Idon't often quote George Bush, but he was right when he pointed out in a 2006 presidential discussion on health care that "doctors practice 21st-century medicine, but they still have 19th-century filing systems."
Patients often wonder, "How come the Instabank in Istanbul tells me exactly how much money is in my account, but my doctor doesn't have access to that test I did down the street last week?"
Many of you use a 21st-century filing system called Google, relying on its e-mail program or its maps to navigate your life. Now, Google is trying to help you track your health.
Last month, Google announced it is pilot testing its own electronic health record with up to 10,000 volunteer patients at the Cleveland Clinic. An EHR is a digital version or your personal medical record. These records exist, in some form, in the offices of some family doctors, hospitals and labs, but there is no common standard.
In a perfect world, an EHR would create a seamless pathway to share your health information across the continuum of care between your family physician, specialists, labs, hospitals and other health-care providers, no matter where they were located.
When I think of Google I think of simplicity, subtle advertising, "cyberchondria" (an Internet-induced fear of a terrible diagnosis) and cool innovation. When I think of Google in the context of an EHR, I feel both revulsion and attraction. On one hand, my inner conspiracy theorist worries about one of America's biggest corporations having access to personal medical data. On the other, the riddle of building a universal EHR has thwarted major corporations and governments worldwide and I can't help but think that Google stands a pretty good chance of creating an elegant solution to a problem I see every day: not having all the facts about a patient at my fingertips.
When we think of holy grails in medicine, we tend to think of cures for cancer and miraculous surgical recoveries. But for many experts in the Canadian health-care system, the biggest grail is a universal EHR.
Imagine a world in which I wouldn't be allowed to prescribe a medication for you that you reacted to 15 years ago; where the smartest pediatric neuroradiologist was looking at your child's MRI while held her hand in a rural emergency room; where health interventions could be measured in real time.
These things do happen to some degree now, but in isolated experiments and not in a networked or national way.
Google's EHR is in its early phase and won't make all of that possible, but it will start to organize your data from tests to X-rays to doctor's visits, and it will interface your medications with a database to let you know about any drug interactions.
Can Google translate its success in helping me locate the arena where my kid's hockey game is into helping you map your health history?
Michael Guerriere, managing partner of the Courtyard Group, an international consulting firm that helps institutions overcome challenges in electronic health records, also has mixed feelings.
"If you had asked a banker or a travel agent in the '70s whether it was a good idea that people enter their own transactions or book their own flights, most would have said no," he says. "Yet most industries today have been transformed by serving clients online and giving them hands-on control of their own transactions. Google and others are trying to apply this idea to health care, which is good. On the other hand, I believe health care is much more complex than these industries. It has taken 15 years to understand how to best display information to clinicians that is meaningful. The same might be true for the general public."
If the EHR makes so much sense, why isn't it a reality? The obvious answers are concerns about privacy and access, establishing a common language and overcoming significant technical challenges. But I know the real challenge: An EHR changes the culture of care. A lot of people would have to change their behaviour for it to work, from me taking the time for data entry when I already have no time, to you feeling okay with me looking at a screen instead of you while I transcribe your personal health concerns.
The idea of a shared EHR fits perfectly in a new era of patient self-management. I love the idea of looking at information with my patient as we make health decisions. Having said this, I tend to put what I think into the chart and I fear the reactions of patients to my comments. But perhaps these are good discussions to have.
Research shows that many users want to verify and correct their own medical records. This raises an important question: who is right about the content of your medical records, you or me?
With careful planning, these problems are probably surmountable in closed systems such as hospitals, large group practices and those focused on specific diseases.
But most care actually happens in smaller family practices, which raises the issue of financing such an initiative. An EHR isn't as sexy as a magnetic resonance imaging machine, and while significant resources are raised for hospitals and diseases, there is limited support for the trenches of primary care and for boring infrastructure.
All this explains why Canada Health Infoway, the national body pushing for an EHR, has set 2015 as a possible date to deliver. Google isn't going to wait (and neither is Microsoft, as it launched a similar product, HealthVault, in October, 2007).
In Canada, there are 2,000 health transactions every minute and 322 million office-based visits annually. Ninety-four per cent are done on paper. There is significant opportunity to improve this culture, and billions of dollars to be made in rendering health systems more efficient.
I often ask my patients what their Internet search says about their health problems. It turns out Dr. Google is often right, but sometimes wrong. Usually it's wrong when the patient wants to hear a certain answer.
A Google EHR adds a new dimension to Dr. Google, but my concerns remain. I can't wait to see what happens.