tended to demonstrate improvements in outcomes
and metrics; however, several barriers to optimization
also were identified (see Table 1, page 21). Improved
outcomes generally are well received by all stakeholders in health care delivery, but the cost has been the
intrusion and otherwise indelible mark that IT has
left on the patient-physician encounter.
To maximize the clinical benefits of IT and minimize the strain it places on the patient-physician
relationship, surgeons must explore new ways of
applying technology. Jonathan Weiner, DrPH, professor of health policy and management, Johns Hopkins
Bloomberg School of Public Health, Baltimore, MD,
has identified several educational and socioeconomic
factors that influence how electronic-health (e-health)
can impact patient-physician communication (see
Table 2, this page).
14 To improve communication,
Dr. Weiner argues that efforts in the e-health domain
will require dedicated investment by clinicians, managers, policymakers, and scientists, who must work
hand-in-hand with consumers to drive a shift from
the standard 15-minute face-to-face, one clinician/one
patient interaction, toward a more global concept of
population health and wellness support. Moving forward, surgeons will need to leverage these factors to
close the digital divide in terms of patient and physician access to IT as well as their familiarity with its
use to preserve the sanctity of the patient-physician
The path ahead
The challenge for the surgeon leaders of the future
is determining how to maintain the core elements
of patient-physician communication—creating interpersonal relationships and exchanging information
to determine optimal treatment plans in a culturally sensitive and value-centered manner—in the
face of the rapidly changing and often disruptive
nature of technology and social media. A truly multidisciplinary effort that draws expertise from the
fields of interpersonal/mass communication, clinical sciences, health informatics and IT, public health,
IMPACT OF E-HEALTH ON PATIENT-
• Health IT and its embedded software will mediate
almost all health information and will be the
source of almost everything that physicians and
other clinicians will learn about their patients.
• Patient information will be accessible to
all providers anywhere, anytime.
• Almost all patient-provider interactions will
be mediated by the electronic workflow
(that is to say, supported by digital
guidelines and protocols) before, during,
and after any patient-provider contact.
• Patients can become full partners in their health
care and wellness-enhancing processes. These
patients will have electronic access to almost
as much information about their condition and
the medical evidence base as their providers.
• The art and science of care surrounding the
traditional face-to-face patient-provider
interaction will be forever changed as all
aspects of communication, interaction, and
information flow will become mediated
and monitored by electronic tools.
• The IT-mediated process will also dramatically
change communication patterns between
providers. IT will enable all providers to work as
a team and to coordinate their actions far more
effectively, even if they are at different locations.