Information Technologies Bring Fundamental Changes to
Patient-Provider Interactions
By Andrew Small
It is notable that the authors of a qualitative study investigating patients’ perspectives on emerging health information technologies sometimes use the future tense. In this study, they describe a future health care landscape where, among other things, “personalized computers will present information about new drugs, treatments, and clinical trials targeted to each patient’s medical conditions.”
The participants in this study were all frequent Internet users who already incorporate developing information technologies into their everyday experiences. The focus group data gathered by the researchers demonstrate a surprisingly extensive and fundamental acceptance of these technologies, should the health care system begin utilizing them.
The researchers at Beth Israel Deaconess Medical Center in Boston focus their attention on the role that new electronic personal health records (PHRs) will play in enhancing the quality of health care and empowering the patient’s position in making health care decisions. Previous experience and research in the field of health technology demonstrates that researchers, software engineers, and health care providers most often ignore the patient perspective when developing health information hardware and software. With this in mind, the authors developed a discussion guide for their groups, asking participants to consider how they currently organize their health care information, how they would ideally manage and use that information, and how new technologies could tend to any shortcomings.
The authors held eight focus groups in four cities—Boston, MA; Portland, ME; Tampa, FL; and Denver, CO—selected to provide regional, ethnic, and cultural diversity. Six of the groups consisted of consumers, and among these were represented groups of healthy consumers, consumers with chronic illness, young consumers, and caregivers. The remaining two focus groups were made up of health care professionals, with the view that they “could provide a useful reference for unanticipated consumer ideas.”
The authors note being “struck by the similarity of participants’ views across race, ethnicity, education, and professional lines.” Five key findings in the study include:
- Patients want full access to their provider-based records. All groups expressed a desire for more transparency in the management of patient medical records, with the professional groups being slightly more hesitant. Many note the great value in maintaining medical records that “move beyond institutional control to become shared documents, with both patients and clinicians contributing to their final form.”
- Patients may value privacy far more when well than when sick. Although aware of the inherent risks of unauthorized disclosure in having online access to personal medical information, the groups “focused far more on the benefits of remotely available records than on concerns of privacy,” especially where a chronic illness or a medical emergency is involved. In this area, the health professionals voiced far more discomfort than did the consumer groups.
- Patients expect computers to foster far more self-care in the future. Groups discussed “using the computer to diagnose and manage common recurring conditions” in lieu of clinic or hospital visits, which overtax clinicians who are already often pressed for time. A situation where PHRs could be integrated with disease management algorithms for “small” self-care concerns may serve as a “filter” for doctors, allowing them to devote greater attention to more serious cases.
- Patients expect new technologies will watch over them. Both consumer and professional groups advanced scenarios in which “portable devices worn on the person or implanted in the body” could interface with an individual’s PHRs for the ongoing management of chronic illnesses. Devices could be used in a similar way to promote wellness.
- Patients envision a truly personal computer.For a group with some degree of Internet savvy, one of the biggest frustrations involved in using online health care resources as they are currently offered is an “inability to sort through infinite information effectively.” As a way of optimizing clinicians’ services, participants want more efficient ways to communicate with their health care providers and “see PHRs as the prime mechanism for such communication…also want[ing] PHRs to integrate their personal health information and preferences with the Internet.”
The study’s lead author, Jan Walker, draws attention to the rising desire for health care consumers to play a more enlightened, proactive role in maintaining their medical records and managing their care choices, claiming that “for the most part, patients are very comfortable with the idea of computers playing a central role in their care.” Her colleague, senior author Tom Delbanco, agrees, adding, “We want our health care system to be as patient-centered as possible, and patients have broad and deep experience with technology in other sectors of their lives.”
If the trends outlined in this study continue to develop, the Personal Health Record can become a powerful tool in advancing communication between health providers and their patients. As the authors seem to allude, only time will tell where the limits lie in the future of health information technology.
Source: Walker, J., Ahern, D., Le, L., Delbanco, T. 2009 Insights for Internists: “I Want the Computer to Know Who I Am.” Journal of General Internal Medicine 24(6): 727-32.
Prescott, B. (2009, May 18) Patients Reveal a Willingness to Trade Hands-On Medical Care for Computer Consultations. Robert Wood Johnson Foundation website. Retrieved June 18, 2009, from http://www.rwjf.org/pr/product.jsp?id=42849.
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