Eric Topol, MD, Chief Academic Officer of Scripps Health, Editor-in-Chief of Medscape, and author of the “bible” of digital health, “The Creative Destruction of Medicine” joined us on camera to talk about the results of the recently released (September 2014) WebMD/Medscape Digital Technology Survey about doctors and patients perceptions of digital health technologies. The survey found that sometime docs & patients see eye-to-eye and sometimes they do not.

 

How was the survey done

Topol bookThis is an interesting survey because doctors and patients were asked the same questions during almost the same time period. The consumer survey was done via WebMD, one of the leading providers of health information services for not only consumers, but also physicians and other healthcare professionals as well as other stakeholders such as employers and health plans. The survey was available on the WebMD site from August 20-27, 2014. All site visitors has an equal probability of answering the survey – and 1,102 of them did. The clinician survey was done via Medscape, an important source of clinical news, health information, and point-of-care tools for health professionals. The site serves PCPs, specialists, medical students, and other health professionals. According to a WebMD press release, the survey “was fielded August 22-September 8, 2014, via email invitation that included generalists and specialists. The occupations invited to respond were physicians, nurse practitioners, nurses, physician assistants, and medical students.” All had been active on Medscape within the prior 12 months. Of the 1406 clinicians who responded, 827 were physicians, 152 nurse practitioners, 85 nurses, 107 physician assistants, and 235 medical students.

 

And, the findings are:

  • 84% of patients said technology should be used by patients to assist in the diagnostic process compared to 69% of physicians. Further, when asked whether patients should be allowed to self-diagnose using technology without provider input, just 17% of physicians said yes. So docs are ok with patients using digital health tools as long as they are the ones to make the final diagnosis. [Check out Dr. Topol’s response to my support for do-it-yourself (DIY) healthcare in the video below – it mirrors this finding.]
  • 63% of both doctors and patients thought smartphones should be used for routine blood tests (when technology permits) and docs and patients also were more or less in agreement about using smartphones to transmit EKGs and rhythm strips. About half of patients thought digital health devices should be used to replace office visits for eye and ear exams compared to about a third of docs. When it came to skin problems, 63% of patients compared to 47% of doctors thought this was reliable enough to avoid a face-to-face visit.
  • Most doctors and patients thought that patients should be able to see their electronic health record and most thought it should not be limited to parts of the record that the doctors chose to share. [This is a pretty amazing change from the time when Eric and I were residents together at University of California San Francisco – then, there was no question, we owned the record and patients should not be allowed to see what we wrote…period…end of story.]
  • The next question is interesting because, taken literally, it implies that some of the information recorded by physicians may not be entered into the EHR. See below:

 

WebMD/Medscape Survey on Digital Health

 

  • 54% of patients say they own their medical records vs 39% of doctors who say they own them. Although there is confusion on the part of doctors and patients, but some medical associations are pretty clear that the records belong to physicians. Check this out:  The Texas Medical Association states, “Although the medical record contains patient information, the physical documents belong to the physician. Indeed, the medical record is a tool created by the physician to support patient care and is an asset of the practice.”
  • There is strong support among both patients and physicians for a patient’s right to see their lab and diagnostic test results, but the majority of patients and about 3/4 of physicians felt that physicians should review the test results before sharing them so that they would be able to discuss the results with their patients.
  • The majority of patients and doctors don’t view privacy and security issues as barriers to using digital health technologies for communication or for accessing and sharing electronic medical records.

There is many more interesting findings in the survey – including a discussion of the difference in responses between docs and medical students as well as nurse practitioners, nurses and PAs – that can be found via this link to the full survey results.

Patricia Salber MD, MBA (@docweighsin)
Patricia Salber, MD, MBA is the Founder and Editor-in-Chief of The Doctor Weighs In. She is also a physician executive who has worked in all aspects of healthcare including practicing emergency physician, health plan executive, consultant to employers, CMS, and other organizations. She is a Board Certified Internist and Emergency Physician who loves to write about just about anything that has to do with healthcare.

61 COMMENTS

  1. Thanks for highlighting these opinions on digital health. As a consumer, I want to take an active part in my care, and ditgital health tools informs and empowers me to help myself. I want the provider to be my consultant. I respect the provider’s role, and I see ditigal health tools helping me provide more accurate information to the provider on events outside the clinic. I view the patient invested in their own health and information, and who better to be the counter balance in this system of care.

  2. Pat,

    Great interview. Perhaps a recent (last week to be exact) experience puts this discussion about about “digital health” in a bit more perspective from an end users’ point of view. My wife had to be hospitalized on an emergency basis in Virginia for complications arising from a recurrence of her Lung CA. She was discharged (on a Saturday) after a week and we drove to MD Anderson Cancer Center in Houston, Texas which was our intended destination for a planned visit. While hospitalized, mMy wife signed up at the Virginia (Sentara) hospital’s patient portal so that she could access her records to take them with us for her doctors in Texas to see. Turns out that in order to access her digital records we had to drive/fly back to our home in California in order to open our snail mail to get the access code sent by the Virginia hospital so that we could then take them to Texas. We could of course missed my wife’s appointment in Texas and waited a week for medical records in Virginia to give us a hard copy but we chose not to wait.

    The other point I would share is that to date my wife now has 11 separate “patient portals” (and passwords to recall) from11 different providers (hospitals, doctors and health plans) none of which talk to each other and none of which actually provide any relevant/helpful health information clinicians can use to help my wife.

    While I applaud the enthusiasm of health care professionals like Dr. Topal for digital technology there is a huge gap between the promise and reality of HIT espoused by Topal and others. Open Notes might be great in concept but unless and until “other” treating physicians can 1) access and see them and 2) take the time to read them…I guess I don’t really see the point. At this point I would just be happy with a hard copy of a comprehensive Office Visit and Discharge Summary I can hand carry from one doctor to the next. I realize hard copies aren’t sexy or disruptive…but at least they work which is more than I can say for digital HIT.

    Stephen Wilkins, MPH
    Mind the Gap Academy

    • Thanks Steve, it is distressing to me that we are still struggling with jillions of portals all with different sign-ins and not linked to each other – but then, I think it reflects what is going on in our fragmented health care “system” in general. As a long time Kaiser Permanente member, I don’t have that problem – one portalt, all my docs use it, integrated with pharmacy ordering, lab results, notes, etc. etc. All my best wishes to you and your wife. Pat

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