One of the biggest obstacles to electronic records is getting doctors to enter patient details onto systems electronically. A US company, Primetime Medical Software, believes it has the answer – get patients to enter their own medical history.
Instant Medical History (IMH) is based on getting patients to complete a series of simple, yet highly structured questions about their medical history on a computer screen ahead of their consultation. The medical history is then made available to the doctor in a familiar standard format and can be integrated into the electronic medical record.
This means the doctor does not have to spend the majority of the brief time available in a consultation taking the basic medical history and can spend more time on examination, diagnosis and talking to patients about their treatment plans.
Allen Wenner, M.D., founder of Instant Medical History, told E-Health Insider on a visit to London this week that the idea for software that asks questions like a doctor first came to him 15 years ago.
One of Dr Wenner’s patients, whom he had already referred to five different consultants, was finally diagnosed as having a rare condition after a young medical student spent an hour asking questions and taking her medical history. Recognising the need to for software that could take a thorough medical history from a patient, Dr Wenner was unable to find an existing product, and began to develop his own system – initially as "a Sunday afternoon" project.
“The very simple things about medicine are true,” said Dr Wenner. “If you talk to patients they will tell you what is wrong”. The problem though is that "Three to seven minute consultations are woefully inadequate to do anything".
The system begins with the simple question "why are you here?" explained Dr Wenner. Instant Medical History is now a massive knowledge base with over 32,000 questions, which asks patients one simple question per screen.
"It doesn’t make a diagnosis, but just asks questions," said Dr Wenner. The software can be used over the Internet, before a consultation or in the practice waiting room, and can be used as a stand-alone system or as part of an electronic medical record or e-health platform.
Crucially, he added, the system improves quality, and stressed that it is patients that have the strongest incentive to ensure that their medical history is accurately recorded – a point he admits some clinicians are initially loathe to accept.
Unlike a human doctor the system always remembers to ask the key questions — providing vital evidence to reduce medical litigation risks — and includes peer reviewed tools, such as psychiatric ratings scales, which automatically generate ratings from the answers given.
But the key benefits of the system are safer higher quality care. “More people die in the US from medical accidents than died in the Twin Towers (11 September),” said Dr Wenner. "This is a potential solution to that problem that focuses on the patient."
He added that medicine is almost alone as an industry in not using technology to deliver efficiency gains, with family doctors still seeing roughly the same number of patients as they did in the 1950s. "Unless things improve patients will vote with their feet".
Dr Wenner said that another advantage of the system is that it provides the medical history data vital to electronic medical record systems, without requiring clinicians to find extra time to enter data electronically — one of the biggest hurdles to the adoption of electronic record systems.
Now used by about 4,000 US clinicians and in institutions including the Mayo Clinic, Johns Hopkins Hospital and the University of Iowa, work is now underway to adapt the system to be used in the UK and Netherlands.
Dr Richard Sills is currently adapting the system for use in the UK, through his company IMH UK Ltd . He believes there is an even greater need for Instant Medical History among UK GPs, who only have three to seven minutes for an average consultation, compared to the 12 minute average of their American counterparts.
“IMH takes the time pressure off, and makes the five minute consultation seem like a 20 minute one,” said Dr Sills, who said that patient "projection" means that patients mentally include the time with the IHM system as part of their consultation.
He added that the IHM system also produces more accurate medical histories, as studies show patients are "far more likely to be honest when answering questions on a computer".
Dr Sills believes that the system can be used in the UK as a component of electronic patient records and could be integrated into telephone triage and internet based e-health platforms.
In the Netherlands, the Dutch e-health company dokterdokter.nl is looking to use the IMH system as part of a programme of home care.
Dr Richard Sills of IMH UK Ltd ,and Dr Wouter Keijser of doktordoktor.nl, will be presenting on Instant Medical History at Mobile-Health Europe , Maastricht, The Netherlands, 14-16 April, 2002.