HEALTHCARE
January 17, 2017

A Direct Line to Your Doctor

When patients can tell their doctors about symptoms as they happen, ER visits go down and survival rates go up.

That strange pain you were feeling last week — will you remember to tell your doctor about it at your next visit? Will you remember what may have led up to it? Symptoms that go away often slip our minds, and there are always plenty of other issues to bring up during a visit. But what if there were an easy way to report the symptom when it happened?

Accurate symptom reporting is especially valuable for people with chronic conditions, many of whom take several medications and so may experience drug interactions or other complications. Suppose patients could report what they are feeling as it occurs, using a web-based questionnaire or smartphone app that could place the information in their electronic health record? It would give their doctors more to go on.

When cancer patients' symptoms were collected by computer survey, there were fewer emergency room admissions, better adherence to medication, higher quality of life and improved survival.

Ethan Basch, director of the University of North Carolina Lineberger Cancer Outcomes Research Program and a professor in the UNC School of Medicine, is also a doctor who works with cancer patients. He thinks patient symptom reporting could become reality quickly, if the right people made it a priority.

“There's nothing earth-shattering here,” Basch said. “Patients already can call us when they have health concerns — although often they are hesitant to call the office or can't get through. What we want to do is switch this process over to an electronic format. It's taking something we've been doing, and making it more efficient and systematic.”

There's more than convenience involved here. Basch and his colleagues had found that when cancer patients' symptoms were collected by computer survey, there were fewer emergency room admissions, better adherence to medication, higher quality of life and improved survival.

Yet it isn't happening.

There are several reasons for this. According to Basch, current electronic records software and apps have a very limited ability to collect patient data; and the applications that are available to do so are very clunky and rarely used by patients. Moreover, the companies that develop electronic records systems aren't seeing much demand for this type of feature.

There's also little financial incentive for doctors and hospitals to implement systems that make it easy for patients to report their symptoms. “These systems cost money to set up and to accommodate,” Basch said. “There needs to be a business model for doing that. It would save money, ultimately, because there would likely to be fewer ER visits, and outcomes would improve.”

Even if all these problems were solved, the systems would still need to be put in place and doctors would have to figure out how to integrate them into their work flow.

Yet the same was once true of computers, which are now standard medical equipment.

“There is tremendous unnecessary suffering and unnecessary utilization of emergency services because we are not addressing patients' problems between visits adequately,” said Basch. “This is just one mechanism for monitoring people, but it could help us turn ‘patient-centered care’ into a reality.”

The Perspective piece appears in the New England Journal of Medicine.

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