e-health, or 'me' health?

e-health, or ‘me' health?

I found an essay in the May issue of Harper's so compelling I gave a copy to everyone I know. Entitled "The Museum of Me," it is an insightful discussion of the role the Internet is playing in our lives and what the long-term implications might be. Among other things, the author discusses disintermediation—a concept I was not familiar with but found very relevant to something that has been bothering me about the whole e-health phenomenon: that the Internet somehow empowers the individual (i.e., the consumer) by removing the middleman.

A seductive proposition, to be sure. Who hasn't been annoyed by salespeople and telemarketers and advertisements on every surface and airwave imaginable? Who wouldn't welcome the opportunity to make unmanipulated information-gathering and buying decisions?

But how appropriate is this concept to healthcare? I attended the "Toward an Electronic Patient Record" conference in San Francisco last month and was struck by one of the meeting's central themes: the electronic health record. EHRs differ from EMRs or CPRs in that they are created and controlled by the patient/consumer via the Internet. It is anticipated that they will be linked to records residing at the doctor's office or hospital, thereby creating a broader record of a patient's health, well-being, and medical history.

In theory, the EHR is a step in the right direction. It does empower individuals to better care for themselves while still respecting their right to privacy. It also, in a time of managed-care restrictions, reduces the burden on the physician by placing more of that burden on the patient/consumer.

But do we really want to give up the middleman—the physician—in this case? Do we really trust that all these patient-centric Web sites and Internet services are not just profit-motivated opportunities to exploit the consumer, once again? As Ian Morrison points out in his book Health Care in the New Millennium, Americans often confuse choice with quality, and he questions whether, as healthcare consumers, we will ever have the power to achieve the level of quality we seek.

The truth is that I really want someone to tell me how much I should worry about the history of cancer in my family. I really want someone to tell me if 45 is too late to have another child. I really want a physician who can (and will) take the time to talk with me and address my fears and concerns in real time, face to face.

Some companies are already launching products designed to facilitate patient/physician interactions by eliminating a more ominous middleman: the insurer or HMO. Vivius, a provider of Web-based medical services, has developed a concept it calls the "personal healthcare system," which allows physicians to set fees, gives consumers the ability to create custom "physician panels," and doesn't require anyone to get approval for medical care.

The only problem I see with this approach is that more than one survey of physicians has found that many do not use or trust the Internet, nor do they have the time to become e-mail "buddies" with their patients. If the goal is to create a better bridge between patients and their healthcare providers, it may take a while for the doctors to catch up.