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Chapter 1. Expecting the Unexpected: Health Information Technology and Medical Professionalism
- Rutgers University Press
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professionalism. As information technology provides patients with plausible diagnosis and treatment options, medical practice will change. Physicians will come to recognize and appreciate their new role as guides, information management experts, not as the first and last word as decision makers. The next two chapters focus attention on the impact of HIT on the organization and oversight of medical care. Mark Hall and Kristin Madison see signi ficant opportunities for improvement. They point out that physicians will come under a professional obligation to facilitate data collection and measurement efforts that will enhance medical regulation by external forces and improve the quality of medical guidelines. HIT will promote transparency, with significant benefits for the delivery of care. Physicians will have little choice but to become deeply involved in the development of regulatory and measurement tools, such as provider report cards and pay-for-performance programs—otherwise they will lose the power to shape their own professional identity and practices. Hall and Madison encourage physicians to take up this charge, explaining that the new regulatory apparatus can strengthen three fundamental principles of medical professionalism: the primacy of patient welfare, respect for patient autonomy, and a commitment to promote social justice. Nancy Tomes has a more skeptical position on HIT’s ability to ensure quality care. She places the technology in a broad historical context, emphasizing, in particular, the forty-year-old consumer movement and its relationship to health care. She moves from consumer guides like Zagat to print and electronic media like U.S. News and World Report to advocacy organizations and health system analysts like Public Citizen and the Dartmouth Atlas to convey a sense of how varied and extensive the data collection and promulgation enterprise already is. But Tomes takes issue with the common perception that publicly accessible information is a prescription to remedy the ailing health care system. She notes that many interventions, including ratings of doctors and hospitals, often have unintended consequences—patients make some use of the information, but health care marketers and advertisers make even greater use. Appreciating the extraordinary advantages that come from an electronic system for compiling and analyzing data, Tomes still questions whether “information fixes” are adequate to address the problems consumers confront with so many stakeholders and such complex rules. Indeed, she wonders whether by undermining the profession’s self-regulation and monopoly on valued knowledge, HIT will end up strengthening the very market forces that professionalism was supposed to overcome. The following two chapters examine the likely impact of HIT on professional responsibility and behavior from the vantage point of law as well as medicine. Sara Rosenbaum and Michael Painter address how new forms of 4 David J. Rothman and David Blumenthal information distribution are likely to affect legal liability cases. Invoking the case of the T. J. Hooper, where tugboat owners were found negligent in an accident for not having radio communications technology on board, they argue that IT may well soon become the equivalent of the radio, not just encouraging but compelling physicians to adopt HIT. Given the value and ease of the adoption, physicians who resist may find themselves liable for not having an IT system. Rosenbaum and Painter go on to suggest that HIT may also create new expectations about the quality of health information and transparency. Physicians will be required to submit the clinical decisions they have made (prescriptions, diagnostic tests, etc.) to their groups and their patients, both to ensure the quality of their care and to inform not only their patients, but all patients—that is, the society at large. Indeed, if under the umbrella of HIT, medicine becomes a public rather than only a patient-centered activity, a no-fault compensation system might replace the traditional medical tort system for liability. Marc Rodwin’s chapter also explores how data collected through HIT might be used to enhance medical decision making through the creation of a database on outcomes, injuries, and side effects. Patient data, he too insists, should be made to serve the public good. However, the only way to accomplish this end is through public, not private, ownership of patient data, an issue that the law has not yet fully addressed. At the moment, innovation is stifled by private property rights which now cover the collection of health care data. Rodwin believes that both policy makers and medical professionals should join forces to change this paradigm so as to create more manageable and uniform datasets. Although Rodwin recognizes that...