A Network of Networks
Many people believe that doctors continually share data electronically with one another to coordinate treatment, do research, or track disease outbreaks. The reality is that only a few hospitals and cities in the U.S. are able to securely exchange health records, and even fewer have economic reasons to do so. Over the next few years, however, new standards for secure e-mail of data between providers will be integrated into electronic health records. The use of the fax machine will wane and patients will expect that every time they see a new doctor, or visit a new hospital, their health record will follow them.
Will one giant database hold all our health records? Will a monolithic network link insurers, doctors, and patients? Given privacy concerns, that’s unlikely. What we are seeing instead is that cities, states, and regions are developing regional data exchanges. Just as the Internet has many e-mail providers and many Internet service providers, a collection of private and public “Health Information Service Providers” will be able to exchange data among themselves, creating a nationwide health information network that is a federation of subnetworks.
Engaged, Connected, E-Patients
In my parents’ generation, doctors were considered largely infallible, and the medical record was something owned and viewed only by clinicians. Today, with credible medical knowledge available on the Internet and electronic records allowing doctors and patients to view the same data, joint decision making is becoming more commonplace. Research shows that shared decision making between doctor and patient results in better outcomes. An engaged patient is also less likely to assert malpractice and sue.
New reimbursement models will pay clinicians to keep patients well rather than for ordering tests or performing procedures. Such an emphasis on early intervention will lead to the rise of home-connected devices such as electronic blood pressure cuffs, glucometers and bathroom scales that report data wirelessly to clinician offices and patients’ personal health records. Teleconsultation in the home will become much more common. The pendulum is swinging. Fifty years ago, doctors made home visits and attempted to keep you well. Today, we have abbreviated office visits that result in prescriptions to treat disease. Home monitoring and telemedicine will return us to the bygone era of wellness.
Genomes Lead to Information Prescriptions
The first human genome was sequenced in 2003 at a cost of nearly $3 billion over a 10-year effort. Today, the full DNA code of an individual can be sequenced for under $10,000 in about a week. I was one of the first 10 people sequenced (via the Personal Genome Project) and can say there is still a wide gap between knowing one’s DNA and acting upon it. For most people, DNA just doesn’t yet tell us that much.
This situation will change sooner than many expect. Researchers are already investigating novel ways that people’s genome data might be stored inside electronic health records and used to speed up diagnosis, for instance by predicting ahead of time the chance a person will develop diabetes. Treatments will be more effective, too, as your DNA is compared electronically to that of thousands, maybe millions, of other patients. Rather than just medication prescriptions, doctors will use your DNA to write “genomic information prescriptions” for personalized educational materials describing the risks, evidence, and likelihood that a treatment will work for you.
In my opinion, a golden age of electronic medicine is now dawning. And just in time. The U.S. currently expends 18 percent of its gross domestic product on health care, and that is hurting America’s position in the world marketplace. Health-care IT can bend that cost curve by ensuring that patients receive the right care (not too little or too much) at the right time, and by improving quality, safety, and efficiency. While health care reform has proven controversial in Washington, the good news is that reform of health-care IT is universally embraced. With $27 billion in federal stimulus, an urgent need to change, and alignment among government, insurers, and providers, we’ll create an electronic future for health care in our generation, not our children’s.
John D. Halamka, M.D., M.S., is a professor of medicine at Harvard Medical School, chief information officer of Beth Israel Deaconess Medical Center, chairman of the New England Healthcare Exchange Network, and co-chair of the national HIT Standards Committee.