Industries moving away from paper transactions—examples from this week

Industries moving away from paper transactions—examples from this week

Douglas W. Blayney, MD, FASCO

Dec 18, 2008

Three recent examples of industries which are moving from paper-based transactions into the online world:

Newspapers moving from print to online

This week, the two main Detroit daily newspapers, the Detroit News and the Detroit Free Press, announced discontinuation of daily delivery of their hard copy. They will continue regular home delivery of the issues heavy with advertising: Thursday, Friday and Sunday.

Many observers have seen this as an austerity move, but one writer in our local paper, the Ann Arbor News, sees this as a positive. Moving less paper to the front walks and driveways of subscribers and substituting electrons and bits delivered to their homes or mobile computers, may be a smart economic move, but is one with great risk. The electronic delivery of daily newspaper-type information does not yet have a viable business model. I for one, live in a far suburb 80 miles from the city center, and don't pay a subscription fee to either paper. I do read both most every day. I suspect that my free ride will soon end.

This move illustrates some business challenges that ASCO, the host of this site, will soon face. The popularity and support of our print journals (JCO and JOP) is dependent on their advertising revenue, which suppliments the subscription fee. ASCO is engaging in charge-per-impression or charge per page view model experiments with online advertisers, but is early in this game. We will have to balance the need to recover our editorial and other costs with the potential intrusiveness of advertising on the reading experience. Others are exploring these models and techniques -- we don't need to be first in this endeavor, but we do need to get it right.

The challenging Michigan economy

A hopeful note on the otherwise bleak Michigan economy that relate to paperless transactions (but not EHR, necessarily). Last weekend, at a neighborhood holiday party, I met two other fathers, both of whom had recently moved to Ann Arbor from the New York City area. Both retained their NYC-based jobs after the move.

One of my new acquaintances sold financial printing for a New York based company. Though his main office was in NYC, he found himself on the road alot, and he and his wife decided to return to Michigan, where they both had families, to raise their own children. He commuted to NYC, when he needed to appear in the home office, but otherwise worked from home or from customer's sites. The other dad was an consulting economist of some sort, with offices in London and NYC. He also decided to move to Ann Arbor tto renew his family connections and to raise his children, as he could work from home or the road as well as from New York or suburbs.

The internet has made such a lifestyle possible. I am reminded of the convenience of my own experience, catching up on my medical records at home, instead of at a cramped, ugly desk in the hospital medical record room. My new acquaintances are conducting most of their work either face-to-face or by generating or moving electrons; paper is playing a vanishing role.

The Thick Envelope

I remember sitting at home, awaiting the postman (now letter carrier), to deliver the thick envelope. The envelope was thick, because in addition to an acceptance letter, it contained enrollment, housing and other forms for matriculation to either college or medical school.

This morning, my youngest daughter's thick envelope arrived -- in the form of an internet posting on the school's fire-walled internet site. Most of her friends receive notification of their college admission online these days. She tells me that she immediately added this information to her Facebook page, but I am not one of her friends (in the Facebook sense), so I haven't checked.

With her internet "thick envelope" she was directed to a video of one of her potential professors (also a woman) welcoming her to the college of engineering. Nice touch, but another reminder of how far ahead other industries are ahead of medicine in their transition away from paper-based transaction processing.


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