Archive for October, 2007

Patients are Getting On Line Access to Their Own Charts

October 28, 2007 · Filed Under net-friendly docs · 1 Comment 

A big “thumbs up” to Toby Cosgrove, CEO of Cleveland Clinic for being the champion of “My Chart”, a program that allows patients, through password protected access, to obtain information from their own chart. As patients become “ePatients” and increasingly assume responsibility for their own health care decisions, they will demand this type of access to their own lab results and other health information. In addition, Dr. Cosgrove’s patient portal allows them to request prescription refills and ask for second opinions.

Since so much good (and bad) health information is available online, this access to your own chart, and having a portal to communicate with professional health providers on line is the big “missing” piece in the e Patient revolution.

I hope many others will follow Dr. Cosgrove’s example and begin offering this service to their patients.


Improving Care by Emailing the Doctor

October 22, 2007 · Filed Under net-friendly docs · 2 Comments 

A study in the October issue of Pediatrics found that allowing patients to e mail their physicians improved their ease of access and their perception of the quality of care they received. Families who used this system also reported that they had a better understanding of their childs’ tests. The study reported that using e mail communication provided an answer, on average, 57% faster than use of the telephone.

It is no surprise that allowing doctor patient e mail improves care. I’ve been actively involved in this activity for over a decade (http://www.edocamerica.com. ) and have personally seen it benefit thousands of patients. The interesting thing is how long it is taking for this form of care to take off, and how many skeptics remain. Although a few insurance payors reimburse and have codes for “e visits”, the majority still don’t.

According to a Harris Interactive Poll, 83% of patients want to be able to email doctors, yet only 3% of physicians engage in e mail communication, citing reasons that include lack of reimbursement, concerns about opening up access, and potential liability issues.

But, as more studies like this one document improved quality, access and increased savings, it will slowly creep into the medical mainstream. And that can’t happen fast enough!


Superbugs

October 17, 2007 · Filed Under hc's problem list · 1 Comment 

Today I heard a story on NPR about a new “superbug” that caused ear infections in children that were resistant to all currently recommended antibiotics used to treat this infection. This reminded me that antibiotics are being over used. This is, in part, due to physicians who aren’t being careful enough to use them only when clinically indicated and, in part, due to patients who request (or demand) antibiotic treatment for what is most likely a viral upper respiratory infection. Antibiotics cause resistant strains of bacteria to emerge by killing off strains that are susceptible, thereby allowing resistant bugs that emerge over time to proliferate.

So, health care providers, please resist the use of antibiotics unless they are truly needed and patients be a little more reticent to take antibiotics for an upper respiratory infection, since over 90% of them are viral and, thus, don’t respond to antibiotic treatment.

This is one way to be an “e patient”, knowledgeable, empowered, and taking control of your own health care!

Your comments are always welcome…


What Works Best for Patients on the Web?

October 11, 2007 · Filed Under trends & principles · Comment 

Joe Shapiro’s piece on patients turning to the internet was well done and interesting. Our thanks to Susannah Fox for her contribution to this article, and for her work on the survey about patients with chronic condititions who use the internet.

I particularly found Robert Hawkin’s statement interesting in this excerpt from the article: “You find contradictory information. You don’t know who to believe,” says Robert Hawkins of the University of Wisconsin. “It’s a very chaotic, tough world out there on the Internet on health.” Suzanne Pingree, Hawkins’ colleague at the University of Wisconsin, says the cancer patients were overwhelmed by all the information they found. “Part of the difficulty is how hard it is to get information on the Internet and be sure you can trust it,” Pingree says.

I have concluded from over 10 years of working directly online with patients (http://www.edocamerica.com), as well as from comments from colleagues such as this, that a “guided” approach to patients’ use of the internet for health is preferable to having folks just go online and start reading web sites randomly. They are often confused and overwhelmed and, as noted above, often get incorrect or contradictory information.

If you are able to identify a trusted physician with whom you can correspond about this information, or who can recommend sources of information that are reliable, that is preferable.

More physicians are getting involved in corresponding with their patients via e mail, but this has been hampered by physicians who are ill prepared for online work, and by the absence of a compensation mechanism that makes sense to all concerned. Check with your own physician to see if he/she is willing to participate with you in e mail exchanges about your health. It won’t be long before physicians will need to do this, or else see their patients walk down the street to see someone who will!


Open Internet vs. Closed Doctor-Directed Systems

October 11, 2007 · Filed Under trends & principles · 1 Comment 

This morning’s NPR story, “Patients Turn to the Internet for Health Information,” featured data from my e-patients report, but also some research that has been conducted at the Center for Health Enhancement Systems Studies (CHESS) at the University of Wisconsin. CHESS researchers Robert Hawkins and Suzanne Pingree talked about how breast cancer patients in their study seemed to benefit from being directed to doctor-approved health information online.

If you are interested in learning more about such doctor-directed health information sources, I recommend looking into the Center for Information Therapy, as well as some health search engines, like Organized Wisdom, Kosmix, Healia, Healthline, Mamma Health,and Medstory.

But I’m also interested in people’s opinions about the open internet vs. closed systems. Our research shows that most people just use a general search engine when they have a health question, but many report feeling overwhelmed by what they find. What’s the trade-off? What other resources are out there for e-patients?


E-patients With Chronic Conditions

October 9, 2007 · Filed Under patient networks · Comment 

Sometimes my research becomes a little too much for me to bear alone. Like when I find that people living with chronic disease and disability are among the least likely to have access to the internet, but who, once online, are among the most avid e-patients. Or when I am emailing with an ACOR member who has volunteered to talk with reporters, but asks that they call tomorrow because she’s in chemo today. Or when another e-patient asks that reporters call her at work to discuss how her ACOR friends have helped her face the possibility that her cancer has returned; she doesn’t want her two children to overhear the conversation at home. That’s when I think about Tom Ferguson, who not only fought his own cancer, but was a tireless advocate for everyone else to have access to the same excellent resources that he did as a self-care expert and doctor.

Read more


Towards Universal Health Records

October 8, 2007 · Filed Under reforming hc · 3 Comments 

Recently, Microsoft Corporation announced the launch of Health Vault, a new, free service that allows anyone who needs an individual’s health information to view it online. While this is a great idea and is sorely needed to reduce health care costs and reduce errors, it is a long way from meeting the goal of creating a universal health record. This is, in part, due to the enormous technical difficulties involved but, even more important, falls short because of the intricacies and complexities of individuals’ health records and the myriad of related privacy issues involved that are far from resolution. Many issues need to be addressed to assure appropriate safeguards are in place to protect this information from those who should not see it. Microsoft is hoping to assuage most of these concerns by putting the consumer in charge of who sees what–and that’s all well and good.

I signed up for this service by completing the relatively brief registration process. While the site is well designed and shows promise for the future, it has a limited number of “partners” which can, with the client’s permission, share files into it. The client, if they have access to their own files in a computerized format, can upload health information that can then be viewed by others who have permission.

Though this effort is laudable, it is really just another free personal health record site that hopes to generate revenue through advertising. There are many others like it. The concept of partnering with others who may have information about the client shows promise of an added benefit that isn’t currently available, but it is so limited at this point that it is not likely to be of use to very many people. But, if any company is able to garner the resources to make a serious effort at accomplishing this task, Microsoft can. Perhaps this effort will provide a spark that will spawn a more serious effort to accomplish this important goal.

Your comments are welcome…


MicroSoft & e-Patients?

October 4, 2007 · Filed Under found on the net · Comment 

Personal Heath records have long been an issue for e-Patients. Today MicroSoft announced that they have the answer: www.healthvault.com. Although no launch date announcements have been made by Google, the rumor is they are working on the answer, too. Looks like the race is on! But how will that impact e-Patients?


Is Your Diagnosis Wrong?

October 2, 2007 · Filed Under pt/doc co-care · Comment 

One of the greatest benefits of the internet is its empowerment of patients by providing them with health information. We all know that doctors are human and make mistakes. Furthermore, the office practice of medicine is often as much an art as a science, so a doctor’s diagnosis is often an educated opinion, one that might very well be wrong. When you bring a problem to the physician, especially if it is not straightforward or common, the history, physical, and laboratory evaluation often produces a “most likely” diagnosis, rather than a rock solid answer.

Physicians need patients’ help to practice optimal health care. Patients who keep track of their own lab tests and medications, and who review their medical problems using information on the internet are more likely to discover errors, and are also more likely to suspect that a diagnosis that has been made is incorrect. These five rules can help you figure out whether the diagnosis the physician has made is correct. Take a look and, if your illness fits one or more of these criteria, consider going back and questioning your doctor further. Or, consider getting a second opinion from another doctor.

Having a trusting relationship with your doctor is one of the most critical aspects of working through a difficult, potentially erroneous diagnosis. If you trust him/her, it does not need to be a contentious or confrontational interaction. In fact, your doctor will likely appreciate your concern about your own health and appreciate the assistance in arriving at the correct diagnosis. If not, then its time for a new doctor anyway!

Your comments and dissenting opionions are always welcome…