Is There an App for That? Electronic Health Records (EHRS) and a New Environment of Conflict Prevention and Resolution
2011; Duke University School of Law; Volume: 74; Issue: 3 Linguagem: Inglês
ISSN
1945-2322
AutoresEthan Katsh, Norman K. Sondheimer, Prashila Dullabh, Samuel Stromberg,
Tópico(s)Ethics in Clinical Research
ResumoInformation is the lifeblood of modern medicine. Health technology (HIT) is destined to be its circulatory system. (1) I INTRODUCTION In January 2007, Dave deBronkart was diagnosed with stage IV kidney cancer, a condition which at the time, had a median survival rate of twenty-four weeks (2) He immediately underwent surgery and became a participant in a clinical drug trial, deBronkart, who was employed in the computer industry, also became a determined e-patient, (3) using any and all online resources that might help his treatment and aid him in coping with his condition. All of this was successful, and deBronkart became a technology-focused cancer survivor, an active blogger on an e-patient website, (4) and a year later, co-chair of the Society for Participatory Medicine. (5) The hospital that provided his medical care, Beth Israel Deaconess Medical Center in Boston, had been a pioneer in providing patients with online access to their medical records, (6) and in early 2009, deBronkart took advantage of a new feature that allowed him to download his medical data into an electronic health-record system called Google Health. (7) The Beth Israel system was not linked electronically to other hospital systems. Therefore, the primary benefit of Google Health was that it would allow deBronkart to keep all his medical data, from any system or physician, in one place, accessible from anywhere. Shortly after Beth Israel copied deBronkart's data into the Google Health system, the Google site reported to him that his cancer had spread to his spine and that he had chronic lung disease and many other illnesses and conditions. (8) He was informed via a Medication Alert that his blood-pressure medication required immediate attention. Given the news he was receiving, deBronkart probably did need a much higher dosage of blood-pressure medication at that point, but he eventually figured out that he did not have any of the problems Google Health told him he had. What he learned was that in downloading his file to Google Health, Beth Israel Deaconess sent billing codes instead of clinical diagnoses. (9) Google, however, accepted the codes as medical diagnoses and then informed deBronkart that he was quite ill. deBronkart's problem was novel and his response unusual. Instead of consulting a lawyer and threatening to litigate, he recounted his experience on his blog. (10) That led, eventually, to a front-page story in the Boston Globe (11) and prompt attention by the hospital to correcting the problem. In the long term, deBronkart used the publicity he received to focus attention on the role of the patient in healthcare, and his credibility in this regard enabled him to turn his avocation into a vocation. (12) This article is about new problems and the need for new solutions. The new problems are a consequence of a new technological environment in healthcare, one that has an array of elements that makes the emergence of disputes likely. This novel environment, for example, will generate large numbers of transactions; innovative entrepreneurial efforts; and the appearance of new roles, responsibilities, and relationships; all generating large amounts of data being used in novel ways and supported by an extraordinarily complex technological infrastructure. If, as noted earlier, information is the lifeblood of modern medicine, it is also true that high-quality is the lifeblood of high-quality medicine and, conversely, that low-quality is the lifeblood of low-quality medicine. The manner in which is currently employed in healthcare is highly inefficient, which slows down communication and can, as a result, reduce the emergence and discovery of problems. Accelerating communication and the use of creates new opportunities to improve healthcare, but also new opportunities for problems to occur. The problems that surface when the digital merges with the physical world (13) need to be addressed with tools made possible by the digital world. …
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