A doctor on the Upper West Side of New York City can instantly compare his patients’ data in-practice – and across hundreds of other private medical practices in New York City. We read this week in the New York Times that there are nearly 1,000 primary-care physicians giving up their pens in 2008 to collect patient details in a database as part of a $60million city health department project. Pretty cool.
To those of us with diabetes, especially those with type 1 and very used to downloading meters, pumps, and other devices to share data for doctors to log and keep and track, it seems simple. But a couple of years ago it wasn’t so simple – time has been on our side and we’re finally looking at numbers more. But if you think about it, to get a city wired, it takes a large amount of capital, government backing, willpower, and an agent of change to get primary-care physicians into the 21st century and using electronic medical records.
Apparently, this is the most ambitious government effort nationwide to harness electronic data for public-health goals like cancer screenings or disease frequency. If you’ve heard about Google’s attempt to monitor and predict flu trends, this system is predicted to better Google’s efforts in tracking the flu and other outbreaks of diseases.
We’ve considered before that it’s hard for doctors to change from the tried-and-true methods to new, innovative ways and means to control or manage diseases such as diabetes. So what’s the benefit to these doctors? The NYC health department will soon offer bonuses of up to $100 per patient who hits target goals up to $20,000 for each doctor. Before we get too excited about doctors jumping on board, however, note that a typical doctor’s office must pay $45,000 to implement (city subsidies will reduce that to $24,000 for practices with min. 10% of patients on Medicaid or uninsured; those in high poverty rate neighborhoods pay only $10,000). So, the system aims to help doctors achieve positive results in patients and increase preventative measures. Hopefully, there will also be some peer pressure as doctors notice their peers improving in terms of diabetes management for their patients.
Why is this system so special?
We’re really excited about the possibilities this has for diagnosing diabetes, keeping more patients on track, and helping doctors stay on top of the myriad of checks and balances needed for regular checkups (remember, a lot of people are diagnosed routinely by their PCPs). This will help “less experienced doctors” handle medical problems by flagging unusual results, advising appropriate treatment and/or medication, and can warn of potentially dangerous drug interactions. Sounds like a winner to us!
The new system gets even better – it can remind doctors to check and see if patients have filled prescriptions (that doctors send electronically to the pharmacy). We’re excited about the possibilities this can bring for patients with diabetes. Perhaps one day the system could remind doctors to look for patients’ emailed pump/CGM data in their inbox to review after a week, to see if the implemented changes and adjustments to management were effective – though we’re careful to say, that unless there is reimbursement for this, it can’t happen, since as it is, most endocrinologists and diabetes educators are toiling away long hours without being paid. We need more systemic change on this front, that’s for sure.
Also, what about the patient side? Wouldn’t it be great for patients to be able to log on and see our records over time? We could use a simplified dashboard version to see changes in A1C; our kidney function tests; our cholesterol levels, blood pressure fluctuations; and other diabetes data we forget about in between three month checkups.
Unfortunately, only five (five!) doctors in this exclusive group have agreed to allow patients to check their data and access the system from home. We were initially surprised, but not so much after we remember this is a group of primary care physicians who may be worried about delivering “bad news” over the Internet versus by phone call or a follow-up office visit.
There are always improvements to be made, and we see patient access as the next set of improvements to this innovative system. The possibilities are endless, from providing ‘report cards’ to doctors; tracking effective preventative measures; more easily targeting at-risk patients for various diseases; and empowering patients to take charge of their health. Here’s to New York for leading the way in the US once again…
-by Dana Lewis and Kelly Close