Bryan Vartabedian, MD blogs at 33 Charts about the convergence of medicine and social media. A post last year gives a vision of how current social media concepts will merge with existing electronic medical record (EMR) technologies to produce a fully integrated communications system for health professionals.
The picture Dr. Vartabedian paints is a dream for those of us who extensively use technology in other parts of our lives (which I think would include nearly all current medical students). Social media technologies such as Facebook and Twitter have fundamentally changed the way the world communicates. Texting and email have also altered our communication habits. These technologies have brought added speed and functionality to many types of communication.
Yet, the medical world is still stuck using 1980s communication technologies. Many clinicians still rely on pagers and telephones as their primary means of communicating with care teams. Email systems within medical centers are secure and often used extensively, but violate HIPAA regulations if communicating with another health care professional outside the medical center. Many offices (probably the majority of private practices) still fax progress notes.
Although I dream of the day when we have a system like Dr. Vartabedian’s vision, I am not very optimistic such a system will come to fruition anytime soon. The biggest barrier is the general fragmentation of our health care system. Academic medical centers, hospitals, private practices, and ancillary facilities (imaging and laboratory centers) exist in silos. No form of integrated communication currently occurs between these pieces of the health care system. More importantly, each of these players is adopting their own EMR systems, few of which are interoperable.
I have tempered my expectations of what future systems will look like. Integration of audio clips into the EMR or speech recognition software to automatically include communication seems like a stretch for now. Also, automatic linking to relevant medical literature based on entering a diagnosis into the EMR would be fantastic but not practical at this point (put something like “ulcerative colitis” into PubMed or Google Scholar or even UpToDate and see all the irrelevant crap you come up with). I would be satisfied with truly interconnected EMR systems (i.e.–I can pull up any patient’s chart from any hospital or clinic and see their entire recorded medical history), the elimination of pagers and subsequent replacement with secure smartphone communication systems, widespread use of tablets at the bedside that update the record in real-time so I can finish notes at a workstation, and some level of integration of Facebook/Twitter-like communication within care teams (i.e.–during a hospitalization, I can see a feed of everything that has happened to my patient with links within the feed to notes/imaging/labs as they are updated in real-time and be able to leave short messages for other team members).
Health information technology seems to be steadily progressing towards this type of system. However, the speed is pedestrian at best. We need an increased pace of innovation and adoption to ensure health information technology keeps up with technological innovations outside the medical world. Ideally, the medical world could become a place where such technological innovations are pioneered, and it’s the rest of the world trying to keep up. Keeping pace would be good for now.
Josh Herigon is a medical student who blogs a Number Needed to Treat.
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