Yes, I agree that it's happening. There have been huge changes in the way
medicine is practiced in just the 25 years since I was a medical student,
and those changes will continue to happen. For the most part, that's a good
thing.

And yes, I do discount your take on it. Nothing personal, but your
information is from anecdotes relayed to you, from web sites, and a strictly
theoretical concept of how a medical practice might work. You have virtually
no clue about the real world of medicine. My practice is steadily
implementing an enterprise medical record too (including an email and
patient access module), as are virtually all other medical practices that I
know of here in Minnesota. I'm very familiar with the problems.

Don't misunderstand - I applaud your determination to find a better way to
do things and to not want to accept the status quo. I teach medical students
and residents, and the bright-eyed and bushy-tailed are my favorite kind.
But surely you must grasp the concept of the response engendered when a
medical student presumes to lecture people experienced in setting up,
running, and maintaining a medical practice (including EMR), especially when
it's something that's obvious, and already happening anyway. You are as
locked into your own concepts as you accuse such physicians of being.

Idealism is a very good thing in medicine. Too many medical students and
residents have already been saddled with the cynicism imposed on them by a
hugely cumbersome medical-industrial complex. But you need to leave some
room in your practice plans for modification when reality supervenes, as it
ultimately will.

HMc

Not to try to oversimplify, but, while you are correct--that boththe
DEMAND--and the rationality of meeting it ARE here-there is a 'legacy'
problem.  The problem for implementation on which most health
informatics professsionals seem to agree (and which the HHS NHII/NHIN
proceeding seeks to resolve) is the need to have all the different
systems (at least 4000 clinical "networks in the US today) that would
allow you to REALLY "email" your doctor not only TALK to each other,
but AUTHENTICATE their USERS and DEVICES to each other.  This means
authenticate at the technology/device/platform/network level (clinic
data base A "knows" that blood gas monitor from lab B is legitimate,
licensed and calibrated), and at the "credentialing"  AND at the
party/identity levels (patient knows--or has given permisison,
e.g.--for current encounter provider (say, vacation ER) to extract last
encounter data from stored record (say, hometown hospital's PMR) and
retrieve image of xray, eliminating need for ER to repeat.(you produce
authenticating credential to ER.)  Even tho' they've never communicated
before, in an NHIN era, ER and hometown hospital use same
authentication standard, which recognizes AND authenticates YOU to
them, AND THEM TO EACH OTHER, and retrieves data exchange permissions
previously agreed to by everyone when they become part of the network).

In your basic "email your doc" scenario, your identity as a patient is
known to the doc--not just at the personal familiarity level, but at
the clinically significant identity level. The doc's identity when he
or she replies to your email is known to you.  (So you can trust the
answer.).  You can send an image of your skin rash (or your vitals).
The DOC can order LABS; the doc can even reply by PRESCRIBING for you
in reply to your email, and copy the PHARMACY, which can (since you are
known and authenticated to both DOC and PHARMACY) bill your PAYOR
online. So, the implications are obviously more profound than just
lowering the cost of OV encounter or raising the number of potential
encounters--it completely overhauls the system.  Throws out dozens of
decades-or-centuries old assumptions.  It says the technology (to
borrow from the Twilight Zone) can "Serve Man."