The Evolution of Primary Care: Part 1

Primary care used to involve a physician and a patient. The physician would see the patient in a clinic, conduct an examination, enter notes in a paper record, prescribe a follow up appointment, and say goodbye until the next scheduled visit. Usually this process occurred within a 15-minute window arranged by the physician's front office staff. Although this type of primary care visit still occurs it is fast becoming an exception to the new rules of primary care. This column focuses on technology's role in driving change and is the first in a series examining some of the trends and companies at the vanguard of the evolution of primary care.

One important technology innovation in primary care is the electronic health records (EHRs). Rather than fill out paper charts, primary care providers can enter patient data into digital forms. Some of these forms can be accessed by other providers, facilitating referrals and limiting redundant services. An example is UCSF and SF General Hospital. This large provider group developed a proprietary, "eReferral" system to streamline patient exchanges between providers. Incentives in the recently passed health care legislation will encourage other providers to follow suit although a standard EHR for the health care system remains elusive.

Other technology innovations changing the traditional primary care paradigm rely on the web. These web-based applications are making physicians more accessible and erasing the prior dictates that constrained consultations to health care clinics. For example, a company called Hello Health offers applications that allow providers to treat many patients online through video messages and online chat. Patients may submit email inquiries at any hour, not just during a 15-minute visit. Robotic technology is also allowing remote treatment. Some hospitalized patients can now interact with their provider via a bedside robot equipped with sensitive cameras and video screens.

The list of technology innovations changing primary care is long and these are only a sampling. How do you use technology to interact with your primary care provider? Add your comments below and stay tuned for later columns in this series on the evolution of primary care in America.

Photo: Hello Health founder Jay Parkinson speaks at a PopTech! conference

Credit: PopTech! flickr stream

For more on eReferral check out Alice Chen et al.'s Practice Profile in May's edition of Health Affairs. A previous Justmeans column (here) discusses Hello Health backer Myca. And more information is available at HelloHealth(dot)com. Lastly, details on robots in clinics can be found in John Markoff's front-page NY Times article from 9/4.