Saturday, October 20, 2007

Consumer Driven Care - Bill Gates and the Physician Disconnect

On Oct. 6, I posted a blog “Microsoft Vaults into Personal Health Records Arena with Health” It was based on a Oct. 5 Wall Street Journal Op-Ed article “Health Care Needs an Internet Revolution” by Bill Gates, chairman of Microsoft, in which he said:

"What we need is to place people at the center of the health-care system and put them in control of their health information. We envision a comprehensive Internet-based system that enables health-care providers to automatically deliver health data to each person in a form they can understand and use. We also believe that people should have control over who they share the information with. Technology is not a cure-all for all the issues that plague the health-care system. But it can be powerful catalyst for change.”

On October 17, the WSJ published three doctor rejoinders to Gates’ in three letters to the editor.

1) Mr. Gates alludes to a never replicated study claiming that 98,000 patients die yearly from medical errors. Like others, he accepts this figure uncritically, despite the fact that the study contained enormous biases and conclusions are not supported by what is known to be true about medical errors from ongoing reporting to health departments in many states. He has an unreal expectation that computer-based advice to patients will motivate them to alter their lifestyles to lower their risk of acquiring chronic disease. I ca and do counsel lifestyle change to my patients. Most of them nod, smile and continue to do the opposite. Does Mr. Gates really believe an integrated network of computers can improve that reality?

Daniel C. Smith, M.D., Burnsville, Minnesota

2) Mr. Gates proposes an Internet-based health-care network to enable sharing of health-care information to prevent errors. Clearly, having numerous systems that don’t talk within and among institutions presents a challenge to creating on “source of truth.” Patients are unaware of their own health data and to some degree don’t even feel it’s their responsibility to know what procedures they’ve had, what medications they’re on.
, etc. Yet this solution at this time appears far worse than the disease. How will a system guard everyone’s privacy against hackers? Now, instead of only receiving 30credit care offers, and 200 spams per day, we can receive personalized junk manil addressed to “Dear Prozak User.”

Marci M. Lesperance, MD, Ann Arbor, Michigan

3) Bill” Gates prescribes a higher dose of computers and digital technology to help cure what ails our health system. However, most patients already have access to a computer and often tell their doctors they have done their “research” on the Internet. But most people do not have the knowledge and training to effectively use the mountain of medical data currently available to them. Why is it that man who is onw lawyer has a fool for a client, but in health care patients are encouraged to “take ownership” amd rely less on physicians?

Brian D. Kent, MD, Orange, California

Mr.Gates may have a IT dental problem, namely, overbyte. In any case, it seems physicians don’t buy the message that data and information at the patient-physician interface will solve the health care crisis.Not all patients are enthusiastic about comprehensive integrated computer-driven information either. I was speaking to a knowledgeable physician the other day, and he observed, “The last thing my patients want to see in the room is a computer between me and them. They want to see me, not watch me key in information in the computer.”


Dr. Bonis said...

Maybe microsoft and google are focused in a "engineer" view: more technology = more quality... and that is not always true.

There is no doubt a internet avaliable electronic health record would be of great value in a society with growing mobility.

But we need tools that emerge from the clinicians that work every day in clinics and hospitals, and from patients (and informal caregivers).

I am developing a tool (which conception comes from real physicians and not engineers) to solve this problem by using a tiny personal health record. It is a disruptive innovation (a technology with fewer features but able to solve the real problem).

Anonimity is assured as the system does not ask for personal data (even email).

Please feel free to try the draft (is not fully opreative but will serve to try the taste). Any comment is welcome.

Phil said...

Two comments:

Bill - we are all concerned about medical errors. I am SURE that they are less prevalent that the errors in your software. I crash several times a day. If you could fix these perhaps you would have more credibility about how to fix medicine.

Years ago, in the first computer era, an engineer presented his plan for medicine. (I was at an academic center and it seemed that the chairman might jam this down our throats.) The plan was this: a BIG database that would record all symptom, the tests done for those symptoms and the patients subsequent diagnosis. Then, he would correlate these and tell us what was the most effective test, and then would prohibit us from ordering anything else. His presentation didn't survive 5 questions from the audience. I still was afraid he would try to foist this on us.
What I learned: Lay people who are intelligent in their own areas, but naive, are very interested in taking control of what we do without getting the benefit of our experience. They all seem to know medicine better than we, who do it every day. This seems to be exactly where Bill is coming from. They