Some 23 million additional U.S. residents are expected to become more regular users of the U.S. health care system in the next several years, thanks to the passage of health care reform. Digitizing medical data has been touted as one way to help the already burdened system manage the surge in patients. But putting people's health information in databases and online is going to do more than simply reduce redundancies. It is already shifting the very way we seek and receive health care.

"The social dynamics of care are changing," says John Gomez, vice president and chief technology strategy officer at Eclipsys, a medical information technology company. Most patients might not yet be willing to share their latest CT scan images over Facebook, he notes, but many parents post their babies' ultrasound images, and countless patients nowadays use social networking sites to share information about conditions, treatments and doctors.

With greater access to individualized health information—whether that is through a formal electronic medical record, a self-created personal health record or a quick instant-messaging session with a physician—the traditional roles of doctors and patients are undergoing a rapid transition.

"For as long as we've known, health care has been 'I go to the physician, and they tell me what to do, and I do it,'" says Nitu Kashyap, a physician and research fellow at the Yale Center for Medical Informatics. Soon more patients will be arriving at a hospital or doctor's office having reviewed their own record, latest test results and recommended articles about their health concerns. And even more individuals will be able to skip that visit altogether, instead sending a text message or e-mail to their care provider or consulting a personal health record or smart-phone application to answer their questions.

These changes will be bolstered by the nationwide shift to electronic medical records, which has already begun (helped along by $19 billion from the federal government's 2009 economic stimulus package). Although the majority of U.S. hospitals and doctors offices are still struggling to start the changeover, many patients already have electronic medical records—and some even have partial access to them. The MyChart program, in use at Cleveland Clinic, the University of Texas Southwestern Medical Center at Dallas and other facilities, is a Web portal through which patients can see basic medical information as well as some test results.

Other consumers are developing their own personal health records by building profiles on Web sites such as Google Health, which allows users to upload their medical history, medications and even their CT scans and MRIs as well as share them with authorized care providers and others.

Medical data is getting a new digital life, and it is jump-starting a "fundamental change in how care is provided," Gomez says.

Enlisting patients
Increased access to personal medical information is likely to be a welcome change for patients who want to be more involved with their health care. Further, doctors will be able to use the additional information to make better diagnostic and treatment decisions. But this "explosion of data," as Gomez describes it, could also be a curse for physicians and the health care industry in general.

Doctors might soon be in full possession of most of their patients' health information—from past lab test results to journals of self-reported symptoms—all in searchable form. But with that access comes "an expectation that you will be smarter about how you use that data to treat patients," Gomez says.

This newly available information could eventually lead to liability issues for doctors who fail to take it into account in treatment decisions. Expanded doctor–patient communication also raises liability and even reimbursement questions, Kashyap explains. If "you're having a side effect and I'm managing it by e-mail," she says, "it's not really clear" how liability and reimbursement will be classified for that advice.

The balance of doctor contact already seems to be shifting. As people expect more access to their doctors—via e-mail, texting and even social media—they might be content with less time face to face or even on the phone. But as in other professions, this digital communication can become a huge time burden. "Physician work flow—it's already almost at a crisis," says Annette Johnson, an associate professor at Wake Forest University Baptist Medical Center, who has studied patient and physician attitudes toward digital medical data. To address the communications demand, some researchers have suggested expanding the responsibilities of nurses and other clinicians, who could help guide patients through basic questions and explanations.

Another way to help reduce the swelling workload for doctors is to encourage participatory medicine, says Dave deBronkart, a former cancer patient and a now patient advocate. In such a partnership, patients would stop expecting doctors to "know everything and do everything," he says. Rather, they would be more actively involved in working with doctors as partners in their care by being more aware of their own health histories, conditions and risk factors.

And this increase in sharing and engaging in the health process—fostered by more and better data—has the potential to improve the doctor–patient relationship, rather than degrading it. "They can be an ally," Kashyap says of patients.

6 Comments

1. 1. reality_check1 07:07 PM 4/12/10

   Harmon mentions that some doctors will feel threatened and concerned about missing a side effect, etc., but a related issue is the doctor's own confidence in his/her ability to accurately diagnose a medical problem. And with hiding misdiagnoses.
   
   The trend towards the more informed "consumer" is already causing stress among some some clinicians. I experienced this after separating my shoulder. I'm a Type-A information gatherer and engineer, and with a little research, I found I needed a specific type of X-ray for accurate diagnosis. When I arrived at the radiologist, the wrong type (I was pretty darn sure) had been specified. I mentioned this to the original doctor on my followup and she admitted the mistake. However, I didn't realize until that point that the correct X-ray would have changed the treatment and improved my outcome. Now I have a minor but annoying shoulder disability. But hey, I understand mistakes happen. What I *could not* tolerate was her final statement when I challenged her diagnosis. She told me, "We don't like our patients to use the Internet."
   
   I'm not implying that patients are smarter than doctors, but I am asserting that patients have a much higher vested interest in their own health. And many of us are well educated and capable of basic research, and capable of separating the Internet wheat from the chaff.
   
   I think Electronic Health Records will create a whole new behavior on the part of clinicians - one that veers away from recording purely medical information towards forward-looking damage control from potential lawsuits, etc.

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2. 2. JEngdahlJ 11:31 AM 4/13/10

   Federal funding may be encouraging a move toward EHR, but there's more to it than just installing systems. How can healthcare data pooling lead to a better system? More at http://www.healthcaretownhall.com/?p=2193

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3. 3. HITinfo 12:47 PM 4/13/10

   The push for electronic health records is certainly supported by federal government, and in fact, medical providers will even be penalized with lower Medicare/Medicaid reimbursements if they do not adopt an electronic health records system by 2016. This push is not met without resistance, and I think what it comes down to is educating providers and patients about this inevitable shift towards an integrated health information system in medicine so they are informed and prepared for this change. Here are some great resources for information on the Health IT industry:
   http://www.ehrtv.com/
   http://www.ehrscope.com/blog/ and http://www.emrconsultant.com/

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4. 4. andreanis 12:23 PM 4/14/10

   ye That's quite true if on the one hand digitalisation allows
   a better healthcare because of more modern technology
   on the other hand personal datas will be very much subject to
   conflicts of interests/manipulation etc.,since this issue hasn't been as yet totally solved in the digital world (in particular the internet..)

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5. 5. Quinn the Eskimo 02:08 AM 4/15/10

   Well, my doc went all HP notebooks two years ago. After starring at the back of the screen (the new EHR WALL) he hasn't listened to my heart or lungs once! I've got great printouts of his notes, though.
   
   Don't know how that'll help my congestive heart failure. Oh well, progress.

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6. 6. Poaul in reply to Quinn the Eskimo 10:33 AM 5/24/10

   Quite right!!!
   Notes and record keeping is PART of the consultation, not THE consultation. I've just had a disturbing chat with an Australian, where the doctor 99% of the time simply listen to the list of symptoms, and without examination, dispences treatment. I still write my notes by hand, after taking a history and doing an examination, draw up a conclusion and advice treatment. Call me old-fashioned, but I'm a far better doctor than a walking MBChB with an HP.

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