[ Tuesday, September 13, 2005 ]
"Physician, Wire Thyself."
That's the advice
of MSNBC's "practical futurist" Michael Rogers. Doctors don't use enough technology, even easy stuff that's readily available and used in other industries. Web-based communication between patient and doctor's office for scheduling and test result reporting, as well as patient questions; wireless communication between testing devices (thermometers, sphygmometers [I'm not even going to bother looking that one up], x-rays) and the EMR; webcams for rural "house calls"; etc.
There are a couple of problems, though, because medicine is special and much more complex than on-line banking. Interconnectivity issues abound; privacy and security issues abound. But he's on a right track.[Update:]
There are two secondary points that have been the subject of some discussion on the AHLA HIT list recently. The first relates to malpractice. Suppose a large hospital community, perhaps with multiple hospitals and multiple physician clinics, converts to an EMR system, and multiple separate records get combined into a bigger, more complete medical chart for the patient. Suppose there's something in the internist's chart for the patient that isn't in the cardiologist's chart for the same patient; is the cardiologist now charged with re-reviewing all patient charts to see if the new information from the internist changes his diagnosis? If the patient suffers and there was something "new" in the chart that the physician had never seen before, presumably the physician could be guilty of malpractice; this is an obvious disincentive for that physician to participate in the EMR conversion.
The second relates to transitional issues. For some period, you may have access problems, or may have some disconnect or inoperability because some sites may not yet have digital chart access. Do you keep the existing paper charts for some transition period while you're going digital, and during that transition period do you continue to update the paper charts? And since there are multiple locations that the charts on some patients are coming from, how do you make the paper chart in each location look like the digital chart? A sensible proposal was that upon establishment of the digital chart, the digital chart should be printed and should replace the paper chart(s).
I'm sure you can think of even more issues on your own. These aren't insurmountable, but they will serve as roadblocks to technological integration.
Jeff [11:44 AM]
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