Medical memoirs

 

In a talk he gave to a group of students and young medical professionals last year, Jay Parkinson said “communication is the crux of the healthcare industry”. That stuck with me. Information is constantly needing to be transmitted from one key player to another in the process of doctor notes, appointment confirmations, prescriptions, imaging files, and phone call diagnoses, etc. Yet one of the big challenges in healthcare is managing health records. Traditionally, there are a handful of companies that sell to over 90% of doctors and own the market:

 
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Most of these EHR companies optimize for being easy to bill patients, instead of optimizing for making navigating the healthcare system easy for patients. One example of this is that even though your primary care doctor and a specialist may use the same EHR (electronic health record) software, it’s still up to the patient to request an export of data from one doctor and transfer it to the other doctor. Another example, on a typical EHR it takes a doctor a couple minutes to bill a patient, and another 3-5 minutes to add something to a patient’s medical history, all while the patient is sitting in the room.

Shifting control

On the sidelines, there are a handful of companies now trying to reinvent this system. And what they are doing is really interesting. Instead of building software for doctors and competing with other EHRs, they are building apps directly for the patient, like a PHR (personal health record). This is a very exciting idea. In line with broadening access to wellbeing, it makes sense that people should be able to access and share their health records independently of a third-party company. And especially in difficult medical situations, that user experience needs to feel like magic. That’s why I like the term “medical stories” because one shouldn’t even realize they are building their own health records in the process of getting care and seeing doctors, it should happen “magically”.

Imagine a world where as you are walking out of your imaging appointment, you’ll get airdropped your scans so that you can seamlessly store them in your PHR with one tap:

 
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The Patient Side

One of the most painful moments in the patient experience is getting news back of a positive scan or an unexpected diagnosis, and then immediately getting hit with a question like, “Can you have your doctors send me…?”. The pressure of having to know all the details such as which doctors, imaging centers, blood tests, specialists, medications, etc. on top of treatment plans, dosages, and the stress of a medical issue is a lot. Telling and retelling this story is tedious, but perhaps having your medical memoir at your fingertips and being able to add to it feels empowering.

Theoretically, the more nodes that are part of network like Epic or Cerner, the stronger the network should be. However, what’s interesting is that the strength of this network varies for each patient depending on which EHRs their specific set of providers decides to use. Instead, what if patients could check some boxes and send necessary “packets of information” to their doctor ahead of time to answer basic questions such as family history, immunization records, and recent blood work:

 
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This would give doctors a chance to interpret and decide potential courses of action before the patient even comes in, without a patient having to get on the phone to transfer files or email the front desk of their previous doctor.

The Doctor Side

With this new model, the patient becomes more important because they have more control over their records. As a result, doctors will not be the target audience for EHRs, patients will. Besides having patient records be accessible, they also need to be easily interpretable. Usually doctor’s notes have the bare minimum and are a series of notes that only make sense to experienced health professionals.

Now, using technology, patients can record their medical conversations and technology can parse the important parts out for them (treatment plans, medications, advice, dosage, etc.). They should be able to reference and flag parts of their conversation to their doctor, and even click on doctor-provided links to credible reading if they want to learn more about something that was said in their appointment.

Wrapping up

Redesigning health records with the patient in mind takes away the need to have large consolidated systems of healthcare and third-party EHR software. Changing the venue of records to every patients phone means that patients will no longer need to ask for records or pay a third party to reach into insurance claims. This fundamentally changes the control dynamic between the health system and patients. Studies have shown that engaging patients in healthcare improves outcomes because a) they feel more ownership and b) there is more purposeful communication between provider and patient. I’m excited for this future.

 
Naomi Shah