The digital doctor’s visit: Enormous potential benefits with equally big risk

One out of at least 10 patients records doctors’ visits, usually on a cell phone; Apple recently released a new Health Records feature built into the Health app as part of iOS 11.3. No longer a wave of the future, researchers have analyzed the benefits of digital recordings of healthcare visits, the need to create a new model of health data ownership, and potential cybersecurity threats.

Dartmouth Institute for Health Policy & Clinical Practice, Science Daily May 14, 2018

While data privacy has been a much-talked about topic lately — with questions still lingering about how giants like Facebook and Google are sharing our personal information — much less has been said about how we are going to manage digital information about our health in the future, particularly digital recordings of doctors’ visits.

In an article recently published online in The BMJ, Dartmouth Institute researchers Glyn Elwyn MD, and Paul Barr PhD, together with patient co-author Sheri Piper, write about the enormous potential of digital recording to improve healthcare, as well as the pressing need to develop new policies on how to collect, manage, and store this data.

The evidence that digital recording is the wave of the future is indisputable, they say. One, or more, in every 10 patients has recorded a doctor’s visit, usually on a cellphone. A few health care providers and organizations around the U.S. are adapting a proactive approach by offering their patients the opportunity to record their visits.

For example, a neurological institute offers patients video recordings of their visits that are accessible via a secure website. Dr. James Ryan, a family physician in Michigan, has been offering to record visits with his patients since 2011. (The audio-files have been ‘tagged’ during the recording to help locate relevant parts of the talk). At the same time, tech giants like Google and Amazon are “racing to create systems” that use recordings of doctor-patient conversations as a means to populate electronic health records.

More than a few isolated ‘experiments,’ or even a trend, the authors say that recording the clinical visit will form the centerpiece of a health system evolution, with far-reaching implications for all stakeholders.

“A simple cellphone recording enables a patient to better remember important information or to share it with family members,” Elwyn says, “but ‘next-generation’ professionally produced recordings can be used to develop and further patient and family engagement, shared decision making, education, and research.”

Accurate digital recordings that can be automatically coded also have the potential to combat physician burnout, the authors say, by “bringing back some sanity to a clinical process that has become encumbered by data entry burdens.” Record-keeping or documentation currently accounts for 50% of a practitioner’s time, with much of it occurring after hours, disrupting family lives.

While the potential benefits of digital recordings are enormous, there are also serious implications for consent procedures, privacy, and cyber security, the authors say. Harvesting data from patient recordings of doctors’ visits could become a viable commercial prospect: Facebook has already declared an interest in health-related data, and DeepMind, a Google-owned artificial intelligence (AI) company acquired vast amounts of data from patients without their consent in a very controversial partnership with a London hospital. And, as of yet, there are no clear policies, let alone talk of regulatory or legal reform in this area.

“We’re going to need to create a new model of personal health data ownership, similar to banking records,” Elwyn says. “But, even if we did that, there are still implications for privacy and cybersecurity; and the question is do we want to leave that solely in the hands of for-profit companies?”

Source Science Daily

Digital clinical encounters, Elwyn Glyn, Barr Paul J, Piper Sheri. BMJ 2018; 361 :k2061  doi: https://doi.org/10.1136/bmj.k2061

Patients covertly recording clinical encounters: threat or opportunity? A qualitative analysis of online texts, Maka Tsulukidze, Stuart W. Grande, Rachel Thompson, Kenneth Rudd, Glyn Elwyn. PLoS One. 2015 May 1;10(5):e0125824. doi: 10.1371/journal.pone.0125824. eCollection 2015.

Also see
Shared Decision Making in The Dartmouth Institute for Health Policy & Clinical Practice
“What matters to you?” is at the heart of person centred care in The BMJ Opinion
Free digital doctor’s appointments available to Swedes at new clinic in The Local
More patients are taking home recordings of their doctor visits. But who else could listen? in STAT News
What’s Inside Your Medical Record? in UC SanDiego Health
Why in the World Do Doctor’s Offices Still Use Fax Machines? in Slate

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