Patient, Heal Thyself in the Digital Future

June 24, 2009— -- Electronic medical records are the holy grail of health care reform, enough so that President Obama sees them as so important that he provided funding immediately through the stimulus bill, without waiting for broader reform.

His optimism has good cause. With the ease of a mouse click, doctors can know everything about our medical lives in an instant -- with no messy handwriting to confuse them.

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But technology alone will not transform health care. It is a tool, and, like all others, is only useful in skillful hands. Those hands will not just be those of our physicians. We, as patients, will play a crucial role, as well.

The ultimate vision of reform is electronic records that are "interoperable." That means anyone can access them from any computer system. No more VHS and Betamax.

Imagine the result: All your lab tests, prescriptions, screening tests and specialist opinions accessible in one place. You can go from doctor to doctor anywhere in the county, and your essential medical information will automatically follow. The doctors will all even know your name.

Fewer errors will occur, as when physicians prescribe drugs without knowing about a patient's other medications that can cause dangerous interactions. Thousands are hospitalized and many die each year from medication errors. The fatality averted could be your own.

Your physician will also know what top experts think of your condition. Electronic records will come with built-in decision support based on the latest medical evidence. All physicians can access the same expertise as colleagues at top academic centers.

This is the vision of what can happen to medicine, but it does not tell us what actually will happen. To imagine that, we must consider the often overlooked missing ingredient. The system will be used by human beings.

The future of electronic medicine lies as much in sociology as in technology. How will physicians use their new tool? Much of their time will be spent entering data. They will check boxes on computer screens and peruse drop-down menus instead of jotting down words. Will this stifle innovative thinking? What subtleties of observation may be lost?

New Skill Sets Needed for Electronic Medical Record Revolution

Physicians will communicate with one another differently through electronic records. Think Facebook versus telephones. Will teams of clinicians function the same in a virtual environment? Interpersonal dynamics will be transformed.

In other words, effective physicians in the digital future will need new skill sets. Norms of professional behavior will change. Fresh training paradigms will have to emerge in medical schools.

So much for our doctors. Where does this leave us as patients? Can we sit back and wait for our caregivers to sort out the technological future? Absolutely not.

The challenge for patients starts in the exam room. Physicians using electronic records spend much of their time staring at a screen, frequently with their backs turned. What diagnostic information is missed when the patient is not even in the field of view? Patients will need to be more assertive.

Rude though it may seem, they will have to interrupt the typing and interject themselves. A new etiquette of physician-patient interactions may emerge.

With all of their medical information in one place, patients will bear more responsibility for monitoring the accuracy and completeness of their own information. The HIPAA law grants patients access to their own records. No one has a stronger stake in using that access to ensure that all medical encounters are included and suspicious entries are questioned.

Electronic records will also empower patients to bring their own expertise to bear. Medical Web sites, chat rooms, blogs and whatever else the digital future holds help patients to ask more informed questions and pursue broader avenues for advice. With complete access to personal information, the opportunities for self-guided inquiry will explode and patients should be prepared to use them.

In the end, physicians and patients will need to know one another in new ways. As observed at a recent symposium of health information experts at University of the Sciences in Philadelphia, there is something inherently personal about disease and illness. Information technology must serve the deeply human goal of alleviating that burden in a way that meets human needs.

Personal Medicine Crucial to Health Care Reform

For medicine to remain effective, it must remain personal. For it to remain so, the astonishing new tools that technology and health reform will bring must be used with great skill. Physicians will have a lot to learn, but we as patients will also have a new part to play.

Robert I. Field chairs the Department of Health Policy and Public Health at University of the Sciences in Philadelphia. He is the author of Health Care Regulation in America: Complexity, Confrontation and Compromise, a comprehensive overview of health care regulatory policy.