|Patients Reveal A Willingness For Computer Consultations
As President Barack Obama calls for streamlining
heathcare by fully converting to electronic medical records and as
Congress prepares to debate issues of patient privacy, one question has
largely gone unasked: What do patients want?
A qualitative study led by a research team at Beth Israel Deaconess Medical Center (BIDMC) helps answer that question.
Reported in the Journal of General Internal Medicine,
the findings provide key insights into consumer preferences, suggesting
that patients want full access to all of their medical records, are
willing to make some privacy concessions in the interest of making
their medical records completely transparent, and that, going forward,
fully expect that computers will play a major role in their medical
care, evensubstituting for face-to-face doctor visits.
"We set out to study patient attitudes toward electronic
personal health records and other emerging and future electronic health
information technologies," explained the study’s lead author Jan
Walker, R.N., M.B.A., instructor in medicine in the Division of General
Medicine and Primary Care at BIDMC and Harvard Medical School. "And we
learned that, for the most part, patients are very comfortable with the
idea of computers playing a central role in their care." In fact, she
adds, patients said they not only want computers to bring them
customized medical information, they fully expect that in the future
they will be able to rely on electronic technology for many routine
"Patients know how busy their doctors are and they want
to reserve us for what they really need us for — treating serious
illness and conditions," added Senior Author Dr. Tom Delbanco, the
Richard and Florence Koplow-James Tullis Professor of General Medicine
and Primary Care at Harvard Medical School and BIDMC. "They may be more
than happy to rely on computer protocols and ‘faceless
doctors’ to help them manage garden-variety medical problems."
Focus groups were held in four cities: Boston, Mass.;
Portland, Maine; Tampa, Fla.; and Denver, Colo. The locations were
selected to represent various geographic areas, to include both rural
and urban populations and to incorporate ethnic and cultural diversity.
Six of the eight groups (consisting of 9-12 participants each) were
made up of consumers. The last two groups were made up of healthcare
professionals from Boston and Denver, assembled to provide their
perspectives on the role of health information technology and to
compare their opinions with those of consumers.
In each case, participants were asked how they currently
organize the information they need to manage their health and medical
care, and explored how they would ideally like to manage and use this
information, including how technologies could address any gaps.
"The discussions showed that, for the most part,
consumers want computers to take into account their personal profiles
in order to bring them customized information and advice," explained
Walker. "They also expect that technologies will ‘watch’
over them, monitoring their health and giving them real-time feedback,
including communicating with clinicians when needed. Participants also
said they expect computers to act as ‘personal coaches,’
and to foster self care."
Strikingly, she adds, privacy of healthcare information
was of less importance to the groups than might be expected. "It seems
that as the population ages and finds itself facing more illness and
serious medical conditions, privacy of health information becomes much
less important to patients than it iswhen they are healthy," she noted.
"Patients are willing to trade some privacy in order to have records
fully available in emergency settings and available to new caregivers
as well as to multiple clinicians."
New health technologies offer patients online access to
parts of electronic medical records, options for maintaining their
personal histories, and support for day-to-day management of chronic
illness, the authors noted. But when it comes to the future design and
utility of these and other elements of care, teams of software
engineers, graphic artists and clinicians rarely solicit patient
"The patient’s view is critical," added Delbanco.
"We healthcare professionals think we know what it is, but we’re
often too arrogant to ask. We want our healthcare system to be as
patient-centered as possible, and patients have broad and deep
experience with technology in other sectors of their lives."
Address: Beth Israel Deaconess Medical Center, 330 Brookline Ave., Boston, MA 02215; (617) 667-7000, www.bidmc.org.