PDF In-Depth

The PDF prescription for health care cost control

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Duff Johnson picture

Duff Johnson

Since 2011, Duff has worked in the ECM industry specializing in PDF technology since 1995. An industry leader, Duff co-chairs the international committee that manages ISO 32000, the specification for the PDF file format. Responsible for marketing and product...  More



Healthcare costs in the US have significantly outpaced inflation for several decades. Alongside the question of universal coverage, the healthcare reform debate in Washington, DC, therefore, rightly centers on controlling costs. Policy-makers have recognized that current long-term trends are unsustainable -- what to do about it is the subject du jour.

To get my blood drawn the other day, I watched entries made in three different systems. At least four distinct pieces of paper were generated to celebrate my hospital visit. Naturally, I'm not including the billing and insurance paperwork, which I haven't yet received. Computers were much in evidence, but they appeared to serve largely as an interface to well-worn laser printers. Instead of simply entering a bloodwork order into the system, paper had to be printed for me to hand-deliver to the lab. The freshly-printed form required a stamp before it was "good". Oh, and the form was only good the day it was printed. If I couldn't wait 45 minutes to get blood drawn, I'd have to repeat the whole process.

These are routine, many-times-a-day operations within a large hospital of good reputation. Standardization, streamlining and rationalization of such overhead should have happened long, long ago. What century are we living in?

Leaving aside the political questions of how care is financed or delivered, everyone agrees that controlling administrative costs is essential to bringing healthcare expenditures in-line. I'm no doctor, but I know a thing or two about documents, and I have a prescription for the healthcare industry: PDF.

An Operational Perspective

From the information and administrative points of view, healthcare is a swamp of files, documents, forms, databases, images, multimedia -- you name it. Security and privacy concerns are serious, persisting and ever more consequential. Hundreds of vendors tout proprietary or otherwise mutually incompatible systems, while every vendor and insurance company has its own forms and procedures.

Today, the many and varied gaps between these disjointed processes are bridged with new paperwork for doctors, hospitals and patients, returning us full circle to fax machines, FedEx and old-fashioned pen and paper.

It's not so much that any one or two or three of these systems is terrible. Even a purely paper-based system could be reasonably efficient and effective -- IF it was highly structured, consistent and systematically implemented.

We don't have to stick with paper and its limitations, but we DO have to deal with the grinding gears between the various systems in use. We can bemoan the fact that the biggest single administrative problem is standardization, or we can do something about it. That's where PDF comes in.

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