YPS President’s Message - July/August

Marc Haber, MD FAAEM
President, AAEM Young Physicians Section

Yesterday, I had a patient brought in by ambulance with generalized weakness and dizziness. If not a favorite chief complaint, it certainly is a common one. You know this patient, you saw her as well. She was described by the nursing staff as a “terrible historian.” Instead of correcting the nurse as to the proper definition of a historian, one who records history, I nodded and tried to get a story from this woman. Nevertheless, my open and closed ended queries were for naught. She was not in a talkative, telling mood. Unfortunately, she had never been to our department before, so my computer search was unhelpful. The paramedics had jotted down the name of some medications they found in her bathroom, but were otherwise unable to provide any information. The 911 caller’s identity was also a mystery. The patient was a little tachypneic and tachycardic. Auscultation revealed coarse breath sounds and a questionable holosystolic LLSB murmur. Also noted was trace edema about her ankles, occasional ecchymotic areas on her flank and upper extremities, and a non-focal, though certainly not normal neurological exam.

Obviously, the differential for someone like this is broad. And more certainly, a “gramma-gram” will be ordered (CXR, ECG, CBC, Lytes, BUN/Cr, U/A, etc…). Most certainly when we diagnosis the pneumonia, renal failure, or whatever disease she harbors today, we will initiate therapy and dispo to the appropriate unit, including the possibility of a discharge home.

Murphy’s Law dictates that when something can go wrong, it will go wrong. Sure enough, she develops anaphylaxis from that aspirin or fluoroquinolone du jour. Or you cannot determine her primary care physician (PCP); therefore, you are spinning wheels trying to get her an inpatient bed. Or because you chose to ignore the next five patients brought in by triage, you got a hold of the paramedic supervisor, sent back the medics to provide you her medication vials and ultimately determined her PCP.

Fret not! Larry Page and Sergey Brin have entered the healthcare arena to help. Who are these two? These folks are Google’s founders. In May, Google, Inc. unveiled their version of the electronic medical record. This new site allows users to enter, update manually or automatically and remove one’s personal medical records. One can then chose with whom to share the information and even select what information each party may view. After care at the hospital, if desired, the medical center will upload your medical information into your account.

This is potentially a very powerful tool in the emergency department. Were we able to view this patient’s electronic medical record perhaps we could have avoided the allergic reaction or contacted her family and PCP. Perhaps we would have been able to glean valuable information from her recent office visit at the Cleveland Clinic. As borderline ADHD physicians, we cherish high yield information; this is one such opportunity to gain high yield information with minimal effort. Cynics will argue that other modalities have greater value; an example is the medical alert bracelet or microchip. No doubt any additional information, that doesn’t simply raise the volume of background noise, will benefit the overall care of the patient. That said, Google commands a lot of respect and has buckets of cash. This, along with a relative vacuum in the area of national medical records, perhaps sets Google up for success.

While it is unlikely that Google will revolutionize the way we gain access to health information, it certainly will contribute to the evolution. Perhaps city-dwelling technology worshipers will readily flock to this method, but it is doubtful that the majority of Americans will buy into this. At least not for a number of years, until the security and bugs have been vetted. Currently, I cannot imagine the majority of baby boomers feeling comfortable with the security of online records. But perhaps even less likely, are those younger workers whose hacked medical information might be considered embarrassing or even career damaging.

There are other challenges as to how emergency physicians and their patients could benefit from access to this information. This includes, though not limited to, knowing that information exists, how to gain access in an emergency and of course HIPPA and other legal concerns. Furthermore, major health systems will have to buy into this. Unless multiple hospital systems allow medical records to be uploaded, patients would have to be diligent at keeping the records current. At the time this is written, this capability is only available at The Cleveland Clinic, Beth Israel Deaconess and some well-known national pharmacies. That isn’t too shabby, considering its’ availability is very recent.

Granted, this system would not have prevented the anaphylaxis in this case. At this time, an allergy bracelet would have been the best option. But in the future, I do believe that electronic medical records will be readily available and invaluable to the emergency physician. It is refreshing to see private enterprise continue this exploration. Google, Inc. has a tremendous amount of clout and capital and if used carefully and appropriately, Google Health records may be a wonderful adjunct.