The talk of the healthcare industry these days is Electronic Health Records, (EHR, EPR, etc.) and other electronic communications (such as virtual visits, email communications with patients, online consults, whether with or without video, etc.) Yes, the Internet and computers have much to offer, potentials we’ve only begun to tap. A few years ago, there was even a program to make preliminary diagnosis based upon a patient’s symptoms, and computers have been avoiding drug interaction and contraindication problems for years now. But before we go plunging headfirst into the maze, let’s take a few steps back and look at it all objectively.
A Harvard study proclaimed that physicians who use electronic health records were about 4% less likely to have a malpractice claim against them. The immediate (and implied) conclusion was that EHRs reduced malpractice claims. To draw that conclusion based upon that statistic is both bad science and bad journalism. It’s just as likely that the practice’s progressive perspective towards healthcare is responsible for the lower incidence of claims, and that it would be the same with or without EHRs. It might even theoretically have been lower without them. So let’s not jump off presuming that EHRs will reduce incidents and premiums too quickly.
The idea of a computer as a tool is a very good thing. It can do repetative tasks lightning-quick and avoids humans suffering some of the tediums of record-keeping. In a perfect world, a well-designed electronic system would be as efficient as restaurants which employ similar systems for communication between the server and the kitchen. A little touch-screen in each room and everything from health records to billing and calling for a candy-striper and a wheelchair can be accomplished in seconds via that screen. Access to a PDR, to medical databases, etc. would also aid the physician. But that’s still just a tool. The idea of a computerized “virtual” physician is dangerous mojo, something that’s best left in the realm of science-fiction.
Virtual consultations are also something to think long and hard about. The first question is whether you’d be covered by your malpractice policy in such a circumstance. The patient isn’t necessarily even on the same continent at the time. So many small nuances that a healthcare professional might pick up on are not apparent online, and that difference could easily lead to a misdiagnosis. Here again, using the computers as tools for scheduling appointments, gaining data (such as a glucose record, etc.) and even programming dosage machines (in the future) may be good applications. Remote surguries, where a full compliment of competent surgical staff is present with the patient, should something go wrong, may also be acceptable, if approved of by one’s malpractice carrier. But diagnosing, treating, and prescribing via online consultations isn’t wise at this time.
We all look forward to the progress and improvement that computers and their interfacing promises. But let’s take things slowly, and make sure that we’re stepping smartly and in the right direction. To quote Galen, Primum non nocere; First, do no harm.