March 21, 2005

Hello!
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."
http://www.pcworld.com/news/article/0,aid,8928,00.asp

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 you know?"
http://www.accessexcellence.org/HHQ/qow/qow030428.php

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 [2002] -- 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."'"
http://abclocal.go.com/kgo/news/091802_assign7_medonline.html

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.

"Posted 11/19/2004 2:28 PM
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."
http://www.usatoday.com/news/health/2004-11-19-online-records_x.htm

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.

"Paris Hilton's 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."
http://www.theregister.co.uk/2005/02/21/paris_hacked/

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. ..."
http://www.contracostatimes.com/mld/cctimes/business/11079690.htm

Doctors cannot electronically examine a patient, but they can answer questions. There are drawbacks, and there are benefits.

"Early research 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."
http://www.contracostatimes.com/mld/cctimes/business/11079690.htm

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.'"
http://www.usatoday.com/news/health/2004-11-19-online-records_x.htm

"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.