Total Recall: How the E-Memory Revolution Will Change Everything (12 page)

The center of every organization, large or small, will be its institutional e-memory. E-memory will be the heart of customer service, human resource management, strategic planning, inventory, shipping, finance, payroll—everything. And with data mining, every aspect of operations can be analyzed and improvements formulated.

The only thing in the way of an institution’s e-memory is their legal department, who often mandate the deletion of records such as e-mail to limit liability. It remains to be seen whether lawsuit settlements can continue their mind-boggling rise to stay ahead of the value of corporate e-memory in the Total Recall era. After all, these records will also include things like alibis against some charges, and proof of an idea formed prior to a competitor’s patent. Furthermore, there is usually someone, somewhere, who has kept a copy and thwarted the lawyers’ intentions. It never pays to take lawsuits lightly, but I don’t see how corporate e-memory destruction policies can continue.

THE FAMILY ENTERPRISE

Everything I’ve said about increased productivity at work could also be applied to your personal life. You might get a lot out of understanding how you spend your leisure time, and of course wonder, “Who the hell is that?” at home just as much in the office. I know I need a cyber assistant for my personal life because I already need Vicki’s help as a personal assistant with things like travel plans for my family vacation.

And while the impact of Total Recall on your professional life will be far-reaching, the home office is where you will feel the personal payoff. The family is an enterprise, much like any business, with financial and legal matters, schedules and plans, and records to maintain. You need to keep track of family members and property such as cars, homes, and investments.

I have more than a hundred unique kinds of items in my e-memory that are part of my virtual home office. There are legal documents like wills, deeds, licenses, and birth certificates. There are all kinds of financial and tax records. A home loan can consist of several hundred pages and dozens of documents with signatures. Your home itself may have wiring diagrams and blueprints. Cars have loans and maintenance records. And every appliance has its warrantee and manual.

Having all this personal information at your fingertips really helps. Recently, I had to fill out a form for the Australian government enumerating all the countries I have visited over my lifetime, including the time and duration of the visit. That would have been daunting in the old days, but with e-memories it was no problem. Jim Gemmell has saved time and made arrangements more quickly on numerous occasions simply by having scans of his children’s birth certificates handy for sports teams that are constantly demanding them. I can’t tell you how many times I’ve been on a trip and can’t remember how to use some feature of my camera. I refuse to carry an instruction manual that is bigger than the camera, but now that my camera’s instruction manual is in my e-memory, it’s never a problem anymore.

E-memory will be of great value to all kinds of organizations. It will be at the heart of businesses like law firms, software companies, hospitals, banks, retail stores, electricians, winemakers, and airports. It will be employed by nonprofit organizations of all kinds, including homeowners’ associations, school boards, lodges, churches, and hobby clubs. From the boardrooms of gigantic corporations down to the kitchen table of a small family, Total Recall will help get things done.

CHAPTER 5

HEALTH

‘Let’s have a look,” said the doctor.

I parted the baby-blue hospital gown to expose my chest, which was dappled with faint red blotches. The doctor peered at them appraisingly.

“Yes . . . well . . . they look a bit better, don’t they?” he said. “I think we can get you out of here by Saturday.”

It was the middle of August 2007, about a month after my second double-bypass surgery. I was in the hospital because those faint blotches might indicate a complication that could lead to another operation. I didn’t say anything, but I knew for a fact that the blotches had not changed. I knew this because I had been taking pictures of them daily with my digital camera and comparing them side by side on my PC.

The reason I kept mum was my desperation to be discharged by Saturday so that I could celebrate my birthday at home. I probably should have told him the truth, but I was miserable after almost a month of hospitalization and reasoned that I would start running a temperature if the situation became serious. The doctor, relying on his memory, discharged me. I got my wish for a birthday party at home, and the blotches eventually went away.

This episode illustrates how often professional health care strays from quantitative analysis. “How long have you had the fever?” asks the nurse, and I struggle to pick a likely time. “Do you recall what you ate before the migraine?” asks the physician, and I realize I have absolutely no clue. I was supposed to be noticing? Then there’s that pseudoquantitative classic: “On a scale of one to ten, how much pain do you feel?” Doctors hear plenty of vague and qualitative complaints: “I’ve been feeling run-down for weeks” or “I get these pains sometimes.” What a difference it would make if patients could follow their complaints with, “Here’s a graph of my temperature every hour for the past two weeks,” or “Here’s a time line of everything I’ve eaten in the last month, with times of migraines noted,” or, in my case, “Here are twenty photos of my rash, taken daily.”

In the Total Recall world, health records will be transformed into minutely detailed chronicles of vital signs, behavior, diet, and exercise along with physicians’ diagnoses, prescriptions, advice, and test results. Your e-memory software will make managing this total health record easy, and you will be healthier.

HEALTH E-MEMORIES

It was recently reported that a university study of more than forty hospitals and 160,000 patients showed that “when health information technologies replace paper forms and handwritten notes, both hospitals and patients benefit.” Neil R. Powe, M.D. from the Department of Medicine at Johns Hopkins University School of Medicine and director of the Welch Center for Prevention, Epidemiology and Clinical Research was the lead author on the paper announcing the findings. He said, “If these results were to hold for all hospitals in the United States, computerizing notes and records might have the potential to save a hundred thousand lives annually.”

Good information is central to good health care, and the old-fashioned paper-based system is inadequate. Most hospitals have not caught up with the efficiencies of our digital world. Many laboratory tests are performed needlessly because of missing paperwork. One study found that while the patient’s chart was available 95 percent of the time, 81 percent of return visits were plagued by missing information. RAND has estimated that the U.S. health care system could save an estimated $77 billion each year from the improved efficiency of electronic health records. Health and safety improvements double that figure.

The paper-based system is not just inefficient; it can be dangerous. In American private-sector hospitals and nursing homes, as many as one in five medications are given in error, harming at least one and a half million people every year, with 7 percent of those errors being potentially life-threatening.

Compounding the issue is a projected increase of chronic illness. We are in for an explosion of chronic ailments as the Baby Boomer generation passes into seniorhood through the 2010s and -20s. Eighty-eight percent of seniors have chronic conditions that require ongoing management and become increasingly expensive the longer they are left untreated. As the baby boom becomes the senior boom, our health record problems will multiply.

Thankfully, paper-based health systems are on their way to extinction. Health-care providers around the world are moving to electronic health records, keeping an e-memory of your medical records instead of paper. Being digital, they can be easily accessed, copied, or updated from anywhere within an institutional intranet or, in some cases, via the World Wide Web. The institution that maintains your records uses them to log every health-related event and transaction relating to you as a patient, from treatment records to consent forms to insurance billing to test results.

The United States Veterans Administration, which cares for the health of the nation’s ex-military personnel, has adopted electronic medical records and other computerized systems with fabulous results. It has almost eliminated prescription errors and the need to duplicate lab tests. Many private American institutions are also implementing electronic health records (EHRs). Kaiser Permanente is aiming to deploy the nation’s largest electronic medical records system by 2010, covering 8.4 million members, 431 medical offices, and 32 hospitals in 7 states. Hoping to shave down high costs of providing insurance for their workforces, a consortium of major companies, including Intel, Wal-Mart, and AT&T, are working to provide electronic health records for their employees.

State-run medical systems can dictate EHR adoption, and even the central storage of all information. The British National Health Service is mandating a move away from paper, with a central EHR system dubbed “the spine.” The European Union adopted an e-Health action plan in 2004, which includes e-prescriptions, e-referrals, and teleconsultations.

But while there has been considerable progress toward EHRs, a lot of work remains. The San Diego County Medical Society Foundation believed in 2003 that they were only a year away from a regional information network but, as of 2007, still remain “years away from full scale EHR adoption,” according to
The San Diego Union-Tribune.
In Santa Barbara County, a nonprofit organization was started in 1999 to set up EHRs in hospitals and doctors’ offices. However, when a $10-million grant ran out in 2006, the effort was abandoned.

One significant hurdle is demonstrating the value of EHRs to physicians. Fewer than a third of American doctors currently use electronic records. They rightly worry that promised savings may accrue in other parts of the health-care system, leaving them with no reward for their investment. And without an agreed-upon or even a de facto national standard, they may have to scrap or retool their electronic health records if they end up betting on the wrong format.

Worse, when different systems use different standards, it is difficult, and even dangerous, to share information. For example, the code “DPT” may stand for Demerol-Phenergan-Thorazine in one system but the Diptheria-Pertussis-Tetanus vaccine in another. Imagine being admitted to an emergency room and being dosed with a drug you’re allergic to because they misinterpreted the code in your record. And yet there are some twenty or thirty commercial electronic health records on the market, most of which use proprietary data formats. Many health-care providers have watched cagily from the sidelines, waiting for a standard to be set. Fortunately, it appears that waiting will soon end, as recent years have seen spreading standardization as well as software coming to market that translates between standards.

At the same time, some health professionals are exploiting unorthodox tools for organizing and sharing medical information right now. In a recent bit of serendipity, radiologists realized that they could use iTunes, Macintosh’s popular music-management program, to manage and organize PDF files just as easily as music files. For example, radiologists generally save medical reports as PDF files in folders on their PCs. If they want to compare images from several articles, they have to pull each one out “by hand,” so to speak, and lay them side by side. But iTunes can search, describe, and rate PDFs just like music files. The physicians can search and sort PDFs according to any desired criteria and publish their “play-lists” for other doctors to see, just like music lovers do with their MP3 songs. Bring up all X-rays of fractured tibias within the past year. Show me all herniated discs in people over age seventy-five stored in my PDF files.

Health-care providers employing PHRs will have decreased costs and better service. This will bring them more business, and force their competitors to adopt PHRs as well. All signs indicate we have already reached the critical mass needed to see personal health records become universal.

OWNING YOUR HEALTH MEMORIES

The typical American can access her bank account from ATMs around the world, check her e-mail from anywhere there’s a Wi-Fi signal, and go online to see charts breaking down exactly how energy is used in her home. But if she wants to look at her own health records, she’s out of luck. The little she can view online is incomplete and spread among many sites, and in any case, most of the relevant information exists only on hand-scribbled forms and printouts stuffed into a dozen manila file folders in a dozen far-flung offices around the country.

No one institution has the full picture of her health. The hospital has one piece of the puzzle, the specialist another, and the family doctor yet another. Her insurer knows everything that has been billed but lacks most of the details, and it has no idea about her out-of-pocket visit to the naturopath, the chiropractor, and the cosmetic surgeon. Factor in the dentist, the pharmacist, the gyne cologist, the dermatologist, and the therapist. Her current general practitioner keeps his own file on her, but everything he knows about her prior medical history consists of whatever she happened to remember (or misremember) on her first visit.

American health care has been fragmenting. Driven partly by technological advances and partly by the bottom-line focus of our system, hospital alternatives are popping up all over the place. Step right up and get your full-body MRI scan in the shopping mall. Measure your blood pressure at the pharmacy counter. Drive in and get your cholesterol measured. Come into the workplace clinic for free advice. Deliver your baby at home using this highly recommended midwife.

Clearly, only the individual is in a position to be at the hub of all his health information. Only you have the right to all your health e-memories. Indeed, you may log some aspect of your health that no one else has a need or right to see. You must take ownership of your health memories.