and x-ray film developing in the evening; but, as in other areas where automated interfaces are being pushed as a replacement for humans, cost cutting will end up being a major use; presumably by a mixture of directly replacing some jobs, where possible, and allowing others to be filled with cheaper, lower skill, people because now the expert systems and the remote specialists are handling the tricky questions.

Re:I just can't see it.

[drinkypoo]

Robots are seen as cold and detached, humans are seen as warm and empathetic. Which would you rather have caring for you?

Humans are supposed to be warm and empathetic, but doctors are seen as cold and detached. Who gives a shit at this point? Stick this probe in your ear, this probe in your mouth, and this one goes up your butt.

Re:I just can't see it.

[Cro Magnon]

I remember one time I was at a doctor's, and he was training a new doc. The newbie seemed to care, but the old timer acted like he didn't give a damn. This was quite a while ago, so I suspect the younger doctor has learned to be a pompous, uncaring ass by now. :-P

Better Cameras

[kelemvor4]

My daughter is a Shriners' patient. I've taken her to the Tampa hospital for telemedicine visits on numerous occasions. I've discussed telemedicine with the doctors and other staff because i was interested.

For security, they aren't using internet - they're using ISDN lines and direct dial connections. Obviously this means the bandwidth requirements are tiny since it can work over ISDN.

Even the high end videoconferencing system they bought was insufficient in video quality. The camera just didn't draw enough light and have sufficient optical zoom for high quality zoomed in video. They had to buy an external video camera and cable it to an aux input port on the system. You could probably do what was needed using a modern DSLR with a good lens.

Further, we went to a hospital. This not only ensured the right camera equipment was available to the patient. It also allowed the specialist doctor to instruct local non specialists on how/what to do for minor procedures.

The whole thing worked out great, but it was slightly more involved than I thought it would be. Judging by other comments on this post, most people don't understand this.

. is the system that has been augmented with a better camera. The photo does not show the better camera.

Re:Better Cameras

[kelemvor4]

OOPS, I screwed up one of the links. http://shrinershospitalcincinn...

wekxime to the 3rd world ,ed help

[Anonymous Coward]

Tele=Med is nothing new. My father was pronouned dead via on seassion in the 50's ( he ready dead in the 2997 ), becuase the system could not handle his slow heart rate.,

They are talking about this for East Kentucky. Where the doctor is in an "air-control" room handling just one type of case. But since he is tele-pretence... he can be in India or another low cost labour country. No H1B are no needed since they are handling medicine.

First tech, then lawyers and accounts that brought the low cost labour, now doctors. So much for the upper middle class.

our doctor

[harvey the nerd]

... knows us personally and isn't afraid to use Skype video or take our call. It has saved our bacon 1-2x and convenience +++ for lesser medical stuff. In the US that might be a problem.

Telepresence is for cows.

[Anonymous Coward]

You are all cows. Cows say moo. MOOOO! MOOOO! Moo cows MOOOO! Moo say the cows. YOU PHONING IT IN COWS!!

Re:Telepresence is for cows.

[Anonymous Coward]

www.cowspiracy.com

Telemedicine is for edge cases for now

[sjbe]

I don't see you listing any barriers that can't be overtaken.

Then you have an insufficient understanding of the problem, particularly of the economics involved.

Get the remote site the equipment needed.

So you are going to send a bunch of expensive equipment to a remote location where it will be infrequently used and operated by people who have no expertise. What could possibly go wrong... Or are you suggesting we staff a quasi-remote location? In that case it isn't really telemedicine anymore is it? Then it's just a branch office with Skype.

Perhaps the staff can't treat the patient for every diagnosed condition, but they can get a better diagnosis

Sometimes yes, very often no. If you are going to have a remote site staffed with trained medical professionals then you don't need telemedicine except for the odd specialty consultation. We can do some fancy remote surgery stuff but we haven't worked out the technology completely and aren't even close to solving the economics of that technology. (hint: it's REALLY expensive) Telemedicine has its uses but they are going to be edge cases for the foreseeable future. It is NOT the panacea that many imagine it to be.

One imagines that you don't realize how complex the human body is, and how many things can be solved remotely.

Well I'm married to an MD who would be happy to explain it to you.

One thing I will never understand is why neo-luddites like yourself even bother to read slashdot. You are clearly against technological progress.

Nice. "Neo-luddites"? Seriously? Are you a medical professional or do you just imagine that you understand the problems involved in telemedicine better than those who are?

Look Moron

[Anonymous Coward]

You argue against someone with direct experience, someone who links to sources, and your argument is baseless assertions and insults?

Off you go.

My Company is Trying This

[Anonymous Coward]

My company is rolling out telemedicine this year. Starting in 2016, before we can see a doctor in person, we are required to have a tele-appointment with an approved online doctor, all of which, of course, are in India.

If that doctor approves (and by "approves," I mean "is unable to provide you medical care"), then you can see a real doctor in person.

I'm sure it's going to go over like a lead balloon.

Real issue to Telemed

[jellomizer]

1. The big one: Most insurances wont pay for it. Lets face it, behind the marketing BS, a major driving factor is making a lot of money. Doctors get paid a lot of money, Big wigs at a large healthcare institution get paid a lot too. Money is a big driving factor. A few insurances are willing to pay for it. But not enough for wide distribution.

2. Health Care Technology is behind the time. There are a lot of reasons for this, Usually due to most of it being very expensive, having to buy a new multi-million dollar MRI just to allow for better transmission of data, or the millions spent on a new EHR system. After the investment they want to keep it for a while to pay off the investment. The bad part is they keep them for far too long and technology bypasses them. This aged infrastructure make telepresence hard because we need it integrated as part of the health record, otherwise it could come down to a point where the doctor said he saw the patient and the patient said no he didn't.

3. The ones who need it the most don't have the resources to use it. If you are in very rural locations, chances are you may not have the internet speed to take advantage of it. Or you are too poor to access transportation, that means you will be on the slowest internet connection (if you have one at all) with a slow hand me down computer.

4. IT Skills. For both Doctors and the Patients. Many of the older doctors are reluctant to learn technology, their Ego gets in the way of them learning something new, as they may look stupid in front of those normal people who didn't study for 8+ years in a particular field. Still even today most Doctors will make paper charts and hand them off to someone else to put in those damn expensive EHR that the government told them to use. As well for patients, many of the people needing health care are the older folks who are not so technology aware, where you suffer from watching them trying to move the mouse, and confused that scrolling down makes the text go up. Also how many times do you see someone struggling to start a web-ex session. Imagine how hard it would be for two people who don't use it regularly?

5. Image quality. It is getting better, however there are some odd things about telepresence... People look at the eyes of the people on the screen... So they look like they are looking down, giving a false non-verbal communication. Resolution at slower speed, or cheaper web-cams may not be good enough to see particular issues, a Rash may be a red blur or may not be picked up at all. Details such as sweating for flushness of face or swelling may not be picked up.

6. Security. Most health care systems have this approach to security. Go with a vendor who will take the blame if there is a problem. This means they will pick a big company with an army of lawyers who will find a way to differ the problem. This isn't security or choosing the best secure system. Just saving your butt. This is newer technology and trying to find a vendor who is willing to take the blame if some how that Dr. visit was captured and transferred to a scrupulous source due to a virus or some sort of malware on the home users PC.

7. Patient location may not be HIPAA safe or just safe for the patient to have a consult. Having that abusive other just outside the door or the child listening in and taking what is said out of context.

There are a lot of issues to be resolved

Re: Real issue to Telemed

[Anonymous Coward]

You neglected to mention potential liability.
As a Dr above and beyond anything I much like ALL of my doctor friends practice CYA medicine.

Fax machines

[sjbe]

Why does our medical system still depend on fax machines?

Several reasons. Among them:
1) Legal requirements. Believe it or not it is literally illegal to email certain types of documents. It is legally ok to fax these same documents. No it doesn't make much sense and the law hasn't caught up yet. HIPPA is a factor in this.
2) Fax machines are kind of a lowest common denominator technology and it works even if it isn't efficient. Staff know how to use them and every doctor's office has them, even ones that don't have email.
3) Electronic records systems are routinely not compatible even when they are available. Faxes provide a straightforward (albeit inefficient) way to transfer documents between incompatible system or to offices lacking and EMR.

Re:Fax machines

[Applehu Akbar]

My point is that fax is a stupid legal requirement to paper over (with curly, fuzzy stock) the legal system's failure to adopt the perfectly good, more-secure-than-handrwriting electronic signature standard that we already have available. Staff know how to use fax because they're forbidden by 'policy' from using anything better.

Electronic record systems that are not compatible is the islands-of-automation problem. As medical groups adopt electronic records, it should be to a common standard.

Technology is a big driver of medical costs

[sjbe]

the cost of medicine today hasn't been driven in very large part by technological advances

Twenty seconds on google would have disabused you of this incorrect notion. Technology advances have played a HUGE role in the rapidly increasing cost of medical care. Don't take it from me, take it from The New England Journal of Medicine.

and technological advances clearly have drastically improved outcomes.

Often yes but not always. It's trivial to find cases where technology improvements have either minimal or no improvements in patient outcomes. Sometimes we use the expensive shiny new tool in ways that don't actually improve medical outcomes. Sometimes the tools are used more for medico-legal reasons than for actual patient safety. My wife is an MD and she has to do things all the time which are unnecessary for treatment but guard against potential lawsuits. She has to order tests which confirm what she already knew with 99.9%+ certainty just for the unlikely chance she is wrong. If a hospital buys a new MRI machine you can bet your ass they are going to find ways to keep it busy to recoup the cost. Often this means ordering unnecessary tests.

Faxes are obsolete but still required

[sjbe]

My point is that fax is a stupid legal requirement...

I doubt anyone would disagree with you about that. Nevertheless it remains a legal requirement and probably will for some time to come. Insane but true.

Electronic record systems that are not compatible is the islands-of-automation problem.

True but that is well understood. It does not appear to be in any danger of being resolved either.

As medical groups adopt electronic records, it should be to a common standard.

The beautiful thing about standards is that there are so many to choose from. There are few common standards for EMR systems. There also are minimal legal requirements for compatibility and few market incentives either. I agree that it SHOULD be to a common standard but it isn't and probably won't be any time soon.