A High Dose of Tech
"Some grocery stores have better technology than our hospitals and clinics." Tommy Thompson, secretary of health and human services
Not all doctors are as enthusiastic. About two thirds of doctors in national surveys would want to participate only if they were compensated, says Sands. The Beth Israel site doesn't charge for messaging capabilities, but that could change. (The Palo Alto Medical Foundation in California charges patients $60 a year for unlimited E-mailing.)
"Consumers have a right to know about their health," says Leapfrog's Delbanco. "That's why we are working so hard to promote a more transparent healthcare system, where we have as much information about our healthcare choices as we do about choosing a car or a dishwasher."
That's a theme heard repeatedly at hospitals that switch to electronic records and open them up to patients. At Palo Alto Medical, more than 25,000 patients now have 24-hour access. "In my mind, it levels the playing field," says Paul Tang, chief medical information officer, "so patients, not just their providers, are armed with information." He plans to launch a disease-management component on his site this fall to give diabetics specialized tools to help them monitor their own progress interactively--by, say, entering their cholesterol and glucose results. "It's one thing to be told your LDL cholesterol is 120," says Tang. "It's another to look at a graph and know what your target is."
Besides involving patients more directly, putting health records in electronic form makes patients safer. At Brigham and Women's Hospital in Boston and its many clinics scattered throughout the area, all patient records are electronic. A patient who comes to one hospital has her record available online at all of them. Perhaps an elderly woman from the suburbs breaks her hip and is taken to Brigham and Women's. The emergency physician calls up her records, says Robert Goldszer, vice chair of medicine, "and sees right away not to give her certain medications because she has a heart condition."
The University of Colorado Hospital in Denver experimented with the ultimate step in 2002, giving 54 regular outpatients at the hospital's heart center full access to their medical records, including clinical notes. Their behavior over the next year was compared with that of 53 other patients matched by age, sex, medical condition, and other qualities. Several physicians resisted, fearing they would have to censor themselves to keep from being E-mailed to death.
"Some of my colleagues may have felt a little threatened," says clinic cardiologist Gene Wolfel. "My philosophy is that these people should know what's going on . . . . If they don't understand something, that's an opportunity for dialogue." Moreover, the feared hounding didn't happen. The 54 patients sent their seven doctors a total of 60 E-mails over the next year, barely more than one per patient. At the end of the study, the 53 other patients got total access, too.
"America's Best" Plugged-in Hospitals
Last week Hospitals & Health Networks, a publication of the American Hospital Association, released its annual list of the "100 most-wired hospitals and health systems." Of the 100, the 38 below have additional appeal: They were also ranked in U.S. News 's "America's Best Hospitals" this year.
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