In my work at the Center for Future Civic Media, I’ve been investigating ways that emerging technologies could be used to better the quality of healthcare in local communities. I’ve been particularly interested in exploring ways to improve the communication between doctors and their patients. I recently spoke with Jay Parkinson [no relation to the disease of the same name], a licensed medical doctor, who offers a creative approach to addressing some of these pressing issues.
In late September, Dr. Jay Parkinson opened an online medical practice in Brooklyn. Nearly every morning, Parkinson goes to what he calls “his office”–the neighborhood coffee shop. From there, he might communicate with his patients over cell phone, instant messenger, or email. He can rapidly access medical records using an online database. It’s idea that has gained considerable media attention since Parkinson offers personalized medical care to the young and uninsured through a mixture of electronic communication and old-fashioned house calls.
Parkinson says he got the idea while in medical school. Many of his friends would IM or email him with medical questions. He says they are representative of many patients who have simple health concerns but without easy access to a doctor often make unneeded appointments. “Fifty percent of doctor’s visits are unnecessary,” Parkinson says. “Communication is one of the biggest issues with medical care.” In Parkinson’s case, he is available to make house calls, or consult over the phone or computer to help guide his patients through any medical query. Once he diagnoses an issue he can easily continue to talk to a patient after seeing him over email or IM. “It’s a mechanism of maintaining patient safety,” he explains. “If it sounds like what I did isn’t working, we’ll try something else.”
Parkinson launched his practice to care for the young, creative, and uninsured in New York City. Some have criticized him for opening a boutique office because his population does not include those most disenfranchised by failings in the healthcare system. Parkinson counters that says that it is really more a matter of his focus on preventive care and community. “There is no population that doesn’t need a doctor,” he says. “Most of my friends are in the arts. This is my community. I fit in well.”
There’s another reason that Parkinson decided to practice medicine in this way–he wants to overhaul the American medical system. His site includes a blog in which Parkinson expounds on criticisms of traditional medical care, the insurance industry, and the pharmaceutical industry. “The system is broken,” Parkinson says. “And there is no real way to fix it without someone who is willing to confront the industry.” For starters, Parkinson charges about $200 a visit, and accepts cash or PayPal but not insurance. He created a database of prices for various medical tests offered by several thousand specialists around New York City. When Parkinson researched the costs of common medical tests, he discovered a wide range of prices. For example, the cost of a mammogram can range from $125 to $750. “House calls are not revolutionary; the database is revolutionary,” he says. “People need to know the prices for tests.” For patients that might need a specialist, Parkinson says that he can now guide patients to those that are most cost-efficient.
Parkinson has met with resistance in the larger medical community. “I am very threatening to a lot of doctors,” he says. “Doctors see 30-40 patients a day. No one wants to answer emails from that many patients every day … I’m going to do it differently and I’m going to do it better. I’m also getting email s from a lot of high-powered people saying ‘You’re the future of health care.”
Parkinson’s model makes intelligent use of new technologies to allow patients and doctors the opportunity to communicate more effectively with one another. His model could work very well for his client base–individuals with relatively few health needs. I’m not sure that it seems feasible, however, for patients with extensive medical needs or suffering a serious injury, or even a chronic problem; the ongoing costs would all be out-of-pocket. Of course, one person can’t be expected to reform the entire healthcare industry, but perhaps Parkinson’s model could be much more effective if it were combined with catastrophic coverage.
A bigger concern is one of security. Parkinson doesn’t comply with the U.S. Department of Health and Human Services HIPAA privacy rules, which was designed to protect individuals’ medical records and other personal health information. This isn’t necessarily an issue, except that it speaks to larger concerns about how safe a patient’s identity and confidential medical information might be on Parkinson’s hard drive and over IM. Parkinson has heard this criticism before, and even addressed it in his blog. “A practical, responsible, physician using common sense to effectively communicate with patients via ubiquitous Gmail or AIM about the majority of health problems that are not sensitive in nature goes a lot further to ensure health in your patients than fear,” he writes. Unfortunately, common sense might not prove powerful enough to protect online identity. Although this issue, and others, still need to be fully addressed not only by Parkinson but by the medical community at large, Parkinson’s treatment strategy makes a big statement about reforming the way that medicine is practiced in this country.