Replies to This Discussion

Permalink Reply by Sean Bennick on July 16, 2011 at 2:45pm

I love the concept here but the cost will keep many from taking part. A lower cost or subsidized system could eventually gain a huge following if it was built right.

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Permalink Reply by Bob Hoyt on July 24, 2011 at 6:26am

Great posts on an interesting but complicated problem. Doesn't look like most patients have the time or expertise to input their own information so patient portals tethered to an electronic health record make sense and work well for organizations like Kaiser Permanente. On the other hand, not all docs plan to have EHRs and information in a patient portal is not easily sharable.

 

While Google Health goes away Microsoft HealthVault is ramping up big time. Not only have they added the ability to input your health information so they are no longer just a "vault", they are members of the Direct Project. This means that a physician who uses an EHR that is direct compliant can send a secure email message with an attachment or send a CCD that gets parsed into the correct section of the EHR but the patient can send secure messages back to the physician (requesting refills, referrals, etc).

Now that is what is in the works but it still may be too much work for the physician (not reimbursed but this is a meaningful use requirement). I would be interested in the opinions of others about whether the Direct Project will make a difference in physician-patient communication or will it sit idly on the sidelines? Cheers......Bob

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Permalink Reply by Su Olschesky on July 24, 2011 at 9:58am

These objectives are noteworthy in their attempts to increase accessibility and transparency to consumers, but you did make a valid point regarding the possibility of creating more work for physicians.
EMR's are presently cumbersome for providers due the redundancy of maneuvers, such as excessive screen clicks. Additionally, some do not have speedy typing skills. Speech to text converters such as Dragon still require precise skillful clicking.
The main thrust of the argument really lies in the greater patient to physician contact that could evolve from this technology.
Although the convenience is offered from the viewpoint of rapid query and response initiatives, the potential for tipping the scales of advantage in favor of patients over physicans is real.
Patients may feel less compelled to make office appointments to discuss issues with their doctors, instead expecting treatment via phone or email.
My opinion is that this "vault" be monitored by support staff, e.g. nurses, prior to this era, for triage/prioritization.
I agree with the "Direct" aspect up to a point. It should not mean direct access to a physician 24/7 because they are not the only problem solvers within a healthcare organization.

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Permalink Reply by Ray Murakami on June 28, 2011 at 7:53pm

The phrase I like to use is "Retrieving useful information from medical records would not go like Google."

 

Medical records look like they are written in English (if they are from the English speaking world, of course) but they are actually written in completely different language. I don't mean they are written in Latin or Greek but it is a highly context-sensitive language similar to, say, Japanese.

 

Google translations between Japanese and English is still terrible unlike translations between European languages. Japanese language changes words, phrases and even grammars according to its context, just like medical language.

 

To master medical language, you need considerable understanding of cultures and shared knowledge behind the actual words communicated, just like Japanese.

 

So for pulling out information from medical records in plain English, you need a human librarian (i.e. a clinical coder) to sort the information, not a computer one. I think that is where Google Health failed.

 

P.S. I sometimes joke if you want to identify a Terminator, the human rebel force should make Japanese their official language.

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Permalink Reply by Karen Day on June 29, 2011 at 12:58am

What about the hundreds of thousands of people who already use small apps on their phones to keep track of their selfcare? I think portals that are designed and managed by clinicians will not necessarily meet the needs of patients who don't think like docs and nurses. Make a small app for a smart phone that helps patients make appointments with their clinicians while on the run in their busy lives and you've got what patients want. Make a portal that clinicians think patients will use and I doubt the uptake will be the same.

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Permalink Reply by Karim Keshavjee on June 29, 2011 at 7:26am

Couldn't agree more.  Clinicians have a medio-legal mindset.  Most PHRs I saw seemed to look like an EMR.  Patients don't think like clinicians, so why would they want a tool that looks like an EMR?

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Permalink Reply by Sean Bennick on July 18, 2011 at 10:23pm

In a perfect world, those apps would integrate with a more complete system and would allow the user to invite their providers to take part as needed. Doctors could pull up a long term report showing the users stats and symptoms. Most of the smartphone apps don't offer the ability to adapt the app to meet the needs of a variety of illnesses or issues.

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Permalink Reply by Jeff Ankers on July 2, 2011 at 11:31am

I agree that Patient Portals are the future. Unless chronically ill, it seems like most people view healthcare like Karim's ATM reference. My company provides an EMR with a Patient Portal and all of the automated functions but also allows the patient to add to the record--in the past medical history section. It remains to be seen how much Docs want to offer patients an in-depth view into their records. Though I read a study about how in-depth views significantly reduced the stress of cancer patients and gave them a feeling of greater control over their treatment.

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Permalink Reply by Abdulrahman Jabour on July 9, 2011 at 1:49pm

PHR will definitely have huge role in future but it will take some time. I think it still early for PHR to be broadly used as EHR which act as base or backbone still has some serious issues to be solved like integration and security.  Solving these issues will make it possible to have easy to use and secure tethered PHR that can attract patients.

The other issue that may be resolved over time is users computer skills. The younger population that seems to be computer savvy currently are not involved in health records as older generation who generally have chronics diseases and needs to have their records available. By the time when this generation starting to need their records, PHR will be essential and well developed. 

 

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Permalink Reply by Karim Keshavjee on July 9, 2011 at 6:27pm

Good point Abdulrahman.  I would point out that young people will get involved sooner rather than later because many are already involved in helping their parents take care of their illnesses. 

 

I know many children of elderly parents who would willingly pay for a system that help them monitor and care for their parents.

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Permalink Reply by Sean Bennick on July 16, 2011 at 2:39pm

Personally I'd like to see a more open system where information from both patient and provider is available. The potential of systems like Patients Like Me to both bring people with similar conditions together and allow individuals to take a more active part in managing their symptoms needs to be explored. Eventually the industry needs to take an active part in creating standards for these external programs to be added to the patient record.

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Permalink Reply by Ben Loeb on July 18, 2011 at 9:10pm

Agree with the concept but I'm not sure how to implement since it turns the patients into virtual doctor in a position when his looking for treatment or second opinion with people that might not be professional in giving these advises. Or in other cases he can get access to his medical result even before he sow the doctor (for me it's OK – I'm not sure that everyone can manage that kind of information). 

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