Doctor-patient teamwork not quite what it could be


One of the oft-touted benefits of health IT is that – in theory, anyway – it will enable greater collaboration between doctors and patients.

But a new study finds that collaboration still isn’t happening to the extent it could be, and the reason may be that the technology isn’t ready to do its part.

According to this article, the study by the RAND Corp, which has been published in the February issues of Health Affairs, “found that health information technology still wasn’t adequate to help patients at eight locations participating in a shared decision-making demonstration project.”

The article notes that the study was conducted in 2009, just at the beginning of the current push for EHRs, but it claims that “in many cases electronic health records systems still don’t have the capabilities to help doctors and patients in shared decision-making.”

The article also notes that pointing exclusively at the timing of the study “doesn’t address two other barriers RAND identified: overworked doctors and a lack of sufficient physician training for such a process.”

As an example, the article notes that, according to the report’s lead author, Mark Friedberg, natural scientist at the RAND Corp. in Boston, “some EHR systems allow physicians to ‘prescribe’ decision aids in the same way they would prescribe medications. But the systems in the demonstration project were not set up to alert physicians to when a patient is a good candidate for a decision-making aid." Friedberg said that without alerts telling the physician which patient might be a candidate for shared decision-making, it’s up to the physician to remember to prescribe that aid.

To a certain extent, we’re inclined to think this study may be looking for definitive answers, or at least significant trends, a little too soon.  It is, after all, still quite early in the health IT transition, at least as it relates to federal programs such as HITECH.

On the other hand, the article’s author betrays a bit of a blind spot when it comes to how the necessary advances may finally take place.  Noting that the RAND report suggests that “shared  decision-making ‘may be an especially promising way to improve quality while avoiding unwanted and costly medical interventions,’” the writer then says “it’s unclear whether health IT vendors will have their own incentives to make systems capable of facilitating shared decision-making, or whether these capabilities could be required under meaningful use certification.”

Another possibility, we’d suggest, is that patients will put pressure on doctors who will in turn put pressure on health IT vendors.  That’s how markets are supposed to work, anyway, and all that may be required is a little patience.