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I think what all of this talk today
about the electronic medical record, Meaningful Use,
et cetera, et cetera, is a discussion about medicine.
The idea of the use of infor-- of tools
in the practice of medicine is not a new idea.
And one of the stories that we like to call on
when physicians or any others
are concerned about that this is in some way
no longer the mainstream of what we do --
there was an outcry at the turn of the last century
with the implementation of the stethoscope.
There was an outcry, saying this was a horrible miscarriage,
that this was interfering
with the contact between the patient and the physician,
that these instruments were the tools of the Devil;
they should be eradicated immediately.
Well, if you went up to any physician today
and said that the stethescope
that he has around his or her neck
is an instrument of the Devil,
they'd probably walk away laughing.
Just as, those days, that was
a traumatic change for our profession, the use
of information systems -- computers --
in the practice of medicine has been traumatic.
The evolution, however, of our understanding
that they are incredible instruments that can allow us
to not only probe new information,
have it available right at the point of care,
and not only extend our capabilities,
in terms of diagnosis and treatment,
but make up for any deficiencies or problems that we have
in terms of availability of the necessary information,
just in time, for the best care
that we can deliver to our patients.
And I haven't met a physician that doesn't want to deliver
the best care he or she can to their patients.
The use of the information tools
that we now have available to us,
and everything from little hand-held devices --
you know, phones -- to pads to our computers
are so vital to obtaining the necessary information,
not to provide just adequate care
or cross-check some drug interactions --
all of that is important -- but it, in fact,
can make the difference
between a life that's essentially destroyed
and one that can be incredibly productive and normal.
One of the things that in the very recent past
I was involved with
was an asthma disease management program
wherein the patient has to engage with not only compliance,
which is really a dirty word for a lot of folks,
because it implies that I just tell you what to do
and you just need to do it, and that's all,
but rather for the patient to engage in measurement,
of actually evaluating how they're doing
and watching to see which stimuli and which events
actually perturb their breathing,
and then keep track of that,
and either avoidance or modification of their diet,
lifestyle, or what have you,
in order to improve their health.
The idea of a patient having devices now
that can be used through their iPhones
and actually record all of that information
and then automatically transmit it to the physician,
the idea that if they're having an acute attack,
they can have a virtual telemedicine visit
with any clinician -- nurse or doctor --
in real time, these are not fantasy stories.
These are happening today.
And the notion of saying, "Well, I mean,
rather than tethering me and letting me live my life,
these new information tools
can allow me to be in better control
and actually communicate with what I need, when I need it."
These aren't stories that are
science fiction and someday will happen.
It's happening right now.
Participation in one's own health,
participation in one's own care,
transmuting the American model of saying,
"Me doctor, you patient,
and therefore, I have all the knowledge,
and you just come in because I have that,"
is archaic, is out of date,
and not only that, but we are ending up
spending more money than almost every other country,
civilized or otherwise, on the planet,
and getting much less for it.
We have to think different.
We have to use our brains in order to get out
of this rut we're in with regards to
more care is not better care.
And last but not least, I think the American public
and the medical profession
is realizing that no one has the corner on information.
It really needs to flow.
It needs to be ubiquitous.
It needs to be something that the patient can access
as easy as the physician
and, hopefully, better educate themselves
as to how to help themselves better, 'cause there is --
they're 7 by 24 by 365.
We're together for an hour every five weeks.
That physicians are not trained in medical school
in detail in the use of these devices
is unfortunately still more common than not,
so that's one problem.
But the other is that, if we belittle
the importance of this incorporation
of these information tools
into the armamentarium of medical practice,
then we continue to make physicians feel,
"Yeah, this is below me.
This really should be my clerical staff,
somebody else, anybody else but me,"
while, in fact, quite the opposite is the case.
When a, for example, a drug interaction
is a potential in ordering a list of medications,
as I'm ordering, why wouldn't I want to know that
before I finish writing it or typing in
the information for ordering those medicines?
Why would I want to wait to see what happens with the patient?
What if there is a reaction that occurred ten years before?
You forgot, but the record is there to be used
for safety and quality.
What if there's new information about diagnosis or treatment
that is superior to what I -- my routine had been,
and because of my poor memory, you know,
I didn't remember everything about that every single time?
Physicians know they're human, too.
With these tools, we can basically transfer medicine
from anecdote -- from memory-dependent --
to latest care, safe care, and hopefully, God willing,
go to the next level in saying, "This is where we really
do need research and new science applied."