Monday, August 09, 2004

Patch vs. Crash vs. ... Switch

I originally sent my Cigna application on 5/13/04. I got a letter back last week informing me that I had been approved as a participating provider. About 3 months, which is what others had told me. I am no longer in the limbo world of out of network providers. I am now a Participating Physician!

Or not...

I looked on Cigna's website and I am not listed in the online Physician Directory yet. So more waiting. Hopefully, I'll be hearing from Blue Cross, Blue Shield and Aetna in the next few weeks as to whether I'm accepted into their plans as a participating provider.


Stop me if you've heard this one before. Complex system and infrastructure integral to providing healthcare has numerous flaws and obstacles to providing excellent care. Patches and fixes are like applying bandaids to plug leaks in Hoover Dam. You can keep tinkering with the system even as more and more problems arise. Or keep up with the status quo and crash and burn. Or you can try a radical change in the way things work.

The Gordon Moore Model? No, this time I'm talking about computers.

Eventually, if you wait long enough, everything converges. I ran into an article on which discusses two of my favorite topics: medicine and computers. Fed up hospitals defy patching rules.

Problem #1: WIndows-based PCs are vulnerable to new viruses and worms. This is bad for hospitals that use PCs, ie. ALL hospitals.
Solution #1: Apply system patches and updates to plug vulnerabilities.

Problem #2: System patches often render software programs inoperable, including medical devices and instruments.
Solution #2: Software vendor tests their program with system patches to make sure they are compatible first.

Problem #3: Testing takes several months.
Solution #3a: Software vendor finally produces a product compatible with patched operating system. Repeat Problem #1.


Solution #3b: Hospitals apply patches anyways, and roll the dice, hoping their medical software and devices will still work. This leads to...
Problem #4: Vendor voids warranty because they didn't promise it would work on a patched system.

"When Microsoft recommends we apply a critical patch, the vendors have come back and said 'We won't support you,'" says Dave McClain, information systems security manager at Community Health Network in Indianapolis.

So the hospital has gone ahead and applied critical Microsoft patches to vulnerable patient-care systems when vendors wouldn't, McClain says. The hospital views the failure to apply patches as a possible violation of the federal Health Insurance Portability and Accountability Act (HIPAA ). "We have HIPAA regulatory issues, and you can't hold us back from compliance," he says.

Sometimes, the software vendor itself is the source of the virus infection:

There have been several instances in which viruses originated from medical instruments straight from the vendors, says Bill Bailey, enterprise architect at ProHealth Care, a Milwaukee healthcare provider. Medical equipment arrived with computer viruses on it or service technicians introduced the viruses while maintaining the equipment, he says.

(Getting on my soapbox)

As medical systems become more and more dependent on computers and electronic medical records, the information confained within them is only as safe as the operating system they run on. Increasingly, the Windows-based operating system is being exposed for its poor design and lack of security. As a physician, I feel that we should not trust our vital data and patient care to a buggy system, especially when there are safer alternatives. Either a Mac or Linux-based computer is a more secure solution.

This is not going to be a viable solution for everyone. There are not as many medical EMR/software/practice management options for Macs as for PCs. But for a solo physician, this is certainly something that is affordable and feasible. I'm living proof that it can be done.

Computer: Powerbook G4 12 inch 867 mHz
Scanner: HP Officejet 6110 All-in-one
Printer: HP Laserjet 1150
EMR: SpringCharts
Billing: Medrium
Financial: Quickbooks
Web browser: Safari (no pop-ups!)
Other software: Microsoft Office, Mail
Backup: daily automatic backup to offsite storage site, once a month complete backup of entire hard drive to external Firewire drive.
No known viruses for Mac OS X as of this time.

For ideas on how to switch to a Mac, go here.

(Getting off soapbox now)