It looks like all of a sudden CCHIT is ready to move in the right direction. I wouldn’t be surprised if it is a direct consequence of e-Patient Dave experience:

“CCHIT certification is based largely on whether a system can exchange information with systems sold by other companies, and on whether a system includes certain functions.

But simply having a function isn’t enough, Dr. Blumenthal said: “We need to ensure that physicians can actually use it.”

Mark Leavitt, CCHIT’s chairman, says the group is considering adding the real-world experiences of end users into certification decisions.The stimulus legislation doesn’t specify whether CCHIT should be the group to certify electronic-records systems, but Dr. Leavitt says the group is open to modifying its certification requirements.

Excerpt from the WSJ:

Mind you, I haven’t dug into them – I just love the idea of people thinking in terms that no politician would dare voice.

I didn’t want to insist too much originally on the four models of patient-doctor relationship but as you have surmised this is probably something that will really help us frame better what we mean by Participatory Medicine and how it fits with the cultural and ethical changes that are happening in the American society and that the Pew Internet & American Life Project is cataloguing.

I discovered the theory of these four models while reading about medical ethics. The authors of the concept are none other than Linda & Ezekiel Emanuel, wife & husband and among the most well known medical ethicists. Dr. Ezekiel Emanuel, formerly an oncologist at Dana-Farber, has been since 1998 Chair of the Department of Clinical Bioethics at the Clinical Center of the National Institutes of Health. Dr. Emanuel, is currently a special adviser to the budget director, Peter R. Orszag. He is also the older brother of Rahm Emanuel, the White House chief of staff. I can only recommend a very recent Times article about this amazing doctor and ethicist, who obviously gets it!

All of that to say that we have the truly unique opportunity to convey to senior officials in the new administration that e-patients, who exist in much larger numbers than usually thought, understand what is at stake and what it will take to operate the necessary changes. Particularly since senior advisors have been promoting for a long time the value of true autonomy for the patients.

Everyone, I urge you to review the “four models” article that Gilles barely mentioned in passing. It’s a bit deep, but that’s Gilles for you. :–) The screen shot in the middle, summarizing the four models, captures what he’s talking about in the shift from “paternalistic” to “deliberative”: in paternalistic the physician’s role is Guardian; in deliberative it’s friend or teacher. How wonderful.

I want to triple-underscore something that sometimes gets lost in considering how much patients can “handle” intellectually. Some people feel strongly that it’s the physician’s *job* to comprehend all this stuff, and the patient’s natural role is to accept the digested wisdom. I have no objection to either of those when that’s what each person wants. But I want to point out that both my surgeon and my oncologist were absolutely at the top of their trade, and both of them completely support my knowing as much as I want, and they always speak to me with complete respect, even honor.

Participatory medicine has nothing to do with dominance or lack thereof. It is, exactly as Gilles says, a partnership – because neither patients nor professionals can do it alone.

Physicians are under enormous pressure these days. Willing patients can contribute a lot more than some people think. Let us.