Medical Professionalism in the New Information Age

Introduction

AAPC American Academy of Professional Coders ACOG American College of Obstetricians and Gynecologists AFEHCT Association for Electronic Healthcare Transactions AHA American Hospital Association AHIMA American Health Information Management Association AHRQ Agency for Healthcare Research and Quality AMA American Medical Association AMDIS Association of Medical Directors of Information Systems AMIA American Medical Informatics Association ART Assisted Reproductive Technologies BLS Bureau of Labor Statistics CAHIIM Commission on Accreditation for Health Informatics and Information Management Education CCHIT Certifying Commission for Health Information Technology CDC Centers for Disease Control and Prevention CHIM Center for Healthcare Information Management CHIME College of Healthcare Information Management Executives CMS Center for Medicare and Medicaid Services CMSS Council of Medical Specialty Societies CPHIMS Certified Professional in Healthcare Information and Management Systems CR Consumers’ Research CU Consumers Union DHHS Department of Health and Human Services EDI Electronic data exchange EFM Electronic fetal monitoring HER Electronic health record ERISA Employee Retirement Income Security Act ESRD End stage renal disease FDA Food and Drug Administration FOIA Freedom of Information Act HCAHPS Health Consumer Assessment of Health Care Providers and Systems HCFA Health Care Finance Administration HEDIS Healthcare Effectiveness Data and Information Set HIET Health information exchange technologies ix Abbreviations HIMSS Healthcare Information and Management Systems Society HIM Health information management HIP Health information professional HIPAA Health Insurance Portability and Accountability Act HIT Health information technology HMO Health Maintenance Organization IAIMS Integrated Academic Information Management System IMIA International Medical Informatics Association IT Information technology JCAH Joint Commission on the Accreditation of Hospitals MIO Medical Information Organization MIS Management information system PCHR Personally controlled health record PHR Personal health record RHIOs Regional health information systems TRIPS Trade-Related Aspects of Intellectual Property UNOS United Network for Organ Sharing x Abbreviations Medical Professionalism in the New Information Age As we write this introduction, President Barack Obama has signed the American Recovery and Reinvestment Act of 2009 into law. This nearly $800 billion effort to shore up the foundering U.S. economy will have diverse and unpredictable effects, but one certain consequence is the wiring of our health care system. Between $14 and $27 billion of the $800 billion will go toward supporting— financially, logistically, technically—the acquisition and use of electronic health records (EHRs) by the nation’s health care providers, including physicians and hospitals. An investment in EHRs on this scale was inconceivable before November 4, 2008, and before the collapse of the U.S. economy. Now there seems to be no turning back. President Obama, his aides, and legislators of both political parties are hoping that the spread of EHRs will yield huge dividends in terms of the quality and efficiency of our health care system. That is a wish that all Americans likely share. But at the same time, a social investment of this size and novelty inevitably raises questions about unanticipated consequences, both positive and negative. In this volume, we explore one such possible effect: the implications of health information technology (HIT)—of which EHRs are just one example—for the profession of medicine, and in particular, for the professionalism of physicians. At first glance, this may seem an odd direction in which to take discussions of HIT. Most of the literature in the field tilts toward economic, clinical and technical analysis: how to design the best electronic records; how to protect patient privacy and data security; and how to ensure that EHRs positively affect quality and reduce costs. We are asking a different but equally important set of Introduction David J. Rothman and David Blumenthal 1 questions: how will EHRs or other digital innovations fundamentally change the nature of medical practice, the professionalism of physicians, their relationships with patients, and their status in society? The practice of medicine has survived centuries of technological change, bending new technologies to its own and its patients’ purposes and emerging more secure, powerful, and effective as a profession. Is health information technology just another in a long line of such advances, or will it create genuinely novel challenges and opportunities? Each of the authors of the chapters that follow is convinced that this new technology will test the profession in unusual ways. To understand why, we need to focus attention on the foundations of physicians’ role and status in society. These foundations rest preeminently on a unique competence—namely, the ability to master and marshal scientific information...