In the last decade, the digital revolution has impacted nearly every facet of our lives. From that, a new trend in medicine has emerged: patient-generated data (PGD), where patients can now seek and share their health, symptoms, concerns and personal information through connected devices. However, medicine as it’s generally practiced and taught today does not have a clear way to handle this new source of information.
With an impending tidal wave of digital health information coming from patients, how do we reconcile the importance and value of a meticulous clinical history? Does this type of technology threaten to replace certain important job functions, like taking an in-person history? Can data sourced from patients hold ground in a profession where the very skill of asking those questions is held in such high esteem?
It’s important to understand that the art of taking a medical history is one of the most romanticized elements of the clinical practice, right after the directed physical exam. Many of us will remember the countless acronyms from medical school to remember what details to probe from patients, such as OPQRS―onset, provoking/palliating, quality, radiation and severity of pain―or even learning how to navigate question-taking based on subtleties in how the patient responds or hesitates, and how we can identify and diffuse the “red herrings” that can so easily lead us astray. Can PGD really account for all these subtleties if it were to replace these skills?
PGD should been seen a surrogate rather than a replacement for an in-person history. It holds incredible untapped potential in its capacity to improve not only the access to and quality of care that patients receive, but it also has the ability to reduce physician burnout as well.
Though the physician burnout crisis cannot be boiled down one or two variables, it’s safe to say that the situations begs a reconsideration of how we approach the very idea of what it means to “deliver health care”.
For nearly the last decade, we have been working to simultaneously improve conditions for the patient and care provider alike through PGD. Working with health care organizations such as the Mayo Clinic, University of British Columbia and RebalanceMD, we have been able to rethink the form and function of a health record system―and created the Collaborative Health Record (CHR).Through this work, we learned three main benefits to PGD:
More efficient clinical encounters for all health care providers and patients.
Tools like patient questionnaires can be used to populate clinical documentation ahead of appointments. Depending on the type of clinical practice, this can mean a dramatic reduction in the amount of time spent on documentation for physicians. For example, in a preliminary pilot we did with the Department of Psychiatry at the Mayo Clinic, we found this reduced documentation time for psychiatrists by nearly 65% over 600 consultations.
Patients are more empowered, with better access to health care services.
With our current system, most patients are at the mercy of a fairly manual process―whether it’s triage, appointments or waiting at a clinic. This can result in a patient waiting until the problem becomes so severe that the individual requires immediate medical attention. By collecting structured information from patients, pathways for care can be tailored to a patient’s circumstances and can help monitor patients without necessarily needing an appointment. For example, a clinician treating a patient with depression could use weekly questionnaires to monitor them―and when their mood and quality of life scores trend down, they could react sooner with an intervention or booking a virtual or in-person appointment. Alternatively, if someone scheduled for a follow-up on their knee OA shows dramatic improvement in their pre-visit questionnaires, they might not need to come in for their scheduled visit, saving both the clinician and patient valuable time.
More holistic data to help with clinical decision-making.
Transformative technologies such as machine learning and artificial intelligence―which will undoubtedly play an increasing role in helping clinicians make data-driven decisions―are dependent on algorithms that are powered off rich streams of high-quality data. Most existing health data comes from EMRs / EHRs and other repositories of health information, where it is has been well understood that there is limited usability (without significant manual “data cleansing”) and a high frequency of errors. PGD means an additional step of verification may take place―the patient reports their symptomatology in digital questionnaire that produces granular, structured data, while the clinician reconciles this information during a clinical encounter.
In many ways, these are indeed tumultuous times to be a physician. In others, they are also incredibly exciting. With increasingly sophisticated tools in our arsenal, we have an opportunity to evolve and build entirely new models of care, increase access for more patients and deliver more efficient and data-driven care. Although it can seem like medicine has been threatened by technology over the past decade, we must recognize that we have a role to play in intelligently building and using these systems. While it will require a shift in how we practice and how we prepare the future generation of physicians in medical school, it will ultimately allow us to do the very thing that brought us to medicine―to provide the best possible care for our patients.
This material is for informational purposes only. It is not intended to be a substitute for professional medical advice and should not be relied on as health or personal advice. The opinions stated by the authors are made in a personal capacity and do not necessarily reflect those of the Canadian Medical Association and its subsidiaries including Joule. Feel passionate about physician-led innovation? Please connect with us at firstname.lastname@example.org.
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