Monday, November 30, 2015         


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Shift to e-health records must keep human factor

By Ira Zunin


Apple pulled off the ultimate IT coup. On the heels of the iTunes revolution, which put iPods in our ears and a spring in our step, we got the iPhone, actually a mobile computer that gives us Face Time. We can "just Google it" to get whatever, whenever. And of course, with Facebook, countless friends unbound by space or time. Why is it taking so long to stop killing trees for patient health records?

The good news is that electronic patient health records are finally becoming the standard of care. Hawaii Medical Service Association moved many physicians off the fence with its HI-IQ initiative that, until this year, partially subsidized qualified vendors to take the bite out of installation. Hawaii Pacific Health has begun to invite providers to join its "EPIC community." The federal government has begun to brandish both a carrot and a stick. Starting next year, Medicare will offer incentives for clinics to establish meaningful use. When the incentives expire, the penalties will begin.

Benefits abound. With their consent, patients can share electronic health records during an emergency visit or when seeing a specialist in a different network. Providers can send laboratory and pharmacy orders without using their illegible handwriting and consultations come straight to the in-box. All this stands to improve response time for necessary care, minimize medical errors and reduce wasted resources for duplicate tests.

Many systems offer a patient portal to review medication lists, check on selected laboratory results, ask questions and make appointments. All this serves to empower individuals to play an active role in their care and to collaborate more effectively with their health providers.

Is there any trouble in paradise? You know there is. I have seen numerous patients request a change of physician complaining that: "My doctor used to engage me during my visits. Now he just looks at the computer screen." The practice of medicine can suffer when providers begin to push buttons from preset, pull-down menus to document a patient encounter rather than write out their impressions and recommendations.

Another sticking point is that electronic patient health records also make it much easier for payers to monitor clinical activity to ensure that providers abide by standards they establish. In most cases, that's a good thing. Yet, though commonly evidence-based, these standards focus on the health plan's bottom line, not the welfare of its individual members. That is the role of the physician. However, the more cookbook health care becomes the more we risk the heart and soul of medicine.

Health care in this country consumes more than 17 percent of the GDP and is projected to reach 20 percent of GDP by the end of the decade. We continue to spend more on health care per capita than any other country in the world, yet these dollars are not justified by outcomes.

While the Affordable Care Act of 2010 ensures more secure access for many, America still has not addressed one of its most vexing problems: People want unrestricted, direct access to high-quality health care at a reasonable cost. As a country, we have not come to terms with the fact that we can't have it all. On the bright side, electronic patient health records will definitely help as they enhance efficiency and reduce waste. Still, moving forward, we cannot allow electronics in medicine to overcome its greater purpose. All concerned must guard against losing what we truly value, a doctor-patient relationship we can trust when it is most needed.

Ira Zunin, M.D., MPH, MBA, is medical director of Manakai O Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to

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