The most recent Bentley Research Colloquium focused on Big Data and a broad range of issues and topics surrounding the topic. This series highlights some of the issues examined or suggested by colloquium presenters.
Cancer survivors need a plan to help them stay healthy. The medical community has made extraordinary advances in life-saving treatments, but when treatment ends many survivors do not know where to turn. Survivors have complex medical histories and follow-up care needs that require a great deal of coordination and communication. Survivors see up to 12 different health-care providers each year, but these providers often to not have easy access to cancer treatment information. We need better systems in place to facilitate communication between doctors and with survivors as they move forward after cancer.
The growth of electronic medical records holds promise as an efficient way to organize and share complex health records. These rapidly expanding computerized information systems hold incredible potential for health care, including helping to make survivorship care planning a common reality.
But first we must address public concerns about digital privacy and security — along with understanding how technology is changing the dynamic between patients and providers.
Over the past decade, the use of electronic health records in physician’s offices across the country has skyrocketed, from less than 20 percent in 2001 to 80 percent in 2013. On the whole, Americans are accepting the transition and trust electronic medical records. In 2012 data from the Health Information National Trends Survey, three-quarters of Americans were confident that safeguards were in place to protect their electronic health information. However, some anxiety about security remains. Nearly two-thirds of Americans report concern that an unauthorized person might see their electronic health information when this information is shared between health-care providers.
Nevertheless, only 12 percent of Americans reported ever withholding information from a health-care provider out of concern for the security and privacy of their electronic health data. Security concerns surrounding electronic medical records do not appear to be impacting communication between patients and providers.
The presence of electronic health records in the examination room introduces a different communication challenge. In a 2014 study, 23 primary care providers from U.S. Veterans Administration clinics took part in a study that examined the effects of provider interaction with electronic health records during medical encounters.
It may come as no surprise that physicians were rated as having less effective communication the more time they spent looking at their computer. Patient-centered care requires attention to nonverbal behavior, such as nodding and eye contact. Looking at a computer screen can get in the way.
In short, the rapid transition to electronic medical records has not been seamless. There is much work to be done in terms of educating physicians as well as patients about the nuances of incorporating electronic medical records into clinical care. Certainly there is much to be done to improve security and quality as we adopt digital.
Now let’s consider what it can do for us.
In the United States, we have approximately 14 million cancer survivors, and that figure will rise as the population ages and cancer survival rates increase. More and more people are living for many years after cancer treatment.
Much of my work explores how individualized care planning helps cancer patients after their transition from cancer treatment to survivorship.
As you can imagine, an ideal care plan would involve communication between the oncologist, primary care physician, other medical specialists and the cancer survivor. All these stakeholders would have access to the patient’s treatment history to inform future health decisions. Yet my research reveals only a small minority of providers creates such coordinated plans and provides them in written form to cancer survivors.
One of my recent studies involved a nationally representative sample of 1,130 oncologists and 1,020 primary care physicians. The results were stunning.
A strikingly low number of oncologists — 5 percent — provide a written care plan to the survivor and talk about follow-up recommendations with the survivor.
And primary care physicians rarely engage in discussion about follow-up care. Only 12 percent talked with survivors about care recommendations.
As these nationally representative data reveal, we have a long way to go in our efforts to improve follow-up care for survivors.
Electronic medical records offer real hope in this context. My research found that when primary care physicians received a treatment history and follow-up plan from the oncologist, they were nine times more likely to have these important discussions with cancer survivors.
Electronic medical records can facilitate this communication between providers. If all providers had access to their patients’ cancer history, it would bring us closer to making life-optimizing planning a reality for survivors.
We know that storing health data in digital form opens myriad possibilities. It can provide countless opportunities for research, play a pivotal role in drug monitoring, and allow for better tracking of important health indicators. Hopefully, it will also enhance future care for cancer survivors.
I’ve come to believe that we must weigh the possibility for important medical advances against security concerns. We must be aware that electronic medical records can act as a barrier in the doctor-patient relationship but that it can also deeply empower it. If digital health data is used the right way, there is no imagining the promise it brings.
Danielle Blanch Hartigan, PhD, MPH is an Assistant Professor of Health Studies in the Department of Natural and Applied Sciences at Bentley University. She is a social scientist with interdisciplinary research and teaching interests in psychology and public health.