Summary Of Cyber Medicine Course At Harvard Medical School
May 1999

The course was essentially one day of material loosely packed into three days of lectures. It was overwhelmingly polarized by the narrow draw for faculty from Harvard and a closely-affiliated program in Wisconsin. Hence, there was an extreme amount of material about the privacy issues and their concerns about patient rights to privacy with both the EMR and other cyber medical modalities. This focus undoubtedly reflected the rampant liberalism so apparent in the faculty and the attendees (about 120).

Of the more interesting observations:

1. There is a rather impressive body of research, including controlled research in the field of IVR (interactive voice response). Studies of cost control and clinical efficacy, including patient satisfaction scores higher than with a face-to-face interview with a doctor were presented in treatment of depression (of all things), UTI, employee satisfaction and preventive health.
2. Despite the evangelistic support for the concept of using computers to increase access to medical expertise, no-one seems to know of any attempt to use IVR or database interviews for medical triage of urgent or emergent medical conditions, like the Call Doctor Program. When asked about why, lecturers simply had not thought of it, although they had spent a lot of time in angst over the patient's right to NOT have an EMR sent to the ER when they were incapacitated. The majority felt the patient's right to privacy and need for informed consent overweighed the needs of the ER doctor in making clinical decisions in the patient's best interest. This sounds absolutely nuts to me.
3. One early discharge program from low birth weight infants claimed a 29% reduction in LOS by simply connecting the home to the care team with an ISDN line provding real-time interactive video linkages. There was no real technology in the home other than a computer and a camera. The neonatologist said that the physicians wanted to see the mother-child interaction and hadn't really thought of the value of an objective measurement such as impedance measurement of ventilation; they thought the observation of the babies respiratory effort was more valuable than the oxygen sats, for instance. This is also nuts but represents the same "paradigm-shift" in thinking that we have faced.
4. The biggest impact I felt in virtually all of these lectures was the prevailing opinion that the real value of the computer was giving patients a feeling of control in their care. This rejection of physician paternalistic thinking and valuation of interactive decision-making was almost universal in the course and parallels what you have heard me call the "doorbell effect" of the housecall physician.
5. Little or nothing seems to have been done connecting home-based measurements with IVR decision-making.
6. The field of cybermedicine is clearly exploding as it is virtually the only conceivable option for the public to gain access for their insatiable need for medical advice and opinion. In that sense, it represents both an opportunity for marketing and network development, and a possible competitive force, in that patients comfortable with an IVR interview may choose no care over a future housecall.
7. The scope of cybermedicine is already huge: online traffic is doubling every 100 days; 100 million computers worldwide are not connected via the internet; half of all internet uses say they have used it for accessing healthcare info; there are over 100,000 health and medical websites now; there are 1.5 million weekly messages on the ACOR site of 60 cancer listserves; surveys show that 50% of patients with computers would like to communicate with their doctor via e-mail, many of these are part of a 20 million caregiver group in the US; everyone seems to think that the computer must be the answer to the 700 million office visits of an average 7 minutes last year...it simply cannot go on.

-Gresham Bayne