History vs the Perpetual Present

by David Orenstein free-lance writer

This column marks exactly four years of Computing Care. The cliché about technology is that virtually everything would have changed five times over during such a “lengthy” period. In fact, sorting what has changed from what never seems to change is a useful way to gain perspective on technology. In five broad areas over the last four years, we have seen amazing innovation and timeless shortcomings.

Office Automation. Everybody runs practice management software now, but most physicians still are running the same software they were years ago, according to Healthcare Informatics (October 2003). Older systems built primarily around billing typically don’t include newer functions, such as scheduling, clinical tools or electronic medical records. Therefore, many physicians have yet to realize the recent benefits of practice management software.

Communications. Physicians can communicate with pharmacies and each other like never before. The state of Texas uses the Health Alert Network to communicate urgent CDC warnings to 64 counties. In September, the AMA began offering its members bimonthly ethics alerts on PDAs that run ePocrates software. But not everyone is in touch. A 1998 survey showed that only 2 percent of physicians were using e-mail to communicate with patients. That number is higher now but not by as much as you might think. Newsweek reported on a study in July that found only 7 percent of Internet users had used e-mail to communicate with their physicians. However you measure it, the Internet has not brought that many physicians and patients in closer touch.

Security. Security technology continues to improve. Encryption technology (and the ability of hardware to handle it) keeps getting stronger. Computer users every day are becoming more savvy about security issues, such as fending off viruses and choosing unguessable passwords. But the bad guys have a knack for keeping up with the good guys. We were incredibly vulnerable to viruses and hacking four years ago, and we still are. When it comes to security, it seems that innovation is necessary just to maintain the status quo.

Hardware Cost vs Performance. The genuinely stunning onward march of hardware capability gives the broader technology world its undeserved reputation for changing faster than we can keep up. There’s no arguing that you can get more for less than you did four years ago. Back in December 1999, PC World’s top pick among “Power PCs” was a Dell with a Pentium III processor running at 600 MHz with 128MB of RAM, a 20 GB hard drive, and a 17-inch monitor. The cost of this top-of-the-line machine was $2379. The magazine’s November 2003 recommendation was a 2.8-GHz Pentium 4 with 512MB of RAM, a 120 GB hard drive, and a 17-inch LCD monitor. Cost: $1713. A near-the-top office system just doesn’t cost what it used to.

Reliability. During the past few years, Microsoft has done a better job than it used to. Windows XP doesn’t crash that often, compared to Windows 98 or 95. The typical desktop has a decent chance of staying up and running all day. Computers remain, however, devilishly difficult to maintain. Back in late 1998, everyone was fretting about the Y2K problem. We made it through that, but the healthcare industry since has been plagued with the system maintenance challenge of HIPAA. Sure enough, in October the Texas Pharmacy Association warned members about HIPAA-related outages in the Electronic Claims Management Systems of the Medicaid Vendor Drug Program.

Next time you hear about some great new technology, remember that it will take a long time to become prevalent. People need time first to determine its value and then to learn how to use it. The pace of innovation in technology is fast, but the pace of change is much slower.

David Orenstein is a technology and business writer in Silicon Valley. To learn more about a technology topic in Computing Care, e-mail him at davealli@comcast.net.