Impact of older technology in healthcare should not be overlooked

Recently, the advocates of disruptive change in healthcare have been focusing on the possibilities of hot new social networking and gaming apps for improving health behavior. There are some indications that this approach may bear fruit. But some older methods of using health IT to improve healthcare quality and efficiency have received much less attention, despite evidence of their effectiveness.

Studies have shown the value of computer kiosks, for example, in several care settings. In urgent care centers and emergency departments, kiosks have been used to eliminate the need for women with uncomplicated urinary tract infections to see a physician; other EDs have used kiosks to teach patients about appropriate use of antibiotics for upper respiratory infections; free and rural health clinics have employed them to educate patients about chronic disease self-care and health behavior change; and in the U.K., kiosks in the waiting rooms of general practitioners have improved outcomes and saved the practices time and money.

Computerized questionnaires like those of Instant Medical History and MedFusion, an Intuit subsidiary, enable patients to fill out medical histories electronically before they see a physician. These patient-entered medical histories, which may be part of patient portals and may be interfaced with electronic health records, can save physicians time and can uncover sensitive information that a patient might not volunteer in a face-to-face encounter. This is a decade-old technology, but has not yet caught on in most practices.

A growing number of physicians use secure messaging and patient portals to answer their patients' medical questions online. But, while 42 percent of physicians say they've exchanged emails with patients, only 9 million patients say they've had that experience. So the use of online consults could be expanded much further.

Studies have shown that patients do not overwhelm doctors with email messages; that routine questions can be safely answered online; that online consults increase productivity; and that giving patients the online option reduces the volume of phone calls to a practice. The main problem is that few health plans reimburse physicians for online consults.

In the future, a combination of kiosks in care sites, medical history questionnaires, online interaction between patients and physicians or care managers, and the enhanced use of pharmacists could lead to the majority of routine primary care being provided outside of physician visits. Moreover, the same technologies could be used to improve health behavior and self-management.

All of this might mean better care at a lower cost while allowing primary care doctors to handle far more patients than they do now. Of course, precautions would have to be taken to ensure that physicians were kept informed of patients' health status and all that was being done for them. Also, some patients might miss the face-to-face interaction with their physician. But going online might be preferable to the current system, in which it can take weeks for a patient to get an appointment with a doctor.

The other conclusion that emerges from this discussion is that we should not ignore older technologies, even if they have not been widely adopted. In some cases, clinicians may not have been embraced these approaches because of externalities such as reimbursement methods. In an era when reimbursement and the entire structure of care delivery are rapidly changing, earlier technologies may be worth reconsidering. - Ken

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