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8 Responses

  1. Mary Dexter
    Mary Dexter March 8, 2011 at 6:25 am | | Reply

    No,we don’t have coordinated care: we have people mumbling “not my job, man.” And, unfortunately, all the new technological advances can’t overcome the fact that many on the “team” are terrified or abhor technology. They don’t like computerized records (my last opto ranted the whole time he was with me), and they don’t want to learn about pumps or even meters, forget about CGMs. A prescription pad and a pen are their comfort level, plus the mantra: Stop eating so much. That way, whatever happens, it’s not their fault. Too often, they protect themselves and their colleagues. We are on our own.

  2. kdroberts
    kdroberts March 8, 2011 at 6:41 am | | Reply

    I think the HITECH act will go along way to helping get coordination of care to a good place where it’s timely, accurate and actionable. The reality right now is there just aren’t enough people in the workforce who know about healthcare centered IT and how to use technology to do all this stuff that’s possible but successfully integrate it into healthcare providers workflows. It’s one thing to have the technical knowledge to to put systems together and one thing to know the medical side and practice workflow but merging the two together is very, very difficult given the limited time providers have to learn and use a system on an ongoing basis.

    PHR’s are a great way to have some sort of medical record portability but since the emphasis is on the patient and they usually don’t have access to a full medical history the record is often very incomplete.

    What happens remains to be seen but there are a lot of boffins spending a lot of time figuring it out and many, many more people being trained to help with the design, implementation and support. It’s exciting times and so far it looks like the right paths are being taken, but it is a massive leap into the unknown.

  3. Leighann of D-Mom Blog
    Leighann of D-Mom Blog March 8, 2011 at 9:15 am | | Reply

    I can’t even e-mail our CDE/endo a PDF with the past month’s BG’s.

    I have to FAX…so 80′s!

    And so frustrating!

  4. tmana
    tmana March 9, 2011 at 8:59 pm | | Reply

    Issue: Many people don’t trust Microsoft Health Vault or Google Health to keep their medical information private from (current or potential) employers or purveyors of snake oil. There was a lot of discussion about this on TuDiabetes about the time Google introduced their product.

    Issue: People don’t trust that online PHRs are safe from hacking, data theft, or medical identity theft.

    Issue: Patients want the ability to annotate their medical records and have incorrect records removed. Perversely, this would include the ability to remove from that record the very information that would make it valuable to a professional treating that patient for the first time, or for health researchers looking for trends and large-scale information.

    Issue: The best use of online data repositories is not to benefit an individual patient, but to mine the data for public health information. This requires a level of (read-only) access to personal medical data that scares many individual patients. Depending on the results of the data analysis, blind tagging of the information back to the (anonymized) patient could result in suggested changes to a patient’s care regimen with which he is uncomfortable or to which he is resistant.

    That said, I have recently purchased a sphygmomanometer that has a USB connection that only works with Microsoft Health Vault. I find this counterproductive as what is important is the ability to upload the data to the health-related program of a given user’s choice, such that the data can be analyzed in ways that make it more likely for said user to manage and improve his health.

  5. kdroberts
    kdroberts March 10, 2011 at 9:21 am | | Reply

    @tmana

    All the issues you raise are being addressed right now. The main problem is that a PHR is just that, a patient health record. It’s designed solely for use by the patient and it relies on the patient to keep it up to date and accurate. They were never designed to be used by anyone other than the patient and people who they felt needed to look at them. There is a huge movement to figure out the best way to merge PHR’s with the provider based EHR’s in order t get a portable and comprehensive record. There is also a big push for health information exchange and a universal format that will allow patients to easily authorize data exchange between different systems with different authorization levels.

    The point you raise about data repositories is interesting because it’s being done and has been done for a while but all personal identifying information gets stripped out and only aggregated data is used. I guess it kind of started with using realtime data for syndromic surveillance (like the CDC’s BioSense) but there are companies who are developing systems that would take historical data and analyze it for trends. Explorsys (www.explorys.net) is one I know a little bit about and they are doing some pretty exciting things.

    Privacy and security are always going to be a concern but there are some pretty good legislation out there saying what can and can’t happen and what will happen if a breach does happen. The security and privacy of HIPAA was recently tightened with the HITECH act and some of the penalties are pretty harsh, like having to notify all local media outlets if more than 500 people are affected on top of all the other fines.

    The world of health information technology is absolutely massive right now and most of what’s going on is not really reported on so you more or less have to look for it. It’s early days really but the future looks pretty exciting.

  6. Don Riker
    Don Riker March 12, 2011 at 6:15 am | | Reply

    Better coordination is desperately needed not just for diabetes, but for all chronic conditions. There’s so much to overcome – the fears others have outlined as well as the silo mentality in medicine and the “run today’s patients through the schedule production line” treadmill most physicians use to stay profitable. I’d love to see the Mayo Clinic, which was founded on the team cooperation model, provide the kind of tools needed. They have done a fantastic job of using technology to keep all doctors linked so they can stay informed and work together on behalf of their patients.

  7. Kevin
    Kevin March 13, 2011 at 12:28 pm | | Reply

    The dream has been in place for a long time in Texas and to your credit Amy, you reported on it a couple of years ago. It’s called Diabetes Housecall and it is an advanced endocrine practice by Stephen Ponder. He sees patients up to age 35 from all across the State of Texas and relies on my company to use technology in the coordination of care including simplistic tools that collect data and educate patient-centric teams.

  8. natalie mcmahon
    natalie mcmahon June 15, 2012 at 1:34 am | | Reply

    MORE STICK FIGURES!

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