Electronic Medical Records, Telemedicine Hung Up on Logistics, Insurance Rules
BERKELEY, Calif. -- The vision of the electronic personal health record has foundered because care providers haven’t filled in patients’ files with information useful to them, Intel and Kaiser Permanente executives said Thursday. Kaiser found in a pilot program with Microsoft that the technology “is just tedious and takes forever” to set up, said Anna-Lisa Silvestre, the organization’s vice president of online services. Consumers haven’t pushed hard enough to make the records a reality, she said at the 21st Century Tools for Health Leadership conference at the University of California campus. Silvestre pointed to a great deal of “hype over the past couple of years” about the concept.
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"Google Health, I think, has been very disappointing,” said Ben Wilson, Intel director of health-care IT. The site was meant as a hub for patients’ access to their information from providers, he said. Kaiser decided not to take part because Google was “going to use a different data-exchange standard,” Silvestre said. The technology is doomed to remain “a patchwork deal” until the government or other force unifies it, she said.
The H1N1 scare last spring shoved California’s Department of Public Health into Web 2.0, said Al Lundeen, its deputy director of public affairs. Video was added to the department’s website and the agency took to Facebook, Twitter and YouTube to spread the word especially about prevention measures, he said. An online contest to create a public service announcement, which the department aimed mainly at schools to produce a message that would get to young people at risk, itself became a big TV news story, Lundeen said.
Lundeen conceded he was skeptical about using Twitter. But only until a tweet was passed along by four other users and ended up reaching 80,000 recipients, he said. The department also developed “a very successful program” allowing state residents to find nearby vaccination sites, including free ones, by text message or by search on its website via Google Maps, Lundeen said. “We've learned that the Internet and new-media tools are extremely useful” in getting this information out, he said.
The big variable for the adoption of IT and communications in medicine isn’t technology but insurance-reimbursement policies and the rest of the structure of the health system, Wilson said. Videoconferencing hasn’t taken off as a substitute for patients’ doctor visits, though Skype makes it very inexpensive, because it isn’t reimbursed, he said. “When people use it, they love it.” Wilson said he’s disappointed that the new federal health law “didn’t go far enough to change the way we deliver medicine,” to make it as productive and economical as possible. But he said he’s glad the law created “a big fund for experimentation.” Intel’s health business is built around home networks, with a “patient monitoring device” at the hub, to keep people out of institutions as long as possible, for their well-being and to save money, Wilson said.
Mythical obstacles to the successful use of the Internet and other new communications technologies in health care are rife, Silvestre said. Security worries won’t keep patients from using online services, as shown by the fact that the proportion of Kaiser members doing it has more than doubled since 2006 to a majority, she said. Of a huge amount of Internet activity, the organization is most encouraged by the adoption of e-mail in doctor-patient communications, online prescription refills and behavior-change programs on the Web, because these point most directly to health improvements, Silvestre said.
Contrary to doubters, Kaiser’s 86 million doctor messages by e-mail show that physicians will adopt the medium, Silvestre said. It allows discussion with patients directly instead of through go-betweens like nurses and the convenience of asynchronous communications replaces phone tag, she said. The record that e-mail creates, unlike visits and phone calls, is helpful in connection with malpractice allegations, too, she said. And in the face of skepticism about service adoption by seniors, Kaiser is finding disproportionate use among members over 40 and those with health problems, Silvestre said. The number of Medicare recipients on its online system tripled from June 2007 to December 2008, she said.