Healthcare reform: Now we know why you can't SuperPoke your doctor

Amidst the ongoing debate about healthcare reform in the United States, there's a burning question that many Americans have: Why the heck can't we email our doctors to talk about symptoms, medication, or treatment? For that matter, why aren't healthcare providers and their patients using social networking or other communications and information-sharing platforms? At MIT's EmTech conference yesterday, one of the speakers, Dr. Ronald Dixon, explained that the technology is not always at fault. Rather, it's a cultural issue -- and a business conundrum -- that's holding back many hospitals and doctors' offices from using even basic Internet tools to communicate with patients.

Dixon, who serves as director of the Virtual Practice Project at Massachusetts General Hospital, used several examples involving his own patients. He described an early experience in his career, when he started using email to monitor patients, gathering data about hypertension and medication-related issues. It didn't last long. "After 3 months, I was told that I couldn't do [email] because I wasn't bringing revenue to the practice," Dixon recalled.

However, for patients who were unable to see him in person because of deteriorating health, there was no other choice -- he either relied on the humble telephone, or, for a patient who had terminal lung cancer, email and Skype. But even though these services made him far more accessible, they had a negative side effect in terms of record-keeping: "Unfortunately, if you look at the medical record [for the lung cancer patient], it looks like I had no contact with the patient for the last four months of his life," Dixon said.

Video conferencing is another technology which has a lot of potential. Dixon described generally positive results when it was tried in his practice -- "We were able to make reliable diagnoses using the technology," he explained, adding that many in the office actually found the system easier to use than their scheduling application. Patients loved having access via videoconferencing, although he said they thought the GUI was atrocious.

But these and other trials may remain limited to experiments or fringe use cases. Many of the tools that hospitals depend on for records, billing, and other functions have not been designed to integrate with what Dixon called "ubiquitous" consumer technologies. Another huge stumbling block is the economics of the nation's current healthcare model. "You really have to start innovating around the business models of how you pay for care," he told the audience.

Sources and research: TechnologyReview.com, EmTech conference website, EmTech preview session featuring Dr. Ronald Dixon, MGH Beacon Hill Web page.

Image: Healthcare reform demonstration in New Orleans. aflcio2008/flickr (creative commons license)

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