So the iPhone has finally made a leap in technology that makes every physician all a twitter, in the old sense of the word. The iPhone now runs a gorgeous and practical version of a medical application called Epocrates.
Epocrates embodies what is great about technology. It makes technology let you be a better doctor and be more accessible to your patients in the here and now of an exam room. A doctor using Epocrates can look up any medication, brand or generic, find out adult dosing, pediatric dosing, contraindications, drug interactions, adverse reactions, even standard cost information, and my favorite, what size pills the medication comes in. In my office I can sit face to face with a patient and quickly look up any or all of this information on my PDA. I love it. My patients love it.
iPhone went from not previously compatible with Epocrates, to one major leap better. Now with an iPhone, Epocrates can show you not only what a pill looks like, in typical gorgeous apple graphics, but also can enable you to take a pill in front of you of unknown content and look up what it is. Got a green and white capsule in front of you? You can look it up by shape and color and presto you know your patient is holding a Prozac capsule.
I tend to be a late adopter of new technology, but I used the "iPhone-cannot-run-Epocrates" as a reason to stay way from this lustful object. But now it does run Epocrates. So I am sorely tempted.
But will technology put my patients' privacy at risk?
I am a private practice psychiatrist. I practice out of network of insurance companies. So if you come to see me, you can pay cash and can pretend like it never happened. And some of my patients do. I am my own secretary. I do my own scheduling with my patients directly onto a paper calendar. I keep paper charts that I keep locked in my home file cabinet, so even a theft in my office will not get the thief anyone's charts. I answer all my own phone calls. I do not use email with patients. I do my own word-processing. I password protect all documents twice over that are patient related. You get the idea.
But I struggle with the potential conveniences of technology. To email about scheduling. To have an electronic medical record that would save my sore hands at the end of the day and enable me to print out old records for a patient instead of standing at a copier for an hour. Would I spend more time with patients and family and less time filing and copying?
Doctors who are 5-10 years younger than I am do not have this struggle. In the same profession, in similar out of network practices, they use Google calendar for their practice scheduling. They use electronic medical records for charting. They have all their patient information on their smartphones.
With an iPhone I could keep my work calendar and all my patient information in one place. I could have instant access to a patient's phone number and next appointment information when I check my messages and get one from someone who forgets when they are due in next. I could have their pharmacy phone number programmed in to call in their run out medication and prevent withdrawal symptoms when they call me for the refill but forget to leave the pharmacy's phone number.
But that information would be on a server somewhere in cyberspace.
Does it matter?
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8 comments:
First: who's Deborah Peel?
I just set up ePocrates on my iPhone. I could never get it to work on my Palm/Mac combos over the years, but oh, my, do I love it.
Since I'm not in solo practice, a lot of those questions have already been answered for me: we use a networked computer scheduler that accesses the network information system, and I have the hospital and hospice info accessible from my computer. So far my EMR (such as it is) is only on my laptop, and I print the notes out to be filed in a paper chart.
It's different for primary care, because so much of what we do involves keeping people on schedule for preventive care and following up on labs and making sure people keep follow-up appointments. We have 20 years worth of literature that shows us that we provide better care when we use computers to help us keep track of things. So it's a no-brainer for me.
Plus the iPhone is sooo much fun.
Deborah Peel, MD is the guru of patient privacy.
Her bio is on the patient privacy rights URL.
http://www.patientprivacyrights.org
Here is a link to an interview with her:
http://www.youtube.com/watch?v=DG13LWfzToM
She makes you think ...
I am not an expert on this, so this is just opinion. I suspect some of the technology is fraught. Some is probably fine.
Google don't have good privacy conditions, although so far they haven't abused it. I am happy to gamble with my own privacy, I don't think I would gamble with other people's. I think I'd use Google without real names.
You need to consider the balance of what is likely and by whom. If someone targets you, they will get the info regardless of where/how you store it.
Network the info at your office (on cable, no wireless) but keep it physically separated from any internet networks. That sort of thing.
In other words, you could probably improve your convenience without significantly compromising patient anonymity, but you would have to be cautious and sensible. You don't have a "standard" set of requirements to digitise your work life. I reckon you could find yourself a suitably privacy minded geek to help you optimise the convenience/privacy balance.
Thanks Ariane.
I will look into this.
Yes, if we were living in a totalitarian state, I'd be concerned if my shrink had any personal data on me accessible through technology. However, I can't imagine what state would be interested in what I discuss with my shrink...just mid-life ramblings of the average neurotic.
I'm a family law attorney with a smartphone and I have the same concerns. The way I've worked it is to ONLY synch my calendar to my phone. I don't usually have any info on my calendar beyond "Smith hearing 2:30 pm". But my address book in Outlook is full of privileged info, so I won't synch it. I suppose this is analogous to your ePocrates. What a cool tool that is.
You can password protect a phone, though, which is the way around this. I'd think both doctors and lawyers would satisfy a reasonable standard of care if we password protected our phones well.
But I don't want to have to log in to my phone every time I touch it! And I'm sure a phone password isn't the world's most complicated thing to work around...
I think these are such good points about technology. I care deeply about privacy but that can run quite counter to efficiency and high quality service in this era of advancing technology.
Ann,
Thank you for your comments. I think your work concerns do mirror my own.
Even as I used the iPhone as a symbol in my post, I do already own a smartphone in which I keep contact information, but not calendar information for work.
I not only password protect my smartphone, but also I hide the contact entries altogether for my patients' information. Much more and I start to go bonkers remembering passwords and spending more time doing that than caring for the patients.
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