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July 09, 2012

The Problem with Patient Based Portals and Mobile Healthcare Today

I was recently asked by a large New York City based consulting firm regarding my thoughts about mobile healthcare and where I see things headed.

I gave them my two cents, but thought to share with my readers.

As any patient who has been through the healthcare mill knows, there is a profound lack of communication among private offices, hospitals, and health systems.

Let's start with a true story...
I recently saw a patient in the hospital who was admitted through the emergency room with severe sinusitis who had been on multiple different antibiotics without relief and even had surgery 1 week ago after which she was hospitalized for a few days for unclear reasons. She also had multiple drug allergies. Problem is, she didn't know much of what was done to her, what her allergies were, and most importantly, received all her care in a different hospital system. It was also the weekend. 
I couldn't really start treatment on this patient until I knew what was done as I didn't want to waste healthcare dollars on treatments already tried and failed as well as repeat CT scans that were already done as well. In terms of life and death, I couldn't really start any medications until I knew exactly what her drug allergies were. 
I called the other health system's medical records... closed for the weekend. 
I called the ENT on-call at the other health system who did not know anything regarding the patient. 
Ultimately, I was able to get the information I required by a back-end route... The patient knew cultures were obtained during surgery. I also had a friend in my hospital microbiology department. I contacted my friend who fortunately knew the microbiologist at the other health system who than looked up the information we needed and faxed them over to me.
If I did not have any personal contacts, I would not have been able to do anything until Monday.

Would a patient portal have helped me out here? Perhaps...

Would mobile healthcare have helped me? Doubtful if a non-functional patient portal system was in place.

The Problem With Patient Portals

It's all fine and dandy if a patient sees ALL their physicians within the same health system like Kaiser Permanente or Duke Medical Center. Mobile health makes perfect sense. Patient portal can access all a patient's records.

Problem is when you get beyond a large health system and where the majority of healthcare occurs which is in community settings.

For example in my community, there is no single large health system.

There are private practices and the hospital. We all use different electronic medical records. The electronic medical records (EMR) do not communicate with each other.

As such, if a patient portal is used, we ALL would have to use different patient portals which can only access information from that one practice and none of the others.

So for a given family, they may see the pediatrician that uses EMR #1. Father see primary care doctor using EMR#2. Mother sees OB/GYN that uses EMR#3. Mother also sprained ankle so also sees an orthopedic surgeon who uses EMR#4. One of the kids also sees ENT for recurrent ear infections who uses EMR#5.

Each of these EMRs do not communicate with each other. As such, even if all of the practices uses a patient portal, they all would require the parents to remember each practices'  different portal web addresses which each require different userids and passwords. Though I'm sure there will be some people who will do exactly that, most will not or won't remember the web information.

As it is right now, I have a hard enough time remembering my current collection of userids and passwords for my bank, Amazon.com, gmail, insurance, etc.

Not sure I will use a patient web portal which I may even think of accessing no more than once or twice a year if I'm basically healthy.

The Problem with Mobile Healthcare

How in the world will mobile healthcare work anywhere except in big medical centers if electronic medical records are fragmented out in the community like it is now? After all, mobile healthcare is basically being able to access medical records quickly and easily from a smartphone rather than a desktop computer.

But if you can't even achieve that task with a desktop computer, how can a smartphone???

It's like trying to build a house with a weak foundation.

In order for patient portals as well as mobile healthcare to REALLY work, communication needs to exist between different electronic medical records regardless of the vendor.

The Solution

For patient portals and mobile healthcare to really work and be used, we first need to treat electronic medical records like the computers they reside on. There currently are many different types of EMR systems just like there are MANY different types of computer models, speeds, makes, cost, sizes, etc.

However, unlike current EMR systems, in spite of who makes a computer and what operating system software it runs, it has standardized components... USB, Firewire, HDMI, VGA, BlueTooth, etc. as well as a universal communication medium called the "internet" that works with phones, computers, laptops, etc regardless of who makes it and what software it is on.

You would think that an EMR system given its digital essence would be able to easily communicate with other systems... but no... they don't communicate at all... which is why paper reports still exist... which are than scanned into the EMR.

Rather than the government dictating what physicians must do and mandating EMR initiatives, I believe the money would be much better spent on mandating inter-operability and communication standards. The free market will create the best EMR systems and physicians will pick the one that best meets their need.

Once inter-operability and communication standards exist for EMR systems, only THAN will mobile healthcare and patient portals be the disruptive concept that is being prematurely attributed to these systems right now.

The golden goose being a patient (or physician) will only needing to access ONE patient portal that can access medical records wherever they may reside.

Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids. Google+ Christopher Chang, MD Bio

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