Blog | Friday, November 21, 2008

When patients control their own records

Steve Spadt, ACP's Director of Interactive Product Development for projects such as the College's Diabetes Portal and the MKSAP product line, delivers a round-up of the latest in electronic health records, including patients taking control of their own health records and Web communities that let patients connect with other patients with similar symptoms and diseases, and possibly by-pass medical providers.

Learn more about the latest in medical informatics from the American Medical Informatics Association's annual meeting in Washington, DC.

Patient Health Records (PHRs) continue to gain steam, though there is a key differentiator which is whether or not the system is "tethered," meaning connected to or integrated with a full Electronic Health Record (EHR) or other clinician-managed systems. Medical informatics experts almost universally share the belief that untethered PHRs (systems that operate independently and contain data that is managed solely by patients) may actually negatively impact care as they could strain patient/clinician relationships as clinicians struggle to coordinate the data in their own systems with that in the patient's PHR--an effort that would further burden an already critically low level of time and resources available per patient encounter. AMIA'S journal recently addressed this topic.

The Patient-Centered Medical Home (PCMH) model is universally appealing, particular to primary care physicians who see the tremendous mismatch between the potential for the model to dramatically improve the quality of care and the current payment systems that conflict with the model. From the informatics perspective, successful implementation will depend largely on information systems and technology infrastructure that can facilitate and track teams as they deliver patient-centered, well-coordinated, high-quality care.

Clinical Decision Support (CDS) may finally be coming of age. Numerous resources are now available to assist physicians implement sophisticated decision support systems, including a guidebook whose lead author, Jerry Osheroff, FACP, is a leading authority in CDS and a former ACP staff member. A summary of key CDS initiatives and resources is available on AMIA's Web site.

Electronic Health Records (EHR) Adoption continues to lag behind predictions, limiting the impact of many informatics innovations. The long-expected "tipping point" of adoption appears to be gradually approaching, but it is clearly still not yet upon us.

Patient Communities are growing stronger and are increasingly empowered through the use of so-called Web 2.0 technologies that enable patients to connect with other patients with similar symptoms and diseases, share encouragement and treatment strategies, and even, in many cases, their own clinical data—a serious concern among informatics professionals already wary of the spread of PHR systems and other tools that may not be as secure or private as patients believe. One such community that is rising quickly in popularity is Patients Like Me, which was profiled recently in ACP Internist.

A Medical Informatics Update, presented by Daniel Masys, MD in the style of ACP's own Update series at the annual Internal Medicine meetings, focused on four broad areas in clinical informatics:
1) computerized clinical decision support,
2) personal health records,
3) telemedicine, and
4) the practice of informatics;

and also three areas in bioinformatics:
1) human health and disease,
2) model systems for understanding biology, and
3) the practice of bioinformatics.

He finished with a Late Night ... -style Top 10 list of Notable Events. All of the information is available online.