Monday, June 30, 2008

Good Technology, Bad Technology

When I pick up the phone, the friendly woman's voice greets me in Russian. Or maybe it's Romanian? Or Polish? Then she begins a long discussion about an upcoming medical appointment in the mystery language. I know this because she mentions my name and a local medical center in English. She calls about once a month, a glitch in some health care provider's electronic appointment reminder system.

Ah, medical information technology. I still can't decide whether I like it or not. At my daughter's pediatrician's office, I wonder why they're still using a giant, scribbled-over paper appointment book and paper folders to hold medical records. Then I remember that a shift to appointment scheduling software and electronic medical records could mean technology glitches like my periodic Russian phone calls and the imposition of a laptop screen between the doctor and me when we talked. On the other hand, I reason, it's incredibly useful when a doctor I'm visiting can pull up electronic test results from another doctor I saw recently. Yet this easy access is also creepily Orwellian. How many people, exactly, do have access to my medical information? And what are they doing with it?

Sometimes, medical IT practices can cause real harm. A recent article in JAMA analyzed how radio frequency identification (RFID) devices, used to identify patients and equipment, can also interfere with medical equipment used to treat and manage medical problems. My daughter and I received RFID wristbands when she was born, in order to make sure that no unauthorized person took her from the hospital. Could the wristbands’ signals have interfered with the lifesaving equipment used on the infants in the neonatal ICU down the hall? Possibly, according to JAMA.

As I sort through my own opinions about information technology and medicine, the technology marches forward relentlessly. At the moment, the Markle Foundation, a public/private collaborative studying IT, health, and national security issues and endorsed by WebMD, the American Academy of Family Physicians, Microsoft Corporation, and others, is analyzing the public/private world of digital personal health information in an age of many grievous privacy breaches. The foundation has developed privacy guidelines for health information and services that consumers use online. With care, I think, health care IT will improve, but only in the way that medicine improves: by trial and error, educated guesses, and unanticipated consequences.

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