While only a healthcare provider is actively encouraged to interface with an electronic health record (EHR), patients of all kinds—and rheumatology patients in particular—are increasingly getting the chance to participate in their care using all things electronic: pads, portals, kiosks, and phones to make an appointment, renew a prescription, participate in research, or see a doctor remotely. The technological blue sky, it seems, is no longer the limit.
Telemedicine
One key aspect of this brave new medical world is, of course, telemedicine. In the vanguard of the push towards widely available telemedicine is the state of Georgia, where the Georgia Telemedicine Network (GTN) was launched in 2004.
“The goal was to link rural patients with tertiary healthcare providers,” explains William McClatchey, MD, a rheumatologist at Piedmont Physicians Group in Atlanta. The problems of rural isolation and a lack of specialty care are of particular concern in this state.
Since its launch, GTN has spread its coverage to many parts of the state. “At the present time, if you are in a remote area and you have RA [rheumatoid arthritis] and your doctor is 20 miles away in the county seat, that doctor can get you into a room in your own community, many miles away from me in Atlanta, and we can all have a face-to-face electronic interchange about patient care,” says Dr. McClatchey. This virtual consultation brings the specialist to the patient.
Patients, understandably, are thrilled, and Dr. McClatchey is, too, for the most part, although there are trade-offs. “I do miss the hands-on,” he says. “There’s nothing quite the same in the surrogate experience, even though there has been a lot of technology applied to the notion of telecommunication—the electronic stethoscope and such—but in terms of feeling a swollen joint … I don’t know anybody that has figured that one out.” Yet on the upside, labs and imaging studies can be ordered and a course of treatment determined, all without the patient leaving their rural community.
Patient participation in electronic medicine can seem to be fairly passive (i.e., try to sit still for the web cam). That perception underestimates the potential role of patients, which can be very active, as described by Dr. McClatchey. In addition to being a rheumatologist, he has served for the last 15 years as the chief medical information officer for a healthcare organization of six hospitals and 450 associated physicians. In this capacity, he has implemented an organization-wide EHR system for providers, and enabled patients to access much of the information through a secure web-based portal. McClatchey sees this innovation not so much as proficient e-medicine, but as good customer service. “Our current proprietary system allows our patients to schedule appointments, get the results of studies—labs and imaging—renew scripts, and have a narrative with their providers,” he notes, all with assured privacy behind a secure firewall.
