As part of the recently enacted stimulus bill the federal government is spending $19 billion to promote the adoption of electronic medical records by physicians. Yet, with all the focus on doctors, lawmakers have forgotten the most critical piece of the puzzle — patients.
Take the case of Joe (not his real name), a patient who came to see one of us recently. Joe is a thirty-something year-old with type 1 diabetes. After a rebellious few decades that included dozens of hospitalizations, he was finally re-engaged in his care. His most recent request — to access his electronic medical record. Joe wanted to track his hemoglobin A1c, an important marker of his diabetes, follow his blood pressure and take a closer look at his cholesterol. After all, it is his information in the clinic's commercially available electronic medical record. Sadly, his request couldn't be honored. Patient-access features simply hadn't been built in.
Health information technology offers great promise to patients. Patients can access their medical information online, communicate with doctors by email, schedule appointments through the web and take advantage of numerous tools to manage their own illnesses. They can become equal partners in their care.
But without further intervention from policy makers, many of these tools will remain unavailable to patients. Doctors may adopt electronic health records, but those health records will be just as inaccessible to patients as today.
This doesn't mean that doctor-controlled electronic medical records won't make a difference. In the background, doctors may have access to tools that may help them make better decisions, be better positioned to measure their performance, and be able to identify patients who need a little extra help.
But focusing on doctors does mean that patients will miss out on a powerful way to improve their own health. Research shows that prevention and behavioral modification influence disease rates and costs on a scale that few biomedical advances can match. Stopping smoking, losing weight and making better daily decisions in caring for chronic illness are better than any pill a doctor can prescribe.
Although the evidence to a support patient-centered approach to health information technology is still emerging, some early evidence has been positive. Our colleagues at Harvard Medical School found that reminding patients to undergo colorectal cancer screening was more effective than reminding their physicians about the same test. And at Kaiser Permanente more than 25% of members now use their personal health record, Health Connect, according to a recent study in the journal Health Affairs. The site allows patients to view parts of their medical records, send clinical information to online tools, schedule appointments, request prescription refills, email their doctors, ask questions of pharmacists, and access tailored programs for behavior changes such as smoking cessation and weight management. The result of Kaiser's efforts is that office visits are down 26% and patients are more satisfied.
So why shouldn't any effort to expand health information technology be focused on accomplishing these goals? Why shouldn't we demand a system that gives patients equal access to all the data, equal rights in the decision making process, and the decision support to make good use of it? Wouldn't that be preferred by patients, save money, and make us healthier?
From where we stand, building a patient-centered health care system is the real promise of health information technology and activating patients is where the real return on investment will come from. That means instead of giving doctors billions to adopt records they don't want, we might be better off encouraging doctors to adopt just the parts of the record that will be useful to patients — problem lists, labs, medications and imaging results. It also means that perhaps some of those billions ought to be directed at helping patients adopt technology they clearly want.
Empowering patients should be the first step in transforming American healthcare. The central question that policy makers should be asking is if we are missing something by leaving patients out of the current discussion. From our perspective we're missing an important opportunity to engage patients, set a new standard for personal responsibility, and provide with them with the tools to make better decisions. Perhaps more importantly, a provider-centered approach to health information technology reflects an antiquated model of medical care where full responsibility for a patient's health is placed on providers. For patients like Joe this is simply not enough.
Gordon Moore, MD, is a Professor in the Department of Ambulatory Care
and Prevention at Harvard Medical School. He is formerly the Medical
Director and Chief Operating Officer of Harvard Community Health and
Board Member at BUPA, the largest private health insurance company in
the United Kingdom. Arun Mohan, MD, MBA, is a
Clinical Fellow in Medicine at Harvard Medical School and Resident
Physician at Cambridge Health Alliance. He is also a Co-Founder of
PictureRx, which is developing online tools to simplify medication