By RICHARD REECE, MD

It is 2020.   Computer evaluation of patients before they visit their doctors has come a long way.

Medical records containing  demographic  data,   personal histories,  medication use,  allergies, laboratory results,  radiologic images,  electrocardiograms, rhythm strips, and even the chief complaint and symptoms of the patient ‘s  present illness, as spoken and digitized by the patient,  are available prior to the visit.

These records, synthesized, summarized,  algorithmized,  and otherwise massaged by massive computer banks,  give doctors everything they want to know before seeing ore examining the patient.

• the differential diagnosis,
• the most likely cause of the visit,
• optimal treatment options,
• a review of recent medical literature in the last 24 hours on the subject,
• the best current medical practices,
• the best value for the dollars in the immediate region and at national centers,
• the best, most cost-effective and results-effective,  specialists  and medical centers  where  to go should further evaluation be needed.
• the tests and procedures to be done before the patient leaves the office.

This barrage of information is available to consumers and physicians alike before and immediately after the visit.   Furthermore,  with advances in speech recognition,  patients and doctors will be able to talk to the computer in each other’s presence, ask questions, and settle any lingering doubt.

Once in the physician’s office,  doctors  and patients can sort out the meaning of it all,  arrive at rational decisions, and negotiate solutions.  In the parlance of government,  these solutions will be deemed “meaningful,”  for they will be based on “meaningful use” of electronic  medical records,  a carry-over from 2015,  when these records became mandatory.

Once decisions have been negotiated and made,  tests performed, and results made available,  They are available  because of advances in on-the-spot-testing and noninvasive procedures.   Patients are now able to leave the office with medical record, treatment plan, and referral information,  if needed,  in hand.

Health 6.0, as it is  now known, is at hand, and it will resolve most of the difficulties of the past – misdiagnoses,  delays in diagnoses, and misunderstandings and confusions leading to malpractice suits.

But surely, you say, you are jesting.   There will always be uncertainties and lack of scientific evidence covering the vast panorama  of medicine.   No computer , even IBM’s “Watson,”  can ever  achieve complete information utopia , i.e,  define and delineate  and resolve all the variables  of humanity.  Computer processing will never offer a completely  rational solution to  the human condition  in an efficient, cost-effective manner.

Besides,  doctors and their humanist allies will object that  medicine is an Art as well as a Science.

You  are right.    Forty seven years ago, I gave an address at Hartford Hospital as part of a symposium to honor T. Steward Hamilton, MD, who had been administrator of that hospital for 20 years.   I foresaw, among other things, “Besides performing his usual duties, the pathologist will become something of an intelligence expert.   He will help collect, evaluate, analyze, integrates, anticipate, and interpret information.  His prime role will be to unify random test results into practical fingertip information that will clinicians can effectively use to make decisions.”

My title was “The Screening Laboratory of 1980” (published in Perspective of Biology and Medicine, winter 1974).  I said it was then possible, using a computer, to generate a list of realistic diagnostic  possibilities in plain English, for I had done so in our own laboratory in Minneapolis.

The Hartford medical establishment received my talk with less than enthusiasm, even with a touch of scorn.   They were correct. The computer was not ready for prime time.    I was  a prophet before my time.  It was a small step forward, before the giant leap forward in health information technology.  It was a byte out of the big  Apple.   But that time has now arrived, and all is well on the digital front.

Richard L. Reece, MD,  blogs at Medinnovation and has a website under construction, www.doctorreece.com.     He is the author of three recent books, “Obama, Doctors, and Health Reform” (Iuniverse, 2009),  “Innovation Driven Health Care” (Jones and Bartlett, 2007), and an e-book, “Pros and Cons of Accountable Care Organizations” (Practice Support Resources, 2011).   He works with, but  does not speak for, The Physicians Foundation.  Opinions expressed in his blogs are his alone.  He can be reached at rreece1500@aol.com and 1-860-395-1501.