How technology is transforming primary care
While we can now bank, socialize, and shop online, most of us still interact with our doctors the old-fashioned way: on the telephone and with pen and paper.
But that may be changing soon. Our recent survey of 660 physicians found that 37 percent now keep patient records entirely electronically—up from 24 percent in our 2007 survey. And though about half of the 49,007 Consumer Reports subscribers we surveyed said their doctor only looked at paper medical records, one in four said their doctor used a computer or hand-held device, and 22 percent said they used a combination of paper and electronic record-keeping.
Moreover, billions of dollars in incentives provided as part of the federal stimulus package might motivate more doctors to finally take advantage of the technological advances made in the past 20 years, and that other industries have already adopted. To qualify for those incentives, medical practices have to use systems that can give patients secure access to their electronic health record. This year, eligible doctors who use electronic prescribing with appropriate Medicare patients at least 25 times during the year will receive an incentive payment of 1 percent of their Medicare payments. Starting in 2012, physicians who don't participate will be subject to a financial penalty.
Some health-care providers have already fully embraced the high-tech office. One medical group in New York, for example, uses a small camera to scan the irises of patients as they enter, streamlining the check-in process, and is testing a thermal imaging camera to screen patients for fever so they can separate the sick from the healthy.
But a good electronic-health record doesn't have to include such slick technology. Its main goals should be to improve care and prevent errors, in part by facilitating communication among doctors. For example, it should allow a primary-care physician to instantaneously share test results and medication lists with specialists and even doctors in a hospital or emergency room.
Here are some of the other tools that might be coming soon to a doctor's office near you:
E-prescribing. An e-prescribing system can access your health-insurance company's formulary to determine your out-of-pocket cost for each drug option. You and your doctor can then choose the most affordable among medically appropriate treatments. And by screening for drug interactions and allergies, it can also help reduce medication errors and adverse events. In 2009, 18 percent of prescribed drugs were being routed electronically, according to Surescripts, a company that operates the nation's largest e-prescription network.
E-mail and e-visits. Only 9 percent of the subscribers in our survey said they had e-mailed their doctor in the past 12 months. That's not surprising. Many consumers have concerns about privacy, and doctors have rarely been paid for online consulting. But insurers are testing new reimbursement models for paying doctors to conduct e-visits with patients. And some doctors now offer password-protected encrypted e-mail or e-visit formats, making communication more secure.
Doctors and patients are also getting a better idea of when e-mail makes sense and when it doesn't. "Some things can be done over the phone, and some things can be done over the Internet," says Ronald Epstein, M.D., director of the Center for Communication and Disparities Research at the University of Rochester Medical Center in New York. E-mail consultations aren't a good option if you're a new patient, have a serious new symptom, or have a medical emergency, for example. But if a doctor is familiar with your history, an e-visit can be an efficient way to respond to requests for prescription refills and referrals, or to provide consultations about ongoing chronic disease management, like type 2 diabetes.
Web portals. Some doctor groups have taken e-mail a step further and developed secure websites that allow you to make appointments online, get test results, view your medical history, pay bills, and set up self-care management reminders.
Personal health records. Google has introduced a tool that allows you to store and manage your health records online, and share them with any provider you choose. Microsoft's Health Vault can also download results from certain medical devices, like blood-pressure and glucose monitors, to track your vital signs. While those and similar tools from other companies are potentially very useful, they don't yet adequately integrate information from doctor's medical records and translate them into personalized and in-depth action plans, according to a commentary in the Jan. 19, 2011, issue of the Journal of the American Medical Association. And while security is getting better, there are still some concerns about medical information stored online or sent via the Web.
Our consultants say that while online personal health records still have a long way to go, they might help you keep your medical information organized. They might be worth considering if you're technologically savvy and are not overly concerned about online privacy.
Health-assessment software. These are online questionnaires about your personal and family health history that you can fill out before you go to a doctor's office, saving time when you get there. Some might also ask you to describe the issues you're most concerned about and what you expect from your doctor. Used properly, technology can be an effective tool for "getting from patients what really matters to them," says John Wasson, M.D., a professor of community and family medicine and geriatrics at Dartmouth Medical School, and a consultant on our Consumer Reports survey. He has developed assessment software that is available to patients and practices free, at www.howsyourhealth.org.
Mobile devices. Doctors can use smart phones like the BlackBerry and iPhone, and tablet computers like the iPad, to access electronic health records, lab tests, and images, or to look up reference materials for themselves or their patients. Of the approximately 17,000 smart-phone health-care apps available, 43 percent are for medical professionals, according to the mobile research firm Research2Guidance. They include reference tools like Epocrates and mobile versions of medical journals such as the New England Journal of Medicine.
An app from the federal Agency for Healthcare Research and Quality allows clinicians to input their patients' characteristics and risk factors to identify recommended screening tests and preventive measures. Physicians (and patients) can also set up alerts from the Food and Drug Administration about recalled drugs or from the Centers for Disease Control and Prevention about the flu, public-health emergencies, and more.
Bottom line. Finding a doctor who embraces electronic health records isn't always easy, especially if, like most people in the U.S., your primary-care doctor doesn't belong to a large group practice. Our poll of primary-care physicians found that 65 percent of doctors in solo practice kept only paper records compared with just 15 percent of primary-care groups with 10 or more doctors.
And even when you can find one, switching to a more technologically savvy physician or group won't necessarily translate into better care. "Infrastructure is really important, but it does not substitute for a trusting relationship between a patient and a physician," Epstein says.
In the end, "technology is the form" says Kevin Grumbach, M.D., professor and chairman of the department of family and community medicine at the University of California at San Francisco, but "the function is good communication." If the office picks up the phone when you call, someone can help you after hours, and you can get your lab tests mailed to you in a prompt fashion, then a low-tech office can still be in your best interest, he says.