I’ve been thinking lately that the model towards where we’re heading is a combination of real-time social media linked to one or more EHRs and PHRs. For example, one of the problems we’re seeing in medicine is the cost (both in time and money) of real-time or near real-time contact with patients. Lack of this real-time contact usually means interventions occur too late, are too costly and sometimes ineffective. I’ve been really impressed with the ability of a group of people to address situations using a tool like Twitter with the primary access device being the smartphone (with 3.3 billion cell phones in the world and 90% of the world population living within reach of a cell phone signal, the smartphone is the natural platform for e-health services).
In this model the physicians and their teams would follow patients in much the same way that we follow others using our Twitter accounts. Patients, with access to their medical records would submit periodic short “tweets” with the tiny URLs pointing to specific parts of their charts. In this example a patient might walk into a drug store, take a blood pressure at one of those free electronic monitors and then tweet the results with a link to their vitals section in their charts. This tweet would be immediately seen by the provider team following this patient. If normal no intervention needed. On the other hand if the blood pressure was abnormal or trending one or more of the health team members would tweet the patient with instructions to increase or decrease their medications or take some intervention. Takes very little time.
So the two-way street would have a Twitter account (as the Patient Centered Medical Home) with all of the patients who have identified that provider as their medical home following the health care team while the team follows all of the individual patients. This would allow a single team member to broadcast important information to all of their patients and patients to be assured they have instant access to all members of the team. Both entities would share the access to the EMR, be able to contribute and link their conversations with the record.
Of course we’d have to come up with technology so that all the followers don’t see all of the person-level tweets (but hey, that should be an easy technological problem to solve) and individual portions of the EMR should be able to be referenced in tweets (like tiny urls). Again, that’s relatively easy solution. I would think we could do something where patients’ tweets would be treated like direct tweets but they could determine whether tweets in any directly are retweeted to the entire group of patients following their medical home or restricted.
We would want to make the record searchable by patients so they could link to other patients with similar problems and collectively manage their diseases in the way that www.dreveryone.com is trying to do. This would allow providers and patients to gain from their collective wisdom.
I think we’re seeing the model for collaborative, cloud computing platforms being developed and will be able to use them daily with Office 10 later on this year. This application links a traditionally personal application to the web so that users can edit documents simultaneously, share portions via links. In short, like Office 10, the EMR needs to move outside an individual physician’s office or hospital to the internet cloud, with each view or portion being directly linkable (with its own URL). That would free up huge resources that are now spent on maintaining individual unique EMRs that only a few people can access.
There are some indications this is happening. Microsoft’s Healthvault and Google Health are finally making PHRs functional by focusing on the automated updates and linkages with providers’ EMRs, laboratories and 3rd party payers’ systems. Interestingly Google Health has been likened to Twitter while Microsoft’s Healthvault’s been likened to Facebook. I’ll be very interested in following www.dreveryone.com to see if researchers, clinicians and patients take the time to answer the surveys on each of their diseases and treatments. Might radically change how we do outcomes studies and manage our patients based on global real-time survey responses. Looks like I, and the patients, might be able to ask whether a specific medication really worked in the real world in real-time before prescribing it.
Hey, medicine is really getting exciting and the key is transparency and sharing of the medical record.