Guest Post: Do EMRs Cause a Mirage of Health?

This is a guest post by Ken Harrington, Practice Manager at the Washington Endocrine Clinic.

The smart phone (blackberry, android, iphone) is an icon of the postmodern age.  In my fingertips, I hold the power of the internet.  I can look up my e-mail messages in real time, search anything in the world on the web, and be socially connected to a world-wide community of people – all in the palm of my hand.  This concept is slowly being applied to medical records.

Many of the new EMR systems that are beginning to infiltrate into the physician’s office now allow patients access (even if partial for now) to their own medical record.  With a few clicks of the computer mouse, a patient can now access his or her labs, radiology, and pathology reports.  Even better, the EMR that we use at the doctor’s office in which I work will soon be available on the iPhone and iPad.  This will enable any of the patients in our office to login anywhere and have instant access to their medical chart.  No longer does a patient have to guess at what she thought the doctor said or didn’t say about her results – the patient can now have access to the official record herself.

This gives a patient a lot of new power over his own healthcare that he did not previously hold.  For example, now the patient can research online about cholesterol if his test results show he had an elevated level. Granted he still cannot write his own prescription for a medication, but he can educate himself and use that knowledge when he speaks to his doctor about the test results.  This is a game changer of sorts which will add the physician’s office to the growing list of other institutions that have become transparent in the postmodern age.

This is all good for the consumer/patient – right?  On many levels, it is.  Patient empowerment in the realm of healthcare is what doctors have been complaining about for years.  Theoretically, this should lead to the patient having greater control over the choices she can make regarding her healthcare.

To boost this empowerment, certain companies are taking all of this patient data and showing what the future could look like.  The particular EMR that we use is partnering with a start-up company called 100Plus.  100Plus is taking the data and filtering it through a computer algorithm to project what someone’s future health would look like if he did not make the recommended choices to improve his health.  A future projection might mean death 10 years earlier if he had not made the choice to start exercising and eating right when the test results began to show a problem.  The entrepreneurs behind 100Plus know they have a market-winning idea because, in the postmodern world, people want to take control of their reality, including their health, as much as possible. This is just one more way to gain a little bit more control.

But what really do you gain by having all of this control and power?  A recent news article described a doctor in California who offered himself up as a test case for a new personal human genome sequencing test.  This test would look at whether a person’s DNA sequence could foretell that the person would be more predisposed to certain diseases over others.  This particular doctor’s test result showed he had a strong predisposition in his genes for developing diabetes, despite that fact that he was in good shape and ate health-consciously. However, six months after the test results were reviewed, the doctor was diagnosed with diabetes.

This makes me wonder whether it’s possible to have ultimate control over one’s health. Will access to a patient’s medical chart cause them to make better choices – or any choice – to improve their health? One would think it would at least give them a leg-up on the limited choices their recent ancestors had and make life-changing decisions possible sooner rather than later. But sometimes empowerment leads people to think that they have ultimate control and can make all the right choices. I’m not convinced that this is the case. If it is built into my genes that I am gong to die of a disease that I cannot do much about, doesn’t this level of transparency simply cause me to worry about something I have no control over? I guess you could say, “Well, we will all die of something, and if we know what that something might be, then we might try to limit its damage with better choices now.” But, unless someone can actually change the direction of my genes, I might actually be quite limited still in what I know.

The same may hold true for open EMRs. If the patient is focused enough to make choices with the knowledge they now have on a 24/7 basis, will it cause their health to be any better? Maybe. But could patients’ thoughts that they have a growing control over their own healthcare (via knowledge of their medical records) also potentially lead to developing a culture of false security? In other words, will such thinking only lead to a mirage of health? For me, I think it might.

* Dr. West’s note: This reminds me of a book titled “Mirage of Health” by Rene Dubos, the famous microbiologist who wrote that mankind develops a false sense of security with the acquisition of technological advances over his environment.