I had a dream.

by francine Hardaway on May 23, 2005

I had a dream. In this dream, it is time for me to have my annual physical. I log in to my physician’s web site and schedule myself for an appointment. I look at my records to see what screenings I’m due for. He has sent me a reminder already telling me I need to have my cholesterol checked, but I want to be sure he hasn’t missed anything. The screen reminds me that I must fast for twelve hours before my appointment, and that I must wear loose clothing so I can have my treadmill test.

On the day of the physical, I log in to a kiosk in his office, swipe my insurance card, swipe my credit card for the co-pay, and sit down. There’s one woman at the front desk, but she is handling phone requests. No one needs to check me in.

Minutes later, I’m called in to the examining room, where the nurse hooks me up to the digital devices that record my vital signs. The table I’m sitting on weighs me automatically and enters my weight in my electronic health record, flagging the record with the fact that I’ve gained weight since last year.

When my blood pressure, pulse and temperature are taken, I say good bye to the nurse and wait for the doctor to come in. He arrives, having already read my chart in the hall on his tablet PC. He has seen the updates, and greets me with “so, you’ve gained four pounds. What’s up with that? Your BMI is now 26.”

I’m shamed. We look at my numbers on the screen. Now he says to me, “you know, you have normal blood pressure by the old rules, but by the new rules we’d like to get it lower.” I say I don’t care. He says,”look at this. You have a 15% of stroking out next year with this blood pressure. If you lower it ten points and lose ten pounds, see how it changes your risk.” A new scenario is on the screen, telling me it lowers my risk of dying to 2%. I decide to lose the weight and quit eating salt.

The doctor looks at all my numbers on all his screens, and compares my old tests to my new ones. Then he compares me to all his other patients, and to all the other women my age in his practice. Then he compares me to all the other women my age in Maricopa County. By comparison, I’m in pretty good shape. I want to stay there. We discuss how to make that happen. More exercise, less food.

An alert comes up on the screen. I’m due for a mammogram. He clicks on the computer and ends up on the Mayo Clinic web site, — where I have my mammograms. He presses a button, asks me when I want to go, populates some fields with the push of another key, and suddenly I’m getting an email alert on my Blackberry that I’ve been scheduled by Mayo for a mammogram.

We talk about my mental health, my back, my hip, and all the other minor stuff I have. He’s not rushed, and I feel like he’s really listening, not running off to the next room. He writes what I say on the tablet, and it comes out on the chart typed.

I get dressed and walk out of the office. On the way, I swipe my card again to pay for things that won’t be covered by my insurance. I also pick up a written copy of my prescriptions, which have already been emailed to my pharmacy. The written copy is just in case I go out of the country and need something.

It has taken me an hour less than usual to have this physical, because my doctor has gone to EHR (electronic health records) and has automated his office. I haven’t had to wait while they pull my chart, and wait again while he shuffles through it to find the last visit.

In the meantime, the doctor has cut his overhead by two people: the one who checks people in at the front desk, and the one who pulls and delivers the charts. He has accelerated his receivables by allowing online bill presentment and payment, and by putting the kiosk in his waiting room. For the first time in his practice, he’s actually MAKING money, instead of just shuffling it in and out of accounts. And he doesn’t have to dictate or write to the chart at the end of the day.

I told you it was a dream. But it doesn’t have to be. Last Saturday I went to a presentation given by some physicians who actually use all this technology, which actually exists. Why don’t they all? Cost, fear of change…whatever. But one of the presenting docs pointed out that in this day and age, he who has the data has the power, and there’s no reason why that shouldn’t be the doctor. All he has to do is be willing to collect it and look at it.

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