By Thomas W. Byron, MD  

Technology presents a dialectic dilemma for this mature physician. My electronic medical (EHR) experience was problematic. The EHR at Hospital #1 was inscrutable even with scribes.  Hospital #2 changed software several times. Needless to say, Hospital #1 and Hospital #2 did not use the same programs. EHR implementation has forced physicians to be data entry clerks and billing department apologists. My solution: delete hospital work and use an outpatient surgicenter. The revenue reduction was offset by the increase in efficiency and personal mental health. Office visits are private encounters that should not be blocked by a computer screen or keyboard. Patients appreciate with eye contact and a real physical exam, not just data analysis. The tipping point for technology will be cost. It is major driver of health care costs. The reaction has been swift. Hospitals are mandating single vendor total joints. Medicare subsidizes basic intra-ocular lens.  Improved implants are patient expense. Surgicenters limit new implants that cost more than the facility procedure reimbursement. Insurance companies deny women BRAC 1 and 2 testing until a second family member is afflicted by breast or ovarian cancer. Patients are declining imaging studies and elective procedures due to cost. In spite of the above doom and gloom, I am optimistic about advances in technology. Innovation will bring new techniques, targeted pharmacology and chemotherapy. There will be triggers for enhanced immune response based on disease and genetic analysis.