Steve Lohr in the New York Times: “Steven Keating’s doctors and medical experts view him as a citizen of the future.
A scan of his brain eight years ago revealed a slight abnormality — nothing to worry about, he was told, but worth monitoring. And monitor he did, reading and studying about brain structure, function and wayward cells, and obtaining a follow-up scan in 2010, which showed no trouble.
But he knew from his research that his abnormality was near the brain’s olfactory center. So when he started smelling whiffs of vinegar last summer, he suspected they might be “smell seizures.”
He pushed doctors to conduct an M.R.I., and three weeks later, surgeons in Boston removed a cancerous tumor the size of a tennis ball from his brain.
At every stage, Mr. Keating, a 26-year-old doctoral student at the Massachusetts Institute of Technology’s Media Lab, has pushed and prodded to get his medical information, collecting an estimated 70 gigabytes of his own patient data by now. His case points to what medical experts say could be gained if patients had full and easier access to their medical information. Better-informed patients, they say, are more likely to take better care of themselves, comply with prescription drug regimens and even detect early-warning signals of illness, as Mr. Keating did.
“Today he is a big exception, but he is also a glimpse of what people will want: more and more information,” said Dr. David W. Bates, chief innovation officer at Brigham and Women’s Hospital.
Some of the most advanced medical centers are starting to make medical information more available to patients. Brigham and Women’s, where Mr. Keating had his surgery, is part of the Partners HealthCare Group, which now has 500,000 patients with web access to some of the information in their health records including conditions, medications and test results.
Other medical groups are beginning to allow patients online access to the notes taken by physicians about them, in an initiative called OpenNotes. In a yearlong evaluation project at medical groups in three states, more than two-thirds of the patients reported having a better understanding of their health and medical conditions, adopting healthier habits and taking their medications as prescribed more regularly.
The medical groups with OpenNotes programs include Beth Israel Deaconess Medical Center in Boston, Geisinger Health System in Pennsylvania, Harborview Medical Center in Seattle, the Mayo Clinic, the Cleveland Clinic and the Veterans Affairs department. By now, nearly five million patients in America have been given online access to their notes.
As an articulate young scientist who had studied his condition, Mr. Keating had a big advantage over most patients in obtaining his data. He knew what information to request, spoke the language of medicine and did not need help. The information he collected includes the video of his 10-hour surgery, dozens of medical images, genetic sequencing data and 300 pages of clinical documents. Much of it is on his website, and he has made his medical data available for research….
Opening data to patients raises questions. Will worried patients inundate physicians with time-consuming questions? Will sharing patient data add to legal risks? One detail in the yearlong study of OpenNotes underlines doctors’ concerns; 105 primary physicians completed the study, but 143 declined to participate.
Still, the experience of the doctors in the evaluation seemed reassuring. Only 3 percent said they spent more time answering patient questions outside of visits. Yet knowing that patients could read the notes, one-fifth of the physicians said they changed the way they wrote about certain conditions, like substance abuse and obesity.
Evidence of the benefit to individuals from sharing information rests mainly on a few studies so far. For example, 55 percent of the members of the epilepsy community on PatientsLikeMe, a patient network, reported that sharing information and experiences with others helped them learn about seizures, and 27 percent said it helped them be more adherent to their medications.
Mr. Keating has no doubts. “Data can heal,” he said. “There is a huge healing power to patients understanding and seeing the effects of treatments and medications.”
Health information, by its very nature, is personal. So even when names and other identifiers are stripped off, sharing personal health data more freely with patients, health care providers and researchers raises thorny privacy issues.
Mr. Keating says he is a strong believer in privacy, but he personally believes that the benefits outweigh the risks — and whether to share data or not should be an individual’s choice and an individual responsibility.
Not everyone, surely, would be as comfortable as Mr. Keating is sharing all his medical information. But he says he believes that people will increasingly want access to their medical data and will share it, especially younger people reared on social networks and smartphones.
“This is what the next generation, which lives on data, is going to want,” Mr. Keating said….(More)”
