Ghosts of Medical Records Future

American physicians will soon join the company of physicians in all other advanced countries, and largely discard the use of paper records. They will increasingly focus on selecting medical record systems that offer true data collection and exchange rather than ones that just focus on managing narratives.

The vendor/government/academic/payer policy-makers will initially haunt the nation with onerous and often abusive privacy/security rules and attempt to convince patients and their doctors that the system is reasonable and secure. Only a minority of physicians and patients (i.e. about 30%) will trust and participate in the official health information exchanges. So it will fail in the same fashion and for the same reasons the U.K. system is failing. However, at the same time this national health information highway is faltering, and in spite of massive attempts to bail it out, an alternative system will evolve and grow. This system will be patient-centered and controlled and be more similar to the one in Denmark. It will most likely evolve out of the PHR movement where patients can designate and control where their records are stored and how they are accessed. At any time, patients will be able to check the access log to see who has viewed their records.
Sadly, there will be much patient and physician confusion and chaos during this phase. Those with wisdom will consistently make choices to be flexible and adapt in order to avoid the shifting waves of false promises and siren calls from ghosts of the past.

Patients will increasingly monitor their online health performance measures in the same fashion they monitor their bank accounts and financial performance. This societal shift will not really gain traction until the payment system evolves to directly incentivize them in some fashion. They will increasingly choose physicians that can share information with them directly and electronically. Electronic and social media communication will become the norm, but most patients will wisely choose a trusted physician to be the primary administer of their personal health records.

Physicians’ medical records and data collection tools will become a blessing rather than a nuisance. Physicians will increasingly see how introduction of information technologies offer welcome relief. They will learn how to allow patients and medical assistants to create and maintain most of the medical histories. Systemic collection of data by patients and assistants will finally start to return the gold to the patient and the doctors deserving of their trust. Physicians will learn how to quickly review the information (that is true data and not just narrative) available, clarify-edit what is less than accurate and have more time to deliver the high-touch care that the technology will never address. Because they no longer have to be busied creating massive narratives, they can finally focus more on the person to person interaction and communication. No longer will they have to focus on collection and documenting masses of information that is better collected systematically by others in advance. Doctors will finally recognize that even though they really enjoyed the old back and forth multiple question-answer routine with patients, they (and their patients) greatly prefer the better outcomes of the alternative approach. Physicians will express amazement that they were data clerks for such a long period of time. Doctors collecting and creating most of the patient encounter documentation will be recognized to be about as sensible as blood-letting. Their focus will be more on monitoring the dashboard views reporting the well-being of their patient population and on addressing alerts when measures are out of range.

Medical record information exchange will rarely take place via paper or fax. However, the initial attempts to force, direct electronic transfer of health information will likely be a series of nightmares as the top-down approaches create a succession of terrors for patients and their doctors. Only later will more sensible methods grow and spread that originate from within the affinity and trust existing between patients and their caregivers.

An unpleasant haunt for the near future will be a phase where it will be necessary for physicians to report “performance” data. While this pseudo-performance reporting will be necessary for physician financial survival for a few years, it will be a temporary approach that will eventually be relegated to the trash bin of false promises.

The future will offer important choices for patients and the physicians deserving of their trust. Some choices promise grave consequences. Other choices could deliver what was always important, but lost.
Will medical records continue to be viewed as a costly nuisance, or will patients and physicians eventually claim their gold?
Will patients step up to recognize, own and be accountable for the gold available, or will they continue to allow others to blindly rob them? Will they become involved and properly manage their gold?
How long will it take physicians to recognize their world is quickly shifting to one that is not going to be rewarding them for how many tasks they can individually complete, but how well their team manages the well-being of the population of patients trusting them?
How many and how soon will physicians wake up to a richer perspective?
How much nightmarish anguish will physicians experience before they finally change their perspectives?
How many doctors will tremble into early retirement or early graves?

We can dream that, someday, patients and physicians will finally use information technology to claim what is rightfully theirs. It would be a true revolution, and could finally liberate them from the vendor/government/academic experts and payer entities that have so prominently littered the path of healthcare history with the bones of “good ideas.”


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