For decades, we have heard from policymakers that teachers using computers in schools will improve student learning and doctors using electronic health records will improve patient care and reduce costs. Yet these champions of electronic technologies are wrong. First, facts on the ground have contradicted their claims repeatedly and second, policymakers have mismatched high-tech fixes to fundamental structural problems of inadequate schooling and unevenly distributed health care.
Recent claims that technology will revolutionize teaching and learning come from such books as Liberated Learning. Just around the corner, authors say, are online courses that will transform brick-and-mortar schooling and teacher-directed classrooms. Such claims, of course, have come from enthusiasts for plug-in machines since film, radio, and instructional television were pushed into schools in the 20th century. But the desktop computer, the laptop, and now hand-held devices are different. They are powerful machines that offer extraordinary access to information, instant communication, heightened productivity, and new communities. In an alternate universe, these devices might transform behavior but in the gritty world of schooling no metamorphosis in teaching and learning has yet occurred.
In the early 1980s, nationally there were 125 students for every desktop computer; now there are less than 4 students for each device with many districts giving a laptop to each child. Yet studies reveal that no more than 30 percent of teachers use computers regularly in classroom lessons. In short, there is little research evidence that as a result of billions of dollars being invested in computers teachers teach differently and students learn more, faster, and better. Nonetheless, the hype about computers in schools persists.
Similarly, for decades, promoters have championed electronic health records (EHR). The recent federal stimulus legislation includes over $36 billion for a national network of computerized health records in doctor offices and hospitals. Doctors using EHR daily, advocates say, will lead to quality patient care and reduced costs. Yet after forty years of pushing computerized patient records, recent studies show that 9 percent of hospitals and 17 percent of doctors use EHR. And even in those particular settings, few studies have shown EHR to be the success that champions predicted.
The gap between high-tech puffery transforming teaching and medical practice in light of schoolhouse and physician realities would be ripe for ridicule in a Saturday Night Live skit. But poor student performance and uneven, costly health care are neither laughing matters nor easily solved by technical fixes. Those promoting technological solutions persistently fail to look beyond teachers’ and doctors’ limited use of computers and EHR and examine the institutional structures, incentives, and human ties that shape practitioner behavior.
Consider the structural split in health care between private insurance and federal agencies. These structures include incentives that push doctors to spend mere minutes with patients while ordering many tests and pills. Between Medicare/Medicaid and private insurance reimbursement of doctors’ and hospitals’ costs (e.g., MRIs and drugs get reimbursed while returning patient phone calls do not), the temptation to maximize revenue over patients’ needs is very strong. One doctor working in McAllen (TX) where Medicare spent $15,000 per enrollee, twice what the agency spent in El Paso with a similar population, put it bluntly: “Medicine has become a pig trough here.” Yet lower costs, high quality care, and considered use of technology do occur at the Mayo Clinic and other medical facilities where doctors put patient care first, not increasing revenue.
The tension between doctors seeking to make money while providing patient-centered care derive from both structures and incentives in the U.S. fragmented health care industry, not whether doctors and hospitals use electronic medical records.
Ditto for schooling. Age-graded school structures combined with testing and accountability regulations have steered teacher lessons toward test preparation. The bonds between an effective teacher and students that spell the difference between classroom learning and mere compliance with policies have become brittle from unrelenting pressures to meet state standards and raise test scores. Incentives to raise scores have driven teachers and administrators to concentrate on test items rather than other basic goals of schools such as becoming self-supporting, engaged citizens committed to improving communities.
Such schools do exist. In KIPP schools, charters like Amistad Academy in New Haven (CT), and teacher-run schools in Minnesota structures have changed, teachers collaborate, and technology is used sparingly.
Pressing doctors and teachers to use high-tech devices to communicate, share information, and practice differently will neither dent these structures nor improve the bonds between doctors and patients or teachers and students. Contrary to what promoters claim, the problem is neither limited nor unimaginative use of new technologies by practitioners; the problem remains anchored in the structures that shape the critical relationship between professionals and those who they serve. Please, no more magical thinking about technology.