Halamka rises to the occasion

When Dr. John Halamka talks about the future of computing in health care, it is worth paying attention.  You will find a superb overview by him in this month's issue of Technology Review, in an article entitled, "The Rise of Electronic Medicine".

I like these excerpts, in particular:

A Network of Networks
Many people believe that doctors continually share data electronically with one another to coordinate treatment, do research, or track disease outbreaks. The reality is that only a few hospitals and cities in the U.S. are able to securely exchange health records, and even fewer have economic reasons to do so. Over the next few years, however, new standards for secure e-mail of data between providers will be integrated into electronic health records. The use of the fax machine will wane and patients will expect that every time they see a new doctor, or visit a new hospital, their health record will follow them.

Will one giant database hold all our health records? Will a monolithic network link insurers, doctors, and patients? Given privacy concerns, that's unlikely. What we are seeing instead is that cities, states, and regions are developing regional data exchanges. Just as the Internet has many e-mail providers and many Internet service providers, a collection of private and public "Health Information Service Providers" will be able to exchange data among themselves, creating a nationwide health information network that is a federation of subnetworks.

Engaged, Connected, E-Patients
In my parents' generation, doctors were considered largely infallible, and the medical record was something owned and viewed only by clinicians. Today, with credible medical knowledge available on the Internet and electronic records allowing doctors and patients to view the same data, joint decision making is becoming more commonplace. Research shows that shared decision making between doctor and patient results in better outcomes. An engaged patient is also less likely to assert malpractice and sue.

New reimbursement models will pay clinicians to keep patients well rather than for ordering tests or performing procedures. Such an emphasis on early intervention will lead to the rise of home-connected devices such as electronic blood pressure cuffs, glucometers and bathroom scales that report data wirelessly to clinician offices and patients' personal health records. Teleconsultation in the home will become much more common. The pendulum is swinging. Fifty years ago, doctors made home visits and attempted to keep you well. Today, we have abbreviated office visits that result in prescriptions to treat disease. Home monitoring and telemedicine will return us to the bygone era of wellness.