In today's world, can computer memory surpass the capabilities of the human mind? This article suggests inputting all paper medical records into computer databases so that they can analyze what's best for the patient? However, this also has many further implications like: the impact of the industry, laws discerning the privacy of medical records between patients and doctors, and ultimately the moral issue of whether computers should have more knowledge than people. Currently there is only one company with a feasible program that allows the computer to analyze the illness, prior medication used, the outcome of that patient and then compare it to other techniques. In a sense, it would be a huge warehouse of tests, and the computer would tell you which solution worked best. In this sense, a child could type in the symptoms, and prescribe the best medication. Moreover, because there is only one company with working software, this would create a monopoly in the industry. Also, the cost of the instrument hasn't convinced doctors that it is worth purchasing. Another problem with this is patient-doctor privacy. There are laws, like the privacy act, that secure your privacy as a patient in regards to giving out information about yourself. Currently, the computer database complies all information put into it. The article doesn't specify whether or not the doctors consulted with the patients or not before giving all information. Lastly, there is a moral issue or whether a computer should hold more knowledge than a person of a very high degree. Although everyone makes mistakes, should doctors be able to rely 100% on computers to be able to correct them 100% of the time?
2 comments:
I think your post on this issue lends itself to a very interesting debate. In addition to the privacy laws between doctor and patient and the cost of implementing such a program, I'd be interested in exploring the liability of having a computer program spit out a diagnosis or a course of treatment for a patient. Would the doctor still be held fully responsible for misdiagnosing or mistreating a disease if he or she used this program?
As a patient, would I be more willing to trust a doctor who had such a database to consult with or would I prefer a doctor that follows his or her instincts, knowledge, and past experiences? In addition, how would this impact advances in the medical field if doctors depended too much on a computer program and less on experimentation and critical thinking when diganosing and treating patients? Just some things to ponder...
Jenny, you raise some significant points for consideration. In general terms you are speaking about the development and fulfilling promise of health information technology in keeping with a vision of a "value-driven" health care system. A value driven health care system is premised on the principle that a healthy population is a paramount social good. A health system focused intently on this objective would achieve individual and population health through prevention, preemption of disease and disability, cost-effective diagnosis and treatment. Collaboration, competition engendered by transparent evidence-based performance standards, and appropriate regards would motivate providers, payors, and patients, as well as states and communities to attain and maintain good health and achieve ever-increasing levels of safety, quality, efficiency, and professionalism in the pursuit of health and healing. Universal and equitable access to evidence-based effective care would help ensure that population health, information, and data management strategies can be implemented in a patient-centered health care environment.
Current systems of care have evolved such that they are mostly opportunistic and rei8mbursement-driven, rather than proactive and value-driven. Many of the shortcomings in our unaligned health care efforts can be traced to non-existent, poor or inaccessible data or information, and the lack of capacity to easily and efficiently share both relevant information and knowledge. It is forward thinking to hope that for this century we continuously develop predictive health capabilities that can preempt and prevent disease-with health interventions that will be aligned with genetic, phenotypic, and related data that enables health care that is "just in time, just for me, and every time". There are several reasons why the adoption of HIT has been derailed, some of which you have noted in your points. Among the most important barriers cited are the costs involved and the ongoing uncertainty about what standards will ultimately be adopted for processing and sharing of information. Additional factors include: practical concerns about time and effort, hoe to integrated the evidence into clinical practice, privacy issues, system maintenance, and who among the many vendors are appropriate. It is clear also that there are both cultural factors embedded within health care practice and structural issues that suffuse the entire health care system and its financing, which must be addressed. David Brailer, the former coordinator of national health information technology, has suggested that the current rate of adoption of HIT could result in having the vast majority of our health system "wired" and interoperable within two decades. If done properly, HIT holds extraordinary promise.
David Brailer notes the potential of the interoperability; "For the first time, clinicians everywhere can have a longitudinal medical record with full information about each patient. Consumers will have better information about their health status since personal health records and similar access strategies can be feasible in an interoperable world. Consumers can move more easily between and among clinicians without fear of their information being lost. Payers can benefit from the economic efficiencies, fewer errors, and reduced duplication that arises from interoperability. Healthcare information exchange and interoperability also underlies meaningful public health reporting, bioterrorism surveillance, quality monitoring, and advances in clinical trials. In short, there is little that most people want from healthcare.
An example that I can provide is for you to consider you live in Hong Kong and you have a patient with symptoms that you have never seen before... several doctors from around the world might provide insight through their data base that would direct the doctor in treating this patient who otherwise might die.
The most important thought I would like to leave you with is that the capabilities and the standards are rapidly evolving, fueled by a national interest in improving health care while reducing cost. There is a wealth of descriptive data available point to the benefits; however there is a dearth of quantitative research related to the value in terms of safe, cost effective health care. It is important to stay engaged in this evolution and help shape its direction, as it has already proven to have significant positive impact on the practice of health care and outcome of patients around the world.
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