March 21, 2005
Even back in 1998, the question was being asked:
"Could a Web site
save your life?
Two New York doctors think so. They've launched an online medical
registry that they say will save lives. But skeptics are concerned
that abuse and misuse of the service could hurt someone instead.
The Medical Registry lets you create a personal medical dossier
on the Web for doctors to access in an emergency, or even when
you make a routine visit to a doctor's office. Its creators hope
that the voluntary online service will give you 'security, convenience,
and peace of mind,' and promote quality medical care. 'A lot of
valuable time is wasted asking how old you are, are you allergic
to any medications, or are you diabetic,' said Murray Friedman,
chief executive officer of Integrated Medical Technologies, which
created the service. The time saved could save your life in an
emergency, he said. ... Ten years ago, while Friedman was on shift
in a Brooklyn, New York, emergency room, doctors made a last-ditch
attempt to revive a heart attack patient by injecting him with
Lidocaine. The patient suffered an allergic reaction and died.
'They had no idea he was allergic,' Friedman said."
In April of 2003, the
Questions of the Week addressed only part of this issue:
"What are the benefits
that will come once the entire medical system is online (providing
patients and doctors with 'up-to-the minute medical records' for
reference and cross-reference)? What are the negative aspects
of having all of this information so readily available? It is
the future of medicine; do you think the benefits outweigh the
risks? How might you and your family personally benefit? What
concerns do you have about how this might affect you or someone
Even when these questions
were posed in 2003, patients and doctors were already doing more
than just viewing and posting medical records online.
"Sept. 18 
-- For no charge, the foundation's 146,000 patients can sign up
for the online service that lets them access parts of their medical
record, including their diagnoses, what medications they're taking
and their health maintenance records. They can also request appointments
or prescription renewals online. And for $60 a year, patients
can communicate directly with their doctors or nurses, with a
response back usually within half a day. ... Dr. Paul Tang, PAMF
[Palo Alto Medical Foundation], Chief Medical Information Officer:
'This is not e-mail, it's electronic messaging, encrypted.' ...
For Charlotte Mitchell, it's been an incredible time saver. Recently
she suspected she had a urinary tract infection, but she didn't
have time to be sick. She logged on to PAMF online. Charlotte
Mitchell, PAMF-Online Subscriber: 'The advice nurse had sent me
a series of questions. I answered them and sent them back. About
an hour later, I got another message that said, "your prescritption
is at the pharmacy, you can go
pick it up."'"
Encrypted messaging seems
to feel more secure than email, but the idea of a doctor prescribing
medication for a patient s/he has not examined raises questions
beyond security. Within the last several months, the topics have
been in the news again. There are medical professionals on both
sides of the issues: those with concerns, those who accept it
as part of the inevitably, and those who embrace the new technology.
Although it has been a long time coming, physicians are beginning
to consider the Internet an integral part of their practice. For
example, instantaneous electronic transmission of a patient's
records from his or her doctor to another part of the country
(or the world, for that matter) could be extremely helpful in
an emergency. There's even a trial going on in Florida in which
doctors are being reimbursed for online consultations. About 1,000
doctors and 100,000 patients are participating. However, there
are still a couple of issues that keep medical professionals from
stampeding into cyberspace. First, old habits die hard. ... Second,
there's the larger issue of security on the Web, coupled with
an already-suspicious public when it comes to releasing their
medical records to anyone without their consent."
The ease of being able
to get medical records from across the globe in a matter of minutes
sounds like a wonderful thing for someone who experiences a medical
emergency while vacationing on another continent. On the other
hand, the idea of their medical records accessible to people around
the world may not be an appealing idea to some.
address book, famously kept on a T-Mobile Sidekick, has been popping
up all over the internet after someone managed to figure out her
password. ... The information landed online just days after hacker
Nicolas Jacobsen pled guilty to a single charge of intentionally
accessing a protected computer and recklessly causing damage.
Jacobsen was arrested by US authorities last October, but had
had access to T-Mobile's servers for more than a year. He reportedly
amused himself by accessing US Secret Service email, and raiding
other Sidekick users' accounts."
With people in this world
who amuse themselves "by accessing US Secret Service email,
and raiding other Sidekick users' accounts," some still think
it is better to keep medical records on paper where hackers can't
reach them. Not everyone feels this way. Other doctors have been
communicating with patients electronically for years, and now
some insurance carriers are seeing the benefits and rewarding
their efforts. "In a move to improve efficiency and control
costs, health plans and medical groups around the country are
beginning to pay doctors to reply by e-mail, just as they pay
for office visits. While some computer-literate doctors have been
using e-mail to communicate informally with patients for years,
most have never been paid for that service. ... For doctors, the
convenience of online exchanges can be considerable. They say
they can offer advice about postsurgical care, diet, changing
a medication and other topics that can be handled safely and promptly
without an office visit or a frustrating round of telephone tag.
And by reducing the number of daily office visits, surveys have
shown that physicians have more time to spend with patients who
need to be seen face to face. For patients, e-mail allows them
to send their medical questions from home in the evening, without
missing work and spending endless time in a doctor's waiting room.
In fact, many say exchanges in the more relaxed, conversational
realm of e-mail make them feel closer to their doctors. ..."
Doctors cannot electronically
examine a patient, but they can answer questions. There are drawbacks,
and there are benefits.
at clinics at the university found that using e-mail improved
the productivity of physicians, decreased overhead costs and improved
access to doctors for patients, including those who still telephoned.
'There was a huge reduction in the number of calls,' said Liederman,
who is a big fan of e-mail exchanges. Doctors and insurers say
online consultations can be especially useful for patients who
have chronic conditions like diabetes, asthma and heart problems.
They have been frequent users and being in touch can help them
to comply with regimens to cope with their diseases. ... Blue
Cross and Blue Shield plans in California, New York, Florida,
Massachusetts, New Hampshire, Colorado and Tennessee are beginning
to pay doctors similar amounts ($24 to $30, including any copay)
for online consultations. Blue Cross of California has made the
program available to 160,000 of its 6 million health plan members.
Doctors who use the medical messaging services are advised to
limit their replies to appropriate topics, and, under standard
rules, the doctors reply only to patients who have already been
examined in the office."
Co-pays and strict guidelines
are already surrounding the use of medical messaging. Even those
who enjoy the convenience know that things will not change overnight.
"Those in the medical
profession who advocate electronic and Internet medical records
say they realize it's going to be a long selling cycle. Yet, this
revolution in health information technology, the advocates say,
will save money through less paperwork, result in greater productivity,
and substantially reduce the number of costly and tragic medical
errors, which claim the lives of an estimated 195,000 patients
annually. The American Medical Association and 13 other medical
groups representing 500,000 physicians have already signaled their
intention to go electronic. ... Lest the hospital point of view
be overlooked, there is one administrator who is already working
through the huge upheaval that he anticipates electronic record-keeping
will bring. Glenn Rispaud, director of Health Information Management
at The Hospital for Special Surgery in New York City, is midway
through phasing in a multi-million dollar system that is still
in the contract negotiation stage. 'The new electronic system
will make my job different, not easier,' he said. 'It is absolutely
going to change the way we do business.'"
"It is absolutely
going to change the way we do business."
Questions of the Week:
How do you think things will change for the better from the perspective
of a patient? a doctor? an insurance company? How do you think
things will change for the worse? In what ways will things just
be different: not better or worse? Do you feel that online medical
records and medical messages could be kept secure and confidential?
What aspects of a doctor/ patient relationship could be better
handled through online medical messaging? What do you think requires
a doctor visit? What would you like to know more about before
making a decision?
Please email me with
any ideas or suggestions.
I look forward to reading what you have to say.