How many times as a doctor do you ask the same questions over and over again as part of the routine process of taking a history from your patient? And how often as a patient do you have to answer those same questions each time you see a new doctor? How long does this take, given that doctors and patients both complain that there is too little time for the modern consultation to cover all the bases to the satisfaction of both parties?
I estimate it takes up to 30% of the time I spend with a new patient, time that could be better used dealing with the immediate problem at hand. Modern technology should allow via PMRs, EMRs that talk to each other, on-line appointment software and online questionnaires for a streamlined consultative process where a doctor knows all the basics about a patient even before the patient enters the room, based on prior records from other doctors, EMRs and similar sources. The same systems could provide follow up information to patients after consultation and diagnosis, avoiding yet more repetition discussing treatment options in later consultations, information that may have been given but forgotten.
The fact that technology to date does not is an indictment on our society in general, one where the ‘me first’ culture has seen the death of good intentions such as Google Health and Microsoft’s HealthVault, among others, that had every opportunity , the money and the clout to create systems whereby this would be feasible.
This has sadly not been the case. Google’s reasons for pulling out of Google Health are not convincing to me, sounding too much like corporate spin to mollify the early adopters listed in their reasoning – the very people most likely to lead society in behaviour change in the long term – and the ones most likely to feel disgruntled at being “abandoned.” Instead, it appears to me that profit motive and intellectual pride have superseded the common good. Shareholders and executive boards have lost sight of the better goal, i.e. not to be richer as individuals but to be richer as a society.
I tried to find evidence of EMR cross-communications via Twitter, asking the question with the #EMR hashtag attached. Surprisingly I got no replies. I assume therefore they may not exist. Yet.
There are efforts to accomplish this goal in the USA, interestingly by governmental organisations like the Nationwide Health Information Network, and The Direct Project. How these will achieve integration into one industry standard that covers all clinical records (and settles the egos of profit driven executives and developers) remains to be seen. As an outsider to the USA health system, I’m not really qualified to comment on them, except to say that in my opinion the USA is most likely to be the source of successful efforts. As for the rest of the world, we sit and watch, waiting to see if someone with more guts than Google and Microsoft in the USA can get it right.
But until then, we will continue to repeat ourselves, doctor to patient and patient to doctor, until we are both blue in the face.
Martin Young is an otolaryngologist in South Africa and founder and CEO of ConsentCare.
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