Promises of a Universal Patient Record

Western medicine is oriented toward short-term treatments of medical conditions.

Recently, my sister-in-law died at age 56 of the many complications of type II diabetes, including kidney and heart failure. I asked the doctor whether her illness, and her ensuing blindness, could have been avoided. He said yes, if she had only taken better care of herself as a young woman.

A medical article I once read said that of 100 people who get hepatitis C, 20 recover on their own and 80 develop chronic infections. Of the 80 who develop chronic infections, 60 remain clinically well despite chronic infection, while 20 develop cirrhosis [1]. If patients with hepatitis C were tracked over their lifetimes and given proper care—with the knowledge of what lifestyle and environmental factors influenced hepatitis C—could these results be improved? If my sister-in-law was given preventive care for type II diabetes, could she have lived a healthier, longer life?

Besides identifying a patient’s medical conditions, a universal patient record could collect lifestyle and environmental factors influencing the health of the patient. The universal patient record would thus serve as a database to associate diseases with lifestyle and environmental factors. Patients could then be identified as having greater risks of a specific disease, with caregivers informing the patients of how the disease could be prevented. Patient care could then become more long-term oriented, preventing, as well as treating, diseases.

Western medicine is the province of physicians, often working individually in the care of a patient, who are usually restricted to work in one very specific geographic location of the world.

One billion people in the world lack even the most basic medical services [2,3]. A book, Where There is No Doctor, is a manual for village healthcare workers, informing them on how to give first aid and emergency care to patients and on how to administer public health to the community, such as educating the community on how to have clean drinking water [4]. The healthcare worker is taught to recognize conditions that absolutely need near-term care by a physician; a patient report document appears in the back of the book for a village healthcare worker to communicate a patient's medical condition to a physician. Could the patient report document of the village healthcare worker be automated to communicate it via handheld computer directly to a physician for review and identification of critical medical situations?

There are too few physicians in the world, too few nurses, and too few other healthcare workers. The world must make better use of all its healthcare workers.

An innovative Web site in India that makes specialty care available to a larger population is DoctorAnywhere.com [5]. It affords communication over the Internet between physicians caring for a patient and specialty physicians geographically located anywhere, including communication of x-rays and other medical documents. Could this communication of medical documents be enhanced by a universal patient record?

A universal patient record could foster team care of patients, serving as a communications vehicle about the patient and his medical conditions between caregivers and a communications vehicle over a long period of time between any one caregiver and any other caregiver (including the same caregiver).

A universal patient record changes medical care from only being short-term care oriented to long-term, preventive-care, oriented. It removes patient care from being the province of the single physician to that of the responsibility of many different healthcare care providers, possibly located anywhere in the world.

With a universal patient record:

· Communication between caregivers of all types would be enhanced, whether the caregivers worked on a single treatment for a patient, over many treatments for a patient (say for a chronic condition), or over a patient's lifetime.

· There would be a single patient medical record, rather than many fragmented ones.

· The lifestyles and environmental conditions that resulted in diseases could be better determined as a result of a research database derived from universal patient records. There would be greater emphasis on preventive care—patients could then be told how they could prevent diseases before they occurred.

· Healthcare workers would work across borders and provide healthcare even when they were located remotely from the patient, or remotely from each other. There would be greater sharing of information on uncommon and emergent diseases.

· Healthcare would become more universal and less costly.

Would there be untoward effects of a universal patient record?

Do we risk loss of the personal contact between the physician and the patient? Do we risk overworking physicians or having them lose their prestige? Would healthcare suffer for the people who can afford the very best healthcare? Would there be enough financial incentives to bring healthcare to the underserved in the world? Would other factors, such a patient privacy, doom the effort to produce a universal patient record?

Can such a universal patient record revolutionize patient care? Or must patient care be revolutionized first to make use of a universal patient record?

All things change, with foresight they improve.

References

[1] Harvard Medical School, “Hepatitis C: The Silent Epidemic”, Harvard Men’s Health Watch, Vol. No. 12, July 2000.

[2] Pilar Franco, “HEALTH CARE: One Billion People Lack Medical Services”, World News, Inter Press Service, June 9, 2000. Visit websites http://www.oneworld.org/ips2/june00/23_41_126.html and http://www.ips.org.

[3] James B. Mayfield, “CHOICE Village Health Program”, Oct. 5, 1996 at website, http://library.wustl.edu/~listmgr/devel-l/Oct1996/0076.html.

[4] David Werner, Where There is No Doctor: a village health care handbook, The Hesperian Foundation, Fifth printing, April 1999.

[5] http://www.doctoranywhere.com.

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