Monday, May 24, 2010

Medical Innovations and The Search for More Private, More Personal, More Decentralized Care

There is something curious and paradoxical going on out there. It combines high tech, low tech, high touch care innovations. It is a back-to-the-home movement - a yearning to escape from hospitals, specialized clinics, specialists, and those health plans we’ve come to dislike. It seeks high-tech alternatives to high-cost care. It wants high tech tests done at home by patients at home and monitored by doctors.

Here is how Steve Lohr, the New York Time’s health care innovation expert describes the high-tech aspects of this transformation,

“Mention health care reform and the image that springs to mind is a big government program. But there is another broad transformation in health care underway, a powerful force for decentralized innovation. It is fueled in good part by technology – low-cost computing devices, digital sensors, and the Web.”

“The trend promises to shift a lot of diagnosis, monitoring, and treatment of disease from hospital and specialized clinics where treatment is expensive, to primary care physicians and patients themselves – at far less cost.”

But there is another leg to this transformation, Lohr did not mention - the search for more private , more personal care. Patients are seeking refuge from the digital revolution, where nothing is hidden and everything is known about their personal habits, illnesses, financial status, and health care shopping patterns. Doctors seek to escape from the expenses and irritation and the prohibitive overheads posed by third party overseers.

Patients yearn for a more intimate relationship, eye-to-eye contract with their personal doctor, absent a computer interposed between them, recording every nuance of the encounter.

In an April 13, 2010, WSJ Health Blog, Katherine Hobson writes,

“Patients already lie to their doctors. And almost half of respondents in a new survey said if there was any hint their health information — even stripped of identifying details like name or date of birth — would be shared with outside organizations, they might be even less forthcoming. “

“A study on electronic medical records use by the California HealthCare Foundation, a philanthropic group, found that 15% of the 1,849 adults surveyed said they’d conceal information from a physician if “the doctor had an electronic medical record system” that could share that info with other groups. Another 33% would “consider hiding information.”

“Privacy concerns still hover around EMRs, with 68% of survey respondents reporting some degree of worry about what happens to their personal information once it’s stored in a doctor’s computer.”

Doctors yearn to break loose from the fetters of third party reimbursement which account for most of their practice’s overheads, now often in the 60% to 70% range and which requires extensive and expensive documentation to justify charges.

In an interview I conducted with Donald Copeland MD, a seasoned family physician who has practiced and taught family medicine for decades, he expressed this dissenting opinion on the need for electronic records to document the patient encounter, monitor doctors, and justify fees, in response to a question of mine,

“Q. President Obama has recommended the government spend $20 billion over the next five years to make electronic medical records mandatory, and there is an underlying threat to restrict payment only to those doctors with electronic records. What do you think?

A: I think it’s ludicrous. You and I know that I know enough about electronic records to know that all EMRs are just a way to keep records. You can teach how to practice primary care or judge how they perform with medical records. How can EMRs transform medicine? EMR advocates say EMRs are a way of teaching or telling us how to practice medicine, but most of the people promoting them have never practiced medicine. “

Doctor Copeland’s opinion is not an isolated one. More and more physicians are not accepting Medicare, Medicaid, HMO, and PPO patients, and many are forming concierge or cash-only practices, or letting patients collect the payment from insurers.

In a May 23 interview on CBS’s 60 minutes, Marty Cooper, inventor of the cell phone, and the first person to make a cell phone call in 1973, shrugged off the privacy issue by saying, “There is no such thing as privacy anymore.”

With wireless technologies, Facebook,Twitter, cellphones, and I-pad, we are being told privacy is no longer the social norm.

The age of privacy may be over. But many of us prefer to think that what occurs behind closed doors between a patient and doctor is a private matter. The interchange during the encounter is confidential, and for the doctor’s ears only. And the outside world should not be privy to what goes on there – particularly things that could be used against us.

The health system is being transformed as patients and doctors alike seek more personal, private, and decentralized, high tech/high touch relationships.

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