The Analogue Crisis of Medicine


A group post written by Michael Moor, Bastian Rieck and Catherine Jutzeler.

It’s 9:00am and Dr. Joana Jones is reading a mesmerising article on how 98% of the Israeli population has been covered in a centralised electronic medical record system, and this for decades now.

A deep but dry cough, together with a headache, force her to finish breakfast and visit her general practitioner Gerald. However, while crossing the street, she collapses, only to wake up in the hospital. Joana is still dizzy and fails to properly reply to the urgent questions of her attending physician, Martha. She must have hit her head during her fall. After having identified Joana, Gerald was immediately called to request the patient history. However, he could not answer the call, as he was hand-writing patient documents in his study, while the landline phone was ringing in the practice entrance. He would only see Martha’s email requesting information about Joana a few minutes later. Gerald doesn’t know Martha, but her e-mail appears to originate from a hospital, which seems trustworthy enough for Gerald.

Gerald is 64 and, like most general practitioners in Switzerland, facing retirement. For requests like these, he is accustomed to transmitting the full patient history via fax. Joana has been his patient for 20 years, resulting to several dozens of pages to send.

While printing out the fax, Martha briefly wonders whether sending sensitive patient documents via fax could pose a security risk. Having replenished the fax printer with more paper, which she could only find in the office down the hall, she realises that her six long years of medical studies did not teach her much about digital data literacy. Why bother when you still have to deal with paper records literally everyday?

Meanwhile, Joana’s state is deteriorating. The attending team requests a CT scan of the head to exclude a bleeding inside of the skull. After the scan, her SARS-CoV-2 PCR test, which was performed due to her primary symptoms, returned positive.

After a short hospitalisation, she recovers at home in isolation. Before discharge, Joana insisted on receiving her data. This included the CT scan, which Joana’s ward was unable to export: apparently, the hospital has an entirely different IT system for clinical data, radiological reports, histological reports, etc., creating a veritable IT maintenance nightmare. Only in the radiology department seven floors below, Joana would receive a Compact Disc with her scan. Unfortunately, her new MacBook doesn’t speak “CD”.

She also insisted on receiving a copy of her faxed patient history, noticing that several parts of the fax were impossible to decipher. Back in Gerald’s practice she finds out that those bits where manually highlighted with a marker, indicating that Joana is highly allergic to Penicillin. Luckily she was not suffering from a bacterial infection, else a fax might have literally gotten her killed!

Later that day, Joana writes a blog post discussing the need for incentives for practitioners and hospitals to actually follow through with the digitalisation of medicine as for instance spearheaded by the electronic patient dossier. Monetary incentives may accelerate this transition, which will ultimately reduce costs both on the patient as well as on the care giver and insurer’s side. Finally, harmonised and interoperable IT systems will massively support the practitioners’ daily work, which far too long has been dominated by caring for chaotic paper piles instead of real patients.