Vik and Al's post on THCB was e-mailed to me this AM with a request for a comment. My reply:
I completely agree. And I completely disagree.
I agree with Zeke (and the research he cites) that the "physical exam" is useless. Indeed, when I was a full-time family physician, I would refuse to discuss/schedule an "annual physical."
But Al and Vik have conflated the "annual physical" with a proactive interaction between a care provider and an individual. Notice that I didn't say "physician" (it need not be a physician) and notice that I didn't say "patient" as we need not think of ourselves – all of us – as flawed or "in need of care" in some way. We're individuals and not patients.
But planning our health, just as planning our finances, or planning our home/car/helicopter maintenance schedules sometimes requires the assistance of a person who has more training or expertise than the individual.
Appropriately managed, this is a regular event, which adds value as the foundation of a trusting collaborative relationship between an individual and a member of a care delivery team.
Just as we needn't gather evidence that parachutes save the lives of humans who fall out of airplanes, we needn't gather evidence that this relationship is important. Yes – text messages, e-mails, activity trackers, wifi scales and video chats are all appropriate adjuncts for the (ideally rare) face-to-face interaction. But they're adjuncts. Not substitutes. We do need time together because we're humans. A physical exam? No. of course not. A "check-in" every year or three? Absolutely.
It’s time to stop calling them EHRs. Yes – we also need to stop calling them EMRs. In 2011, ONC discussed the difference between the two terms, but I think that conversation missed the point: whethere it’s “medical” or “health” that is the focus, these aren’t (shouldn’t be) RECORD systems at all. We need to expand our expectations from CRUD to something that we really need: smart tools that help us collaborate toward improving health for individuals. In November, when I floated this concept, I was teased (corrected?) for focusing on terminology and missing the point that we need EHRs to do more than just store data.
But it’s more than just terminology. Our words mean a lot. A “record” system is for storage of records. It saves information. Our expectations will always focus on storing and retrieving information. That’s the core of the design. But in other industries – we’ve seen migration from information store/retrieve to intelligent platforms that anticipate our needs. Does storage occur? of course it does. But storage of information is the byproduct of collaboration and not the goal.
Let’s call it health IT – or even better – “IT for health.”