Actually, We’d Probably All Be Better Off With Our Health Records on Facebook

A Facebook user’s timeline provides both a snapshot of who that user is and a historical record of the user’s activity on Facebook. My Facebook timeline is about me, and fittingly, I control it. It’s also one, single profile. Anyone I allow to view my timeline views my timeline—they don’t each create their own copies of it.

Intuitive, right? So why don’t medical records work that way? There is no unified, single patient record—every doctor I’ve ever visited has his or her own separate copy of my records. And in an age where we can conduct banking transactions on my smartphone, many patients still can’t access or contribute to the medical records their doctors keep for them.

My proposal? Medical records should follow Facebook’s lead.

Cross-industry innovation isn’t new. BMW borrowed from the tech world to create its iDrive; Fischer Sports reduced the oscillation of its skis by using a technologycreated for stringed instruments. So I asked myself: Who has mastered the user-centric storing and sharing platform? The more I thought about it, the more I decided a Facebook timeline approach could be just what medical records need.
To see what I mean, let’s explore some of Facebook timeline’s key features to see how each could map to features of the ideal medical record.

“About” for Complete, Patient-Informed Medical History

On Facebook: The “about” section is the one that most closely resembles the concept of a user profile. It includes a picture selected by the user and lists information such as gender; relationship status; age, political and religious views; interests and hobbies; favorite quotes, books and movies; and free-form biographical information added by the user.

In medical records: The “about” section would be a snapshot of the patient’s health and background. It should include the patient’s age, gender, smoking status, height, weight, address, phone number, and emergency contact information; the patient’s primary care provider; and insurance information. This section would include a summary list of the patient’s current diagnoses and medications, as well as family history. And importantly, both the doctor and the patient would be able to add details.

FACEBK about-patient

“Privacy Settings” and “Permissions” for Controlled Sharing

On Facebook: Privacy settings allow users to control who can see the information they post or that is posted about them. For example, in my general privacy settings I can choose to make my photos visible only to the people I’ve accepted as “friends.” However, if I post a photo I want the entire world to see, I can change the default setting for that photo to be visible publicly instead.

Facebook also allows users to grant “permissions” for outside applications to access their profiles. For example, let’s say I use TripAdvisor to read travel reviews. TripAdvisor lets me sign in to its site using my Facebook account, rather than creating a separate TripAdvisor account. But, to do this I must grant TripAdvisor “permission” to access my Facebook account.

In medical records: Patients could use “privacy settings” to control whether all or part of their information can be seen by a family member or caregiver. For
example, if my aging mother wanted to give me access to her “events” (upcoming doctor’s appointments), she could do so. If my college-aged son who is still on my health plan wanted to give me access to his knee X-rays, he could.

facebook privacy

Additionally, a patient could grant “permission” for other doctors to access their records. When I visit a new doctor, rather than signing a form granting my previous doctor permission to fax over copies of my records, I could simply grant permission electronically within the record–and presto! The new doctor would have instant online access.

And doctors could use “permissions” in lieu of the paper forms patients typically have to sign during office visits today–to get patient signoff on the sharing of their information with insurance providers or other doctors, in compliance with the latest HIPAA regulations for patient privacy.
“Status Updates” to Document Diagnoses and Treatments

On Facebook: “Status updates” let Facebook users broadcast what’s going on with them at a given moment. (For example, my status update might say: “I just had a great idea for improving medical records.”) A user’s latest status update appears toward the top of the timeline; older statuses can be viewed by scrolling through the timeline.

In medical records: Doctors could post “status updates” to log new diagnoses, medications or treatments. For example, if a doctor prescribes a patient Lipitor, a status update would be posted automatically to note the new prescription. These types of new prescription updates would also generate drug interaction alerts. Think of those drug commercials that warn, “Before using our drug, tell your doctor if you have any of the following conditions.” Similarly, the timeline medical record would prompt a doctor prescribing that drug to ask the patient about those conditions before prescribing.

facebook status

“Photos” for the Online Delivery of Test Results

On Facebook: Users can upload pictures they’ve taken. Photos are organized into albums that are visible on the user’s timeline. There’s also a special “photos” section where viewers of the timeline can go to see all of a user’s photo albums.

In medical records: Doctors could upload scans, X-rays, and other test results to a patient’s medical record timeline. When uploading the images, the doctor would be prompted to select the type of image being uploaded, the applicable body part and the date, which would create an album titled with those details–for example, “X-ray-Left foot-11/17/2013.” The timeline record would serve as a single repository for all such “photos,” rather than each doctor or facility having their own copies. The patient or any doctor granted permission to access the record would be able to view past test results.

facebook photos

“Tagging” to Involve Other Parties and Track Common Themes

On Facebook: Users can “tag” other users to indicate their involvement with the content being posted. For example, when I post a picture of myself with a friend, I can “tag” the friend in that photo. This ties the photo to both our timelines instead of just mine. It also triggers a “notification” to the friend that she’s been tagged. She can remove the tag if she doesn’t wish for the photo to be tied to her timeline.

In medical records: Providers can use tagging to alert other providers involved in a patient’s care of pertinent updates. For example, let’s say my primary care physician refers me to a specialist for some tests. When the specialists posts the tests results as “photos,” she could “tag” my primary care physician to ensure he’s notified of the test results as well.

facebook tagging

“Notifications” for Test Result Alerts, Medication Alerts, or Preventive Care Reminders

On Facebook: Users are alerted by red “notification” messages when another user writes them a message, posts a picture of them or otherwise interacts with their profile. These notifications are a way to make the user aware of interactions or information involving them.

In medical records: Patients would be notified when a provider uploads “photos” of them–i.e., lab results or scans. Notifications should also be triggered when patient vitals are out of normal range at an appointment–for example, when blood pressure is low or temperature high. The medical record timeline should also notify both patients and providers when a patient is due for a preventive care visit or screening.

facebook notification

“Check-Ins” to Denote Office Visits

On Facebook: Users can “check in” to places they’re currently visiting. For example, I could “check in” to the concert I’m at on a Saturday night. This would serve as both a status update and a record of my attendance of the concert. Photos can also be marked with places to record where they were taken.

In medical records: Patients literally check in when arriving for doctor appointments. When medical staff check the patient in, this would automatically generate a note on the patient’s timeline recording the date and which provider the patient is visiting. Visits to a specialist would trigger a “notification” to the primary care provider, allowing that physician to better track a patient through the continuum of care.

facebook check-in

“Friendships” to Track New Provider Relationships

On Facebook: Users can create “friendships” with other users when one party electronically requests a friendship and the other party electronically accepts. These friendships are marked on the user’s timeline (“Jane Doe is now friends with John Smith”) along with the date the online friendship was created.

In medical records: “Friendships” in medical records would really be relationships with medical professionals and caregivers. For example, when a patient checks in to an appointment with a doctor he’s never visited before, the timeline would automatically note the new relationship with that doctor. All providers could be accessed via a list of providers, similar to Facebook timeline’s “friends” list. This would serve as a record of all touch-points for care.

facebook providers

“Events” to Track and Remind for Upcoming Appointments

On Facebook: Users can create online “events” to manage attendance and other details for in-person events. For example, I might create an event for the New Year’s party I plan to host, and I might invite my Facebook “friends” to that online event, where they could RSVP and receive reminders as the event date approaches.

In medical records: “Events” in a medical record would represent upcoming doctor appointments or scheduled tests or procedures. Events would be created automatically when a patient schedules an appointment, and as the time of the appointment gets closer, patients would receive online reminders about the upcoming event.

facebook events

It’s Time(line) for a Patient-Centric Medical Record

Dr. Rob Lamberts–a practicing physician, speaker, blogger, and health IT evangelist–tells me his biggest complaint with today’s digital record: “It’s not a patient-centered [medical record]; it’s payment-centered.” This he credits to the way the US health system has historically paid for healthcare, which is based on the volume of treatments rather than the quality of outcomes, requiring doctors to log complex medical codes into their EHRs.

Lamberts voices support for a timeline-like record, but he points out that the right incentives must be in place: “An improved record system like this would have to go hand-in-hand with a business model of medicine that benefited from it.” In other words, a business model which is patient-centric.

facebook whole timeline-medical-record

Luckily, this looks more like the direction the US health system is starting to take. Healthcare reimbursement models are slowly but surely shifting to reward physicians for better care instead of more care, and as that happens, technology providers will be incentivized to create solutions that align with that goal. Mine is to bring the magic of Facebook to medical records. But I’m open to other ideas that solve the patient-centric needs of tomorrow’s health ecosystem.

Melissa McCormack (@ProfitPractice ) is managing editor of Software Advice. This post originally appeared in Quartz.

19 replies »

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  2. There are certainly a number of details like that to take into consideration. That is a nice level to bring up. I supply the ideas above as normal inspiration however clearly there are questions like the one you bring up where a very powerful factor will probably be working in trustworthy good faith. I don?t know if finest practices have emerged around issues like that, but Im sure that your job is clearly recognized as a fair game. Both boys and girls really feel the impact of only a moment’s pleasure, for the remainder of their lives.

  3. Enjoyed the article, and contrary to other posts, it’s clear to me that you weren’t actually advocating for Facebook to become EMR/EHR.

    The “timeline” feature is key. Right now, most EMR systems are just digital versions of a paper chart. Flipping through them is still tedious and labour-intensive. When someone finally applies the Facebook approach to medical data, I hope to see better ways of displaying relevant “signal” and filtering out a lot of the “noise” that accumulates in charts.

    One thing you didn’t really go into are the research implications of a centralized database. Can you imagine how the pace of evidence-based medicine would accelerate? Conducting retrospective studies would be as simple as querying this mega stash of treatment courses and outcomes. With new developments in wearable sensors and other gadgets, we would have a place to start storing data and making sense of it on a grand scale.

    As far as I’m concerned, medicine is in dire need of a Mark Zuckerberg, a Steve Jobs, a Larry Page, or a Sergey Brin.

    — Th3o6a1d, medt3ch.com

  4. Thanks for the kind words, Leslie! Great minds think alike. 🙂 Glad to hear this seemed to resonate. I’ll be interested to check out your post – shoot me the link if you think of it.

  5. Melissa, so nice to see you here at THCB, and congrats on a very thought-provoking post!

    I *just* drafted a post about needing a good PHR for the elderly patients I work with, and had mentioned a timeline. In truth, I was thinking more about my needs as a clinician trying to keep track of the bazillion health encounters that some frail elders experience, but I love the idea of creating a patient-centered narrative.

    I’m not at all familiar with Facebook, so this was both a great intro to the platform’s structure, and a terrific example of how we can learn from another industry. Well done!

  6. @Legacy Flyer – good questions. Security is hugely important, but I think that’s one area medical software developers have figured out pretty well already with existing Cloud-based solutions. As to your other points, like the logistics of how exactly referrals would work, I’m going to take the easy way out here and say that I don’t have answers to all the important questions. Part of my aim with this article was to surface those kinds of questions, so I’m glad this idea is fostering discussion.

    @Dr. Pitt, you’re articulating the value here better than I did! Love your point about the importance of an organizational structure that supports the “patient narrative.” I hear a lot of people talk about the need for humanization as if it only applies to patients needing to feel validated as human beings, but it’s also an important piece of a doctor understanding a patient’s overall health in that “doctor as historian” role. Thanks for the comments.

  7. Thank you Alan Pitt, M.D. for the clarification!

    Something to bring up in a discussion with my EHR/EMR company and to kick around.

  8. ACO/HIE, like EMRs are aggregators, rather than organizers of information- all information in one place across multiple healthcare providers (doctors, hospitals, etc). The suggestion here is an improved organizational structure.

    In terms of patient entered data, there are personal health records (PHRs). These are records owned by the patient (rather than the provider or other organization). Patients can self manage, but must don’t- most of us tend to want to ignore our health as it’s an admission of mortality. The tools I am aware of in this space (HealthVault is the prime example), again fail to organize information into a usable narrative. There are companies that build on top of HealthVault. These would be the most apt to adopt this FB like strategy.

  9. Isn’t that the idea behind ACOs and HIEs? To have that information shareable between all medical facilities and personnel?

    Some EHR/EMR’s have options where patients have access to their records online and can be updated by the patient. I would believe that we are heading in that direction already.

  10. Melissa,
    Thank you for the excellent post. And I recognize that you are not advocating for FB to be medical records, but rather than structure of an FB record be used for a patients benefit; there seems to be some confusion on earlier comments. A trusted third party using this structure would be of value for patients and providers alike.
    From a provider perspective, most medical charts are now more like the Dewey Decimal system than an organized narrative around the patient. A record tends to be lab, X-Ray, clinical visits, etc, disparate elements…rather than a story of who the person is and how they came to have the “wellness” they have today. Many providers see themselves as the patient’s historian, trying to get the story right so they can offer an appropriate next chapter, next step. Current EMR’s do not support this type of narrative and in some ways further depersonalize the relationship. I have often thought that a FB like timeline would be of great value.

  11. It is just incredible how dumbed down things have become. But, the “quick fix” mentality is just pervasive among the common citizen.

    Just remember what I noted in a George Will column at the Washington Post a week ago, about 20% of Americans think the Sun revolves around the Earth. That is a damning stat! And people take advantage of basic stupidity, it is how legislation like Obamacare gets passed and legitimized ongoing, despite the overt failures and transgressions.

    So, keep rationalizing and minimizing with this kind of thinking. Because enough people will f— up using Facebook. Just pay attention to who makes light of it as it happens.

    Glad I don’t use it!

  12. I think this is a good idea. A number of questions though:

    Obviously, security of data is a big issue. How can the security of this data be ensured?

    How would referrals work? For example an internist sends a patient to an orthopedic surgeon. Does the patient grant access to the orthopod when he/she makes their appointment?

    What portion of a doctors medical records get uploaded to the Internet? All of them, part of them.

    What about X-Rays, CT scans, MRI. Do these get uploaded? Is there enough storage space? Most monitors don’t have the resolution to display all medical images properly.

    Still, I think this idea has merit.

  13. To Vince’s point—agreed, and despite the provocative title, the former is actually what I had in mind. Not that Facebook itself should get into the medical records business, but rather that medical records developers should look to the Facebook user platform for inspiration in creating a patient-centric, combined EHR-PHR.

    Thanks for the dialogue all!

  14. While I acknowledge Vince’s point that we would not want the real Facebook to be the steward of our personal health data, I like this posting from a conceptual point of view. That is, there are many analogies of what we want from a longitudinal health record that Facebook has. As an educator, I found this quite valuable. Thanks, Melissa!