Medical Professionalism in the New Information Age

Medical Professionalism in the New Information Age

David J. Rothman
David Blumenthal
Copyright Date: 2010
Published by: Rutgers University Press
Pages: 236
https://www.jstor.org/stable/j.ctt5hj2n1
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  • Book Info
    Medical Professionalism in the New Information Age
    Book Description:

    With computerized health information receiving unprecedented government support, a group of health policy scholars analyze the intricate legal, social, and professional implications of the new technology. These essays explore how Health Information Technology (HIT) may alter relationships between physicians and patients, physicians and other providers, and physicians and their home institutions. Patient use of web-based information may undermine the traditional information monopoly that physicians have long enjoyed. New IT systems may increase physicians' legal liability and heighten expectations about transparency. Case studies on kidney transplants and maternity practices reveal the unanticipated effects, positive and negative, of patient uses of the new technology. An independent HIT profession may emerge, bringing another organized interest into the medical arena. Taken together, these investigations cast new light on the challenges and opportunities presented by HIT.

    eISBN: 978-0-8135-5036-7
    Subjects: Technology, Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-vi)
  3. Acknowledgments
    (pp. vii-viii)
  4. Abbreviations
    (pp. ix-xii)
  5. Introduction
    (pp. 1-7)
    David J. Rothman and David Blumenthal

    As we write this introduction, President Barack Obama has signed the American Recovery and Reinvestment Act of 2009 into law. This nearly $800 billion effort to shore up the foundering U.S. economy will have diverse and unpredictable effects, but one certain consequence is the wiring of our health care system. Between $14 and $27 billion of the $800 billion will go toward supporting—financially, logistically, technically—the acquisition and use of electronic health records (EHRs) by the nation’s health care providers, including physicians and hospitals. An investment in EHRs on this scale was inconceivable before November 4, 2008, and before...

  6. Chapter 1 Expecting the Unexpected: Health Information Technology and Medical Professionalism
    (pp. 8-22)
    David Blumenthal

    The medical profession—in various manifestations—has survived and thrived since the beginning of recorded history. It now sits astride an industry that accounts for 8 to 16 percent of the gross domestic product of most developed countries, and its scientific armamentarium grows constantly, as does its command of societal resources. Over time, it has sought out and absorbed a vast array of technologies to treat illness, from bloodletting leeches to proton beam therapy.¹

    Now the medical profession confronts still another innovation in the long list of technological opportunities: health information technology (HIT). Based on the profession’s past success in...

  7. Chapter 2 Quality Regulation in the Information Age: Challenges for Medical Professionalism
    (pp. 23-39)
    Kristin Madison and Mark Hall

    Recent studies documenting continued deficiencies in health care quality have prompted a renewed commitment to developing regulatory tools well suited to addressing quality problems.¹ State governments in the United States have traditionally relied on the medical profession to exercise oversight over the quality of medical care by weeding out poor-quality providers through the licensure and professional discipline processes. More recently, however, improvements in information technology have facilitated alternative approaches to assessing and improving provider quality, such as provider report cards and pay-for-performance programs. While these tools have sometimes been criticized as inaccurate or ineffective, their use has been spreading.

    Information...

  8. Chapter 3 The “Information Rx”
    (pp. 40-65)
    Nancy Tomes

    In October 2007, Zagat Survey LLC, the company long known for its popular restaurant and hotel guides, announced a new venture: a Zagat’s guide to doctors. In collaboration with WellPoint Inc., the nation’s largest health insurance company, Zagat began in January 2008 to do online surveys with select patients. Following the same format developed for its other guides, Zagat’s collected information about patients’ satisfaction with their physicians on four criteria—trust, communication, availability, and office environment—and used them to rank doctors on a thirty-point scale. As Nina Zagat, the company’s co-founder, explained, “With this tool, WellPoint is helping to...

  9. Chapter 4 When New Is Old: Professional Medical Liability in the Information Age
    (pp. 66-80)
    Sara Rosenbaum and Michael W. Painter

    One of the more common refrains about health information technology (HIT) is its potential to heighten professional liability exposure as a result of privacy infringement, security leaks, or misuse of an emerging technology.¹ The introduction of a new technology can elevate risk of liability as a result of both anticipated and unforeseen consequences flowing from its use. But where health care is concerned, society increasingly is coming to expect that technology breakthroughs will mean better access to more and better information to assist medical decision making. This heightened expectation involves more than just consumer-initiated online Web searches or aggregated patient...

  10. Chapter 5 Patient Data: Professionalism, Property, and Policy
    (pp. 81-99)
    Marc A. Rodwin

    Imagine if public health authorities could rapidly check what percentage of all patients who had used a drug developed a particular medical problem. Such pharmaco-vigilance could identify dangerous drugs much more rapidly and effectively than is now possible. They could then warn physicians and the public, and develop guidelines on the drug’s use, or recommend that the Food and Drug Administration (FDA) remove the drug from the market. Public authorities could use this information to evaluate the drug’s safety in conjunction with clinical trials and other methods. Similarly, if researchers could compare how all or most patients with the same...

  11. Chapter 6 The Impact of Information Technology on Organ Donation: Private Values in a Public World
    (pp. 100-115)
    Sheila M. Rothman, Natassia M. Rozario and David J. Rothman

    The most intractable problem facing kidney transplantation over the past several decades has been an unrelenting shortage of organs. Transplant patients not only live longer than patients on dialysis but also enjoy far better lives. Surgical techniques and anti-rejection drugs have improved to the point that 95 percent of kidney grafts from living donors and almost 90 percent from cadaveric donors survive the one-year mark.¹ A forty-year-old patient has close to a 90 percent chance of surviving five years post transplant.² The indispensable but missing element remains the organ. Some 80,130 people are now on the waiting list for a...

  12. Chapter 7 Changing the Rules: The Impact of Information Technology on Contemporary Maternity Practice
    (pp. 116-131)
    Eugene Declercq

    Each of these quotes written a century apart identifies an intervention that will redress the pain of childbirth. The absolute faith in a technological innovation is a central theme in American medicine. In the case of maternity care practice, information technology has played a less obvious role than in other fields of medicine, however, it was a critical component of the campaign of obstetricians to gain control of maternity care practice in the twentieth century. As the twenty-first century begins, however, the development of multiple specialized sources of information on pregnancy and childbirth is providing mothers with the foundation to...

  13. Chapter 8 A Profession of IT’s Own: The Rise of Health Information Professionals in American Health Care
    (pp. 132-174)
    Mark C. Suchman and Matthew Dimick

    Professionalism means many things to many people, and those meanings are sometimes at odds with one another. In some accounts, professionalism means simply the ethical and competent practice of a particular set of occupational skills. Other accounts add a dispositional component, such as a lifelong commitment to client service, or to the mastery and embellishment of a particular body of knowledge. And still other (often darker) views emphasize political and economic dimensions, such as the capacity to control entry into, and practice within, a lucrative market niche, or the ability to assert authority and command deference in the workplace.

    An...

  14. Notes
    (pp. 175-208)
  15. About the Contributors
    (pp. 209-212)
  16. Index
    (pp. 213-224)