TalkDocs

Interesting blog at BMJ Group blogs today. Richard Smith writes: Demand online access to your medical records.

Richard Smith is an unpaid member of the board of Patients Know Best and a true believer that the web can ultimately transform health care as it is transforming so much else.

This is a UK author but the sentiment behind it applies worldwide and is especially timely in the US, with the Obama administration including a hefty boost to health IT and EHRs in the stimulus plan.

I spend half my life online. Most of my work is done online. I shop, manage my finances, and do my taxes online. My web footprint is huge. So why have I never asked for access to the most intimate details about me that are kept on a computer about a mile from here?

In his presentation at TEPR, James Mault, MD (Director, New Products and Business Development, Microsoft Health Solutions Group) stated that security and privacy issues aside, most of the information is already online – but the patient doesn’t have the benefit of accessing it or making it available to other providers.

With the EMIS system, which is used by 60% of GPs, it is easy, and cost free, to give patients access to their records. But only 40 practices in the country have done it so far—we are very much at the beginning of this revolution.

Noting that the UK’s nationalized system puts health IT on a different level than the US, one of the points driven home again and again at the TEPR conference was that the adoption of EMRs and EHRs would be market driven. In other words, when physicians see a monetary reason for using an EMR (higher levels of reimbursement, incentives from third-party payers, the ability to see more patients) and have more patients demanding electronic access to their records, they will be more inclined to join this revolution. Likewise, software vendors will react to the demand.

A personal health record is one that the patient rather than the doctor controls, and this is surely where we must be headed. There is published evidence showing that personal health records can produce many benefits, are particularly valuable for patients with chronic conditions, and improve compliance and care. Interaction is better than simply access, and “coauthorship” between patients and doctors creates accuracy and concordance.

In a TEPR keynote, Dave deBronkart and Danny Sands, MD gave a presentation on how Dave deBronkart used free Web 2.0 resources to be a proactive patient after he was diagnosed with cancer (Healthcare IT news article). Dave’s contact with Dr. Sands was through the Beth Israel Deaconess patient portal (PatientSite), where patients can make appointments and communicate with their physicians. Paraphrasing Dr. Sands’ comments on this system:

In what other profession do you set a date and a time for a meeting without also setting an agenda? And yet, this is the norm in medicine. Doctors have no idea why the patient wants to see them until they are in the office. With PatientSite, the patient lets the doctor know why they want to be seen. Tests can be ordered in advance so that everyone is prepared for the meeting by the time the patient is seen in the office.

It makes so much sense, it’s frightening, isn’t it? It’s a simple concept, used in businesses around the world on a daily basis – but the medical profession seems to just be starting to grasp the value.

I am reminded of an appointment I had with a physician in 2007, where I drove to UCLA (30 minutes to go 15 miles, on a good day), parked ($8), waited (20 minutes), was asked to undress (unnecessarily), had blood drawn (again – and unnecessary – but I couldn’t convince the office staff of this) – all to get the results of a blood test that had been drawn 2 weeks previously, only to be told the results weren’t back from the lab yet. I wasted 2 hours of my time, spent money on gas and parking, which online access (or a simple phone call!) would have made completely unnecessary. And UCLA has an EMR – but as a patient, I have no access to it. The UCLA surgeon who referred me to this doctor had access to the records and the test results; the physician I went to for a second opinion had access to them, as well. Why didn’t I?

How would your physician react if you sent an agenda for your next appointment? Or demanded electronic access to your records on an ongoing and updated basis?

The pressure for change must come from the market. Patients need to see the value of having access to their records, they need to pressure the medical community to provide it and they need to pressure the third-party payors to provide incentives for the medical providers for using EMRs and giving patients access to their records.

Healthcare IT