Doctor-patient communication gets technical
By Priyanka Dayal TELEGRAM & GAZETTE STAFF
WORCESTER — At Dr. Lawrence Garber's office, a patient visit is incomplete without the patient, the doctor and one other thing: the computer.
They sit in a triangle. Dr. Garber, an internist at Reliant Medical Group, is at one point; the patient sits at another point; and the computer screen is the third.
The computer becomes a tool, Dr. Garber says, helping him explain how acid reflux occurs, for example, or helping a patient see how her cholesterol and glucose levels compare to normal levels.
When the patient goes home, she can log on to her electronic health records remotely, and if she has questions she can email her physician.
More and more, doctors across Central Massachusetts are communicating with patients through technology, from the low-tech email exchanges to high-tech smartphone applications that can detect medical problems. When used correctly, advocates say, technology can facilitate stronger patient-doctor relationships, leading to better, more cost-effective care.
Scott W. Disch, director of physician practice management at MetroWest Physician Services, said health care is going through a major shift, and that technology is the driving force behind that change.
“It is all about managing care,” he said. “The technology is driving us there. … The name of the game is going to be budget-based, value-based care.”
About 71 percent of Massachusetts doctors use electronic health records, though at different levels. Nationally 57 percent of physicians use electronic records, according to the Centers for Disease Control and Prevention.
Some of the electronic health records in use today include diagrams and glossaries that allow patients to look up medical terms, and graphs that show how lab results trend over time.
Matthew Adiletta, a Reliant patient, uses a smartphone application to view his lab results on MyChart, the system developed by Epic Systems Corp. and used by Reliant (formerly Fallon Clinic).
“Every time we go to the doctor, they take all this information — the weight, the height, the blood pressure,” said Mr. Adiletta, 47, who lives in Bolton. “In years past it was just a sheet of paper inside a folder. The very first thing I appreciated about MyChart is you can actually get that data back and chart it. It's really interesting to see the trends.
“You get to know yourself a little bit better.”
Reliant, which has used electronic health records for more than five years, allows all patients to access their records through the Internet. About 23 percent of Reliant patients have set up logins to access their records remotely.
St. Vincent Medical Group and MetroWest Physician Services, part of Vanguard Health Systems Inc., started allowing patients to access their records through an online portal just weeks ago. Patients can also request appointments through the portal. Vanguard uses electronic health records by athenahealth Inc.
“The goal is really to go as paperless as possible,” said Dr. Thomas Jaquith-Houston, a family physician at St. Vincent Medical Group in Auburn.
A 2011 survey by the IT industry group CompTIA found that just 15 percent of health care practices nationwide have Web portals through which patients can view medical records.
UMass Memorial Health Care Inc., the region's largest health care system, which uses electronic records from Allscripts Healthcare Solutions Inc., doesn't offer patient access to records yet. But a spokesman said it is working on developing a patient portal.
Still, some UMass Memorial patients, such as 25-year-old Joseph R. Skrzek, can see some of their data online.
Mr. Skrzek has Type 1 diabetes, which means he constantly monitors his blood-sugar level. He uses a glucose meter to test his blood. Then he plugs the glucometer into his home computer, where a program developed by MyCareTeam Inc. reads the data and sends it to his doctor.
Diabetes patients like Mr. Skrzek can see their readings at home, and their doctors can see the same information at the clinic. The data becomes embedded within the patients' electronic health records.
Mr. Skrzek said the process of uploading data has helped him become more involved with managing his disease. If he does a good job of entering his data, he and his doctor are able to fine-tune his treatment.
“It really builds a patient-doctor collaboration, which I feel is critical to proper diabetes management,” he said via email.
On a recent morning, Dr. David M. Harlan, director of UMass Memorial's Diabetes Center of Excellence, showed how the MyCareTeam program allows patients to view their data, through bar graphs, line graphs and scatter plots, over days, weeks and years.
“Unless the patient is involved, we can't do a good job,” Dr. Harlan said. “The patient is, by far, the most important player.”
When patients come to UMass Memorial's Ambulatory Care Center to see Dr. Harlan, they typically upload their glucometer data at the office, with help from medical staff. Dr. Harlan would like more patients to do this on their own. He's hoping to put computers in his waiting area, next to the magazines and flat-screen TV, where patients can enter their data before meeting the medical staff.
It's like the automated ticket kiosks at the airport, he said. At first, travelers were wary of using machines to print their boarding passes. But eventually that became the norm.
Researchers are working on other ways patients with various ailments can send vital information to their doctors. Dr. David McManus, a cardiologist at UMass Memorial, has worked with Worcester Polytechnic Institute to develop a smartphone application that can detect irregularities in heartbeats.
A patient places his finger on the phone's camera lens, then the app looks for subtle changes in color. Those color changes can indicate whether the patient's pulse is regular, or if he's experiencing arrhythmia. Then the patient can email the result to his doctor.
The app, which is still in the study phase, will be most helpful for people who have or are at risk of having atrial fibrillation, a common heart condition associated with stroke. Patients who use the app will be more engaged in their own care, Dr. McManus said.
“It's really novel,” he said, “because it doesn't require any extra hardware.”
And it's accurate. A study of 52 patients showed the iPhone app readings exactly matched readings from the electrocardiogram in the hospital.
Dr. McManus said an early version of the app will be available on the market in three to six months. But he wants U.S. Food and Drug Administration approval before releasing the full application. That could take time, because medical apps are a new area for the FDA.
Even with all the advances in medical technology, most patients still communicate with their doctors by calling on the telephone. But email — one of the earliest Internet-related inventions — is catching on as a communication tool with some doctors and patients.
In some cases, the email exchange leads to an office visit, but the doctor enters the exam room armed with preliminary information about the patient's problems. Other times, if a patient is having a minor problem, the doctor can resolve the situation through email, by suggesting treatment, or prescribing medication.
One-third of U.S. health care practices allow patients to email or text questions, according to the CompTIA survey.
One reason most doctors stay away from email is that they don't get paid for the time they spend typing to patients. Most health insurance companies don't count email as a billable service.
Dr. Eugenia Marcus, a pediatrician in Wellesley and chairwoman of the Massachusetts Medical Society's committee on information technology, was one of the first physicians in Massachusetts to email her patients. She started in the mid-1990s, when email was still a novelty. She believes email is a helpful tool, but she makes sure to spend the bulk of her time seeing patients face to face.
“Sometimes I could take care of something through email, but I choose not to,” she said, “because if I did that too often, it would make a big dent in the revenue.”
UMass Memorial's Dr. McManus said email can be a lot of work.
“Reimbursements for hospital visits and in-person visits are going down, so it's a lot to ask us to, on top of that, take on an unpaid activity such as email,” he said.
But Dr. Garber, who serves as Reliant Medical Group's medical director for informatics, said he doesn't mind spending time on email — or the fact that a few minutes spent on email could prevent an office visit.
“We're not trying to generate money by having people coming in our doors and giving them care that they really didn't need to come in for,” he said. “That's one of the problems with health care costs in general, that people are being brought in unnecessarily to see their doctors, and we don't do that.”
Reliant is upgrading its system this year to allow patients to email photos to doctors — photos, for example, of a funny-looking insect bite or a rash. Eventually, Reliant doctors will accept video appointments. But how they will charge for those virtual appointments is still undetermined.
“It's really keeping up with the way people are living now,” Dr. Garber said. “We're all busy. It's a different world, where time is important for all of us.”