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Don't get mad, get connected


Memo from The Connected Physician editor

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"Serious and widespread quality problems exist throughout American medicine." That's what an eminent panel appointed by the Institute of Medicine said in 1998—more than a year before the release of the IOM's now-famous report on medical errors.

It's easy to blame this mess on doctors. But those who do so are missing the point. Physicians, as you know only too well, are hampered by an increasingly chaotic health care system. You're struggling to make diagnoses and prescribe treatments without adequate information—sometimes without even a patient chart in hand. You're forced to waste huge amounts of time on paperwork demanded by managed care and government. And to prevent your practice from being overwhelmed by ever-higher overhead and ever-lower reimbursement, you must see more and more patients every day.

In this context, the dawning of the Internet era in medicine should be viewed as a blessing. The fast-developing online connectivity with payers, for example, will relieve physician offices of much of the labor-intensive work and expense of communicating with health plans by phone, fax, and mail. As the story "The big payers: They want you online now" explains, getting connected also promises to reduce the length of time it takes to get paid and the number of claims that are never paid.

Web-based connectivity can help you in your clinical work, too. While only a small percentage of doctors are using the Internet in patient care today, that number will rise rapidly as more physicians gain the ability to hook up online with hospitals, labs, imaging centers, pharmacies, and other medical offices.

Up to now, little of this capability has been available to most doctors. Even if your hospital allows you to link your desktop computer to its information system over a dedicated phone line, the connection is usually clumsy, often requiring separate logins and passwords to enter each of the hospital's many databases. But as Howard Larkin demonstrates in his article about the University of Michigan Health System, these barriers are starting to disappear as hospitals unite their fragmented information systems through the Internet. Combined with online visit notes and consultant reports, the data form a very useful—albeit incomplete—electronic medical record.

Many health care systems and large group practices have built their own intranets—internal communication systems that use Web browsers to link computers on a local or wide area network. While these secure globules in cyberspace seem to offer a natural avenue for transmitting medical data, physicians aren't using them very much because most systems don't provide valuable patient care information. Greg Borzo's story profiles one group, the Carle Clinic in Urbana, IL, that's trying to make its intranet more relevant to doctors by combining it with an electronic medical record that pulls together data from hospitals, labs, and physician offices.

Intranets, virtual private networks, and other secure messaging systems also allow doctors to exchange clinical information with each other over the Internet. At its most basic level, this connectivity enables primary care physicians to zap medical records to consultants and get progress reports back. But as Lauren Walker reports, it can also give doctors who are caring for the same patient a global view of that individual's problems, medications, and lab results. It's the kind of shared knowledge that can save lives.

Last but not least, a growing number of physicians are using the Internet to communicate with their patients. Security and liability concerns, however, make many doctors hesitant to exchange e-mail with patients. Deborah Grandinetti, in her piece, examines secure messaging systems and explains why some health plans and health care systems are promoting them.

By now, you may be thinking, "It would be great to cut out administrative hassles by using the Web. But why should I change how I practice if it's worked well for me and my patients all these years?"

Your practice style may produce excellent results by comparison with those of your peers. But, however good a doctor you are, you're not really playing with a full deck if you can't access the latest lab results, medication lists, or drug information on a handheld or laptop computer in your exam room.

Also remember that consumers are using the Internet to take charge of their care as never before. Not only are they educating themselves on their conditions, they're also taking advantage of the services offered by countless consumer health sites and disease management vendors.

In fact, as Molly Joel Coye of the Institute for The Future suggested at a recent disease management conference, a lot of visits to your office will eventually be replaced by Web-based monitoring, dosage adjustment, and patient education. Doctors will always be involved, but their roles will change. And those physicians who embrace the possibilities of the Internet will have the edge in adapting to this new world.

This supplement is intended to help you get up to speed on electronic connectivity as it affects your administrative tasks, clinical work, and service to patients. Whether you're already using the Internet in patient care or just getting your feet wet in the Web pool, read on and learn how to get connected.



Ken Terry. Memo From the Editor: Don't get mad, get connected. Medical Economics 2000;22.

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