Cutting Edge Issues

eHealth:
Towards A New World of Communications in Medicine

Case Study: Overlake Hospital Medical Center

Information on Demand: Consumer-Controlled Medical Records

Finding Leaders for Internet Health Care

Building the Security-Capable Enterprise

Planning Business Strategies with Internet Support

Internet Use as a Survival Strategy

Case Study Zone

Who is eMed?

Information on Demand: Consumer-Controlled Medical Records

Part 3

There are billions of possible combinations of patient characteristics and physician actions, even within a single specialty. Often, the medical student determines how to practice medicine by emulating his or her favorite clinicians, since it is impossible to decide what methods are actually best. There are thousands of ways to do everything in medicine, but perhaps hundreds of ways are better than those thousands.

Information and Wellness

Data would enable investigators to determine which methods are superior. They would be able to measure quality and value (quality versus cost). They could look at transactions such as prescribing, and this would let them prevent drug interactions and overdoses. These activities cannot be conducted as well when using paper, but they can be done using electronic data. Physicians could become proactive rather than reactive.

I have a dream that features two physicians. The first has practiced with information paucity (essentially, papers alone). This physician is asked, “What did you do with your life?” The physician claims to have been a good doctor, saying, “When people thought they were sick, they came to me. I decided which ones really were sick. I decided what was wrong, and I put them back together and made them well. Then I told them goodbye, and asked them to come back again when they were sick.” That is a noble thing, but in my dream, the second physician says, “I put people back together when they were broken, and I did it really well. I did something else, too: I enabled them to live, love, laugh, learn, and work because I increased the time between acute exacerbations of illness. I decreased the severity of those exacerbations. I made sure people got sick less frequently.” That is a higher calling, but it cannot be accomplished without information coming in and going out. The Internet is what permits it to happen.

This underscores the asymmetry between seekers and those who need care. If physicians who have practiced for many years are asked whether they see many people who really do not need to be seen because they have nothing wrong with them, they are likely to say that at least 20%, and perhaps as many as 70%, of their patients fit that category. They were seen because they needed some information, were depressed and wanted to talk to someone, brought some problem upon themselves, or had some disorder that would have gone away on its own. The same physicians, asked whether they have many patients who should have been seen earlier, but failed to come in -- despite hypertension, uncontrolled diabetes, or cancer -- will probably report that percentage as significant, as well. Think of the change in the cost of health care if that asymmetry could be improved even 1% or 2%.