The Government’s vision to create a Health Information Exchange (HIE) has the potential to provide a comprehensive patient history at the point of care. In addition to this data exchange, Internet and “meaningful use” of electronic health records will have a positive and significant impact on the delivery of healthcare and its associated costs. This new arrangement will improve the collaboration among providers and health facilities.  The integrated medical groups like Kaiser Permanente, the Mayo Clinic, the Cleveland Clinic, and University of Pittsburgh Medical Center are extensively utilizing technology to improve access.  These big groups are combining doctors, clinics, hospitals and often some insurance and capturing the financial savings from electronic health records.

However, despite all the benefits, adoption of technology is slow in most of the small practices.  It is surely a change in “status-quo”, and as such small practices do not get financial incentives to use computerized medical records and for some practices it is very time consuming process to convert paper records into electronic records.

“And there are privacy and patient centered concerns as well” said Dr. Donald Tavakoli; a Philadelphia based Psychiatrist. “Obviously for psychiatrists, mental health issues and therapy notes raise a major concern of “discoverability” and differ from the rest of medicine (at least in some people’s minds).  Not to mention, typing with a patient in front of you, which happens a lot with electronic systems, takes away from the doctor patient relationship.  On the other hand, legibility, access to records, and streamlining for billing purposes can increase efficiency and decrease redundancy in testing etc.”

Dr. Tavakoli said “technology being incorporated into practice is a good thing as it increases access (as DocAsap proves), increases efficiency, and decreases risk of errors.  And at the end of the day, it is inevitability.  Increasingly, I’m hearing about things like Ipad’s being considered as notepads for clinicians, which could offer simply touch screen checklist items to mark off during evaluations, this not only reduces medical error but healthcare costs as well.  And it is possible increased technology and Electronic record systems dovetails with increased “checklist” medicine.  The big concern is that in healthcare, sometimes the art of medicine can have immeasurable value, and the doctor patient relationship is crucial (and mental healthcare tops that list, especially with psychotherapy, but it is true in all of medicine).”

Please check Dr. Tavakoli’s profile at DocAsap

Health Affairs made available an article entitled “Take Two Aspirin and Tweet Me In the Morning”, which concerns patient empowerment via social media technologies.  It’ll be interesting to see how social media uniquely evolves in healthcare, as privacy issues loom and doctors might not buy in to it unless economic and clinical value is clearly evident.  Firms like Kaiser and Hello Health that are giving patients better access to care and more information are ones to watch, though the article also alludes to the nascent nature of such endeavors.   Furthermore, pure online treatment will likely only ever be an add-on to traditional offline doctor relationships, as you can’t take a shot, get a root canal or perform surgery via the internet (at least not now!).  Still, getting more information about and communication with doctors might radically improve access to care, something DocAsap is passionate about.

One interesting HCIT-related clause in the $787 billion stimulus bill states that the Feds will work toward the “Promotion of the interoperability of clinical data repositories or registries.” While the still-evolving HL7 and other patient data standards are getting the most push from interoperability advocates, there is not currently a universally agreed-upon standard for storing and sending patient data in the U.S. much less internationally.  In W. Ed Hammond’s Health Affairs article on data interoperability, he highlighed the main obstacles of data standardization so far, such as doctor’s idiosyncratic ways of storing patient information, the still-evolving nature of HL7, and the difficulty in getting EMRs to support one data format.   The stimulus bill currently has those issues in mind by letting the CCHIT and HITSP work together under the auspices of the ONC to pick a data standard, and only reimbursing CCHIT-certified EMR purchases.

This data standardization push is welcome, as the current reality is that doctors and patients have a very hard time keeping track of past clinical data unless the patient has stayed in the same hospital network his or her entire life.  Currently, the biggest repository of patient data resides with the payers (i.e., insurance companies and Medicare and Medicaid), as they typically can aggregate data from hospital and doctor visits, pharmacy benefit managers, and wellness/disease management programs across various providers over time.  However, for patients who are part of regional insurance companies who move to a new region, or simply those who switch insurance providers, many will most likely will lose their clinical data forever, as there is no easy way for a patient to record and transfer data their health data to a new provider.   While the EMR and data interoperability initiatives imbedded in the stimulus bill eventually seek to help doctors provide better care by having access to past clinical data and help patients hold on to their personal health record, these benefits will be years in the making.  Still, the stimulus bill gets high marks from us in its extensive protections of data privacy, as those sharing patient data for marketing or non-sanctioned purposes can be severely penalized.