No Signatures Required!

If you live in the U.S., you've probably had the experience of paying for a meal using a credit card.  The server takes your card, disappears to somewhere in the back, does something with it that you can't see, and returns with your card, along with two paper receipts, one of which you need to sign.

Everything that happens to me, I think, what is this, the 1960's?

As of last week, the major credit card companies -- American Express, Discover, Mastercard, and Visa -- are no longer requiring that signature.  As a Mastercard person told CNET, "It is the right time to eliminate an antiquated practice."  

No kidding.  Healthcare should be eliminating its antiquated practices too.

The demise of the credit card signature has been long in coming.  Many merchants already don't require it, or only require it for purchases over specified amounts.  And, of course, the rise of online shopping has greatly lessened not only purchases with signatures but purchases where the card is present at the merchant at all.

Ending the requirement was announced last year, went away last week, but its actual demise will happen more slowly, as individual merchants can still require it.  Some will need changes to their systems to get rid of the requirement.  But, as with the introduction of chips in U.S. credit cards (which is a whole other saga), no signature will gradually become the norm.

The credit card companies realized that, (a) the signature wasn't doing much to verify identity anyway, as many don't take it seriously and no one really seems to check the signature, and (b) loss of physical cards has become only a small fraction of the fraud that credit card companies fight.  Cybercriminals are more likely to steal masses of numbers through security breaches, allowing fraud on a scale that no old-fashioned thief could have imagined (and, oh, by the way, that's one reason those vaunted chips haven't done much to lessen fraud).

Of course, the signature is only part of the antiquated process.  They're probably not looking up your card number on a monthly list of stolen cards any longer, nor using a manual imprinter to charge your card, but both using the physical card and taking it from you are steps that there are 21st century alternatives to.  For example, they could bring the chip reader to you, or they could accept smartphone-based payments. 

Still, I'd be willing to bet that the credit card companies and merchants bring their processes fully into the 21st century before healthcare does.

Let's go through some of these:

• Healthcare still relies heavily on faxes, from which most other industries have, for the most part, long ago moved on.  Supposedly it is because of security, "HIPAA," etc., but this reliance is a lot like requiring signatures for credit cards.  In the immortal words of Inigo Montoya, "I do not think it means what you think it means."
• It is not just faxes.  In an era of ubiquitous smartphones, healthcare is still making heavy use of pagers, especially within hospitals.  As with faxes, proponents cite solid reasons for this continued use, but -- really?
• I can use an AMT pretty much anywhere in the world, and can not only access my bank account to obtain balance or transfer funds, but even to get cash on the spot.  The system "knows" me and my bank and can act accordingly.  In healthcare, I can't even go to a new doctor or healthcare facility without having to start from ground zero in terms of information about me (unless they are part of a health system I've already used).  
• Patient portals have proliferated, with more options to do tasks online, but how many times do you visit a health care professional without having to fill out or sign yet another form?  Why are we ever filling out paper forms?
• We can make online reservations for, say, restaurants, airlines, or hotels.  When it comes to making healthcare appointments, though, we're almost always forced to go through a tedious phone tree and end up negotiating with a human scheduler.   In 2018?
• Manufacturers have overwhelmingly turned to just-in-time processes, so that they get exactly what they need at exactly the right moments in exactly the right amounts, even though they often use supply chains that span the globe.  Meanwhile, in healthcare, an appointment time is usually at best an approximation; we expect to be seen late.  If you are in a facility expecting a test or procedure, it's even worse; things happen when they happen, and no one seems to know when that will be.  These aren't even 1960's levels of precision.
• Chances are, most of the time you see your doctor, it is in person, which probably means you'd had to make an appointment, drive to his/her office, wait more there (while filling out some forms), get ushered into an exam room for more waiting, then hope you'll have enough of his/her time to explain your problem.  Telemedicine is widely available, but usually it won't be with your doctor and the doctor you end up getting won't have your medical history.  Shouldn't virtual visits usually be the first step?  
• For better or worse, with a few pieces of information -- a social security number or a credit card number -- financial institutions can pull up pretty much all of our financial history.  With healthcare there, no institution has access to even most of our medical history, which remains highly scattered, siloed, and sometimes even still paper-based.  How 1980's!  
• We continue to urge people to get annual preventive exams, even though the value of them for most adults is highly dubious.  We still make people get unpleasant procedures like digital rectal exams, or tests of questionable value like PSAs or even mammograms.  We're doing all this more out of tradition than based on solid evidence.  

In many ways, we do have "space age" healthcare, but that space age is too often more like 1960's NASA than 21st century SpaceX. 

Note all the binders at NASA.  Source: Michael Smith-Welch, Boing Boing

We can do better.  Much of healthcare has one foot firmly planted in the 21st century, and its vision looking forward.  But too much of it still has the other foot dragging in the 20th century. 

It is past time to not only identify but also to act upon antiquated practices in healthcare.