e-Patients Live Longer

iUniverse, Inc.

Contents

Foreword.....................................................................viiIntroduction.................................................................xiProfile of an e-Patient......................................................xiChapter One..................................................................1Power Up and Communicate with Your Health-Care Providers.....................1Chapter Two..................................................................11Digital Health Records Could Save Your Life..................................11Chapter Three................................................................28Continuous Care Using E-mail, Portals, and Smartphones.......................28Chapter Four.................................................................44e-Patients Go to the Hospital................................................44Chapter Five.................................................................60Patient Safety: How to Ensure Your Well-Being................................60Chapter Six..................................................................74Receiving Care across Geographic Boundaries..................................74Chapter Seven................................................................92Patient-Centered Care........................................................92Chapter Eight................................................................114Web Resources................................................................114Chapter Nine.................................................................143Protecting Your Privacy......................................................143Chapter Ten..................................................................158How to Manage Your Health-Care Costs.........................................158Chapter Eleven...............................................................178Health Care 2050: Your Medical Future and You................................178GLOSSARY OF TERMS............................................................189Acknowledgments..............................................................198Index........................................................................205

Chapter One

Be what you are and say what you feel because those who mind don't matter, and those who matter, don't mind.

Bennett Cerf, Shake Well Before Using: A New Collection of Impressions and Anecdotes Mostly Humorous (1948) p. 249.

The Patient Experience

Jim has asthma. At his office visit, he tells Dr. Oakes, his primary care physician (PCP) of fifteen years, that despite faithfully taking medications prescribed, he is wheezing a lot at night and sometimes awakens short of breath. Dr. Oakes reviews Jim's electrocardiogram (EKG), finds it to be normal, and listens carefully to Jim's heart and lungs. Everything seems to be fine. While Jim waits, Dr. Oakes searches Jim's records to locate his list of medications. They talk for a few minutes about what could be causing this problem. Dr. Oakes hands Jim a new prescription, which Jim will take to the pharmacy to fill. Dr. Oakes also writes orders for a chest X-ray and a pulmonary function test and suggests that Jim return in a month to review the results of these tests and his blood work. All of this paperwork takes time away from the all too short visit, which lasts a total of fifteen minutes.

This is a typical encounter between a physician and a patient. With time restrictionsondoctorsimposedbyinsufficientprimarycarereimbursement and a paper record system that takes the doctor several minutes to search, this office visit is structured so that there is barely time for Dr. Oakes to properly examine Jim. There is never enough time to formulate an evidence-based diagnosis and discuss a treatment plan, let alone talk to Jim about what else is on his mind. Dr. Oakes also writes his comments as they talk, so he is not able to give his full attention to what Jim is saying. The experience is frustrating for both Dr. Oakes and for Jim.

Sandra, a retired teacher with hypertension, has been a patient of Dr. Clarke for twenty years. When Sandra arrives for her annual visit, she is given a clipboard with a paper form that asks her to list all of her medications and fill in her medical history. She observes that this is the same form she filled out last year, as she diligently tries to remember all of the details required. Sandra is escorted into the exam room by a nurse who asks about her general health; checks Sandra's vitals; gets her weight; draws blood and does an EKG—all part of the routine annual checkup. When Dr. Clarke comes in, she greets Sandra, quickly glances at her update form, and reviews a piece of paper that Sandra has brought with her that has a list of blood pressure results Sandra has tracked over the past several weeks. They talk briefly about headaches that Sandra has been experiencing. After a quick but thorough examination, Dr. Clarke asks Sandra to get dressed and meet her in her office, where she sits at a computer terminal reviewing Sandra's electronic health record. With her eyes on the screen, Dr. Clarke tells Sandra that the exam was fine. She asks Sandra to continue tracking her blood pressure and send a weekly e-mail to the nurse, who will review the data for anything unusual. She enters a prescription for the headaches into the computer, which automatically checks the new medication for interactions with other medicines that Sandra is taking and sends the information electronically to Sandra's pharmacy. Dr. Clarke suggests that Sandra schedule another appointment in six months or sooner if the headaches persist or if there are any other problems. She encourages Sandra to e-mail her if she has further specific questions about the treatment plan.

This office visit, which also lasts approximately fifteen minutes, is a little closer to what a twenty-first century e-Patient visit with the doctor looks like. Sandra's information is in an electronic health record, and her doctor uses e-prescribing to send Sandra's medication to the pharmacy, reducing the possibility of medical errors from illegible handwritten prescriptions and insuring a more comprehensive check of drug interactions. The fact that Sandra is monitoring her blood pressure empowers Sandra to be more involved in her health care and, hopefully, this will keep her stable and out of the emergency room. Although the visit is pleasant and efficient, it does not foster the kind of communication and discussion that physicians and patients should routinely experience. The doctor is rushed. She is facing the computer and has her back to Sandra while they talk, so there is little eye contact and personal dialogue. The use of digital technology is a step in the right direction; however, the technology can be intrusive. Although Sandra has a way to connect with her physician between visits, which helps her adhere more rigorously to her physician's recommendations, there are things about their interaction that are unsettling.

What Do You Want From Your Visit with Your Doctor?

When you go to the doctor, you are seeking solutions to specific health issues. You want to be able to talk with your doctor, to feel welcomed, and to be...