Healthcare information technology has become the center of healthcare delivery, turning doctors into record keepers and patients and caregivers into users who access portals and schedule appointments online, all by the grace of IT poohbahs.
How did the healthcare IT industry go so far off the path?
Health records were originally paper files owned by the physician. Their primary purpose was to collect physician notes and assist in the process of helping patients get better.
EHR – electronic health record systems evolved as an exercise in information technology by healthcare providers in order to reduce the amount of paper that doctors and healthcare organizations have to deal with.
Operational efficiency for the organization and not better medicine was the business requirement for EHR systems. This results in systems like this that seemed to have forgotten that the objective of a medical practice is keeping people healthy:
Epic practice management makes registration intuitive, efficient and virtually error-proof. Prelude provides tailored workflows, wizards and extensive error checking to help users complete registrations swiftly and accurately. Rules-based workqueues efficiently organize follow-up activity according to flexible criteria, targeting problem registrations and delegating follow-up to the appropriate staff.
When healthcare providers migrated from paper systems to electronic health records (EHRs), what we also got was a lot more data. As Dr. Martin Wehlou notes:
What we get in most electronic healthcare records systems is an evenly thick layer of prose stretching from a variable point in the far past to some point in the near past, without any bumps or changes of scenery.
The first problem a physican has with EHR systems is lack of overview of the patient.
You’d think that a patient’s life, from a doctor’s viewpoint looking at the EHR, would present a timeline of medical problems that either are solved, or are ongoing. Instead we get a collection of badly written novels, intensely unreadable and intensely boring.
As a reaction to the top-heavy technology focus of EHR systems, another “health record” was introduced : the personal health record – a PHR – like Google Health or the Carrot. The focus moves to the patient like this:
Healthy living made easier. We believe understanding your body should be simple and intuitive. You record what’s going on and we’ll help you understand what it means.
A PHR contains observations of daily living by the patient – information such as sleep, diet, exercise, mood and adherence to medication plans.
It’s easy to see how PHR systems, not being regulated under HIPAA privacy regulations and not being integrated with healthcare organization IT, and not being integrated with clinician workflow are an easier application to develop and consumer-friendly.
A small team can develop a standalone mobile app or Web application that collect observations of daily living by the patient and help a person diet and exercise more consistently and effectively. It’s the integration and privacy regulation that makes things very complex and costly from a technology perspective, requiring much larger development teams.
Personal health records are excellent tools for patients but the real payback of PHR happens when we get the data to the doctor.
Who leads the process?
Does the doctor lead the process with his medical expertise and scientific training or does the patient lead the process with observations of daily living?
In my mind there is no question that the clinical process must be lead by the physician.
The connection between a physician and his patient is not symmetrical.
The physician is the expert on clinical diagnosis and treatment and the patient is the expert on his personal experience.
If we want to get it right and avoid typical post-hoc errors created by patients using hearsay instead of evidence based medicine, we need to place the patient and caregiver in the center and use the physician as the leader.
To make this happen, and bridge the gap between personal experience of patients and clinical expertise of doctors, we need to provide a practical digital connection between doctor and patient.
The best way we have to do that today is to provide the physician with a consumer service he can plug into like he plugs into the electric grid.
The consumer service provides a personalized, private social network for a clinician and her patients. It uses the best in social applications to enable doctors to educate, provide focused guidance and receive patient feedback on experiences and critical events. It is designed from the ground up to be private and secure.
The private social network for healthcare uses social applications that are integrated, effective and enable a doctor to use patient feedback to make decisions easier and faster.
The private social network for healthcare is of particular importance for patients with chronic conditions such as Parkinsons, diabetes, heart disease, CHF, older people with multiple issues or children with CF, muscular dystrophy, or even worried parents with children going through the usual cycles of illness.
- Just between us - Private messaging 1 on 1, group message from doctor to patients.
- Sharing that is so simple - Share your files, your guidance, your experience, your comments.