The digital doctor's visit: Enormous potential benefits with equally big risk

In an article recently published online in The BMJ, Dartmouth Institute researchers Glyn Elwyn, MD, and Paul Barr, PhD, together with patient co-author Sheri Piper, write about the enormous potential of digital recording to improve healthcare, as well as the pressing need to develop new policies on how to collect, manage, and store this data.

The evidence that digital recording is the wave of the future is indisputable, they say. One, or more, in every 10 patients has recorded a doctor's visit, usually on a cellphone. A few health care providers and organizations around the U.S. are adapting a proactive approach by offering their patients the opportunity to record their visits. For example, a neurological institute offers patients video recordings of their visits that are accessible via a secure website. Dr. James Ryan, a family physician in Michigan, has been offering to record visits with his patients since 2011. (The audio-files have been 'tagged' during the recording to help locate relevant parts of the talk.) At the same time, tech giants like Google and Amazon are "racing to create systems" that use recordings of doctor-patient conversations as a means to populate electronic health records.

More than a few isolated 'experiments,' or even a trend, the authors say that recording the clinical visit will form the centerpiece of a health system evolution, with far-reaching implications for all stakeholders.

"A simple cellphone recording enables a patient to better remember important information or to share it with family members," Elwyn says, "but 'next-generation' professionally produced recordings can be used to develop and further patient and family engagement, shared decision making, education, and research."

Accurate digital recordings that can be automatically coded also have the potential to combat physician burnout, the authors say, by "bringing back some sanity to a clinical process that has become encumbered by data entry burdens." Record-keeping or documentation currently accounts for 50% of a practitioner's time, with much of it occurring after hours, disrupting family lives.

While the potential benefits of digital recordings are enormous, there are also serious implications for consent procedures, privacy, and cyber security, the authors say. Harvesting data from patient recordings of doctors' visits could become a viable commercial prospect: Facebook has already declared an interest in health-related data, and DeepMind, a Google-owned artificial intelligence (AI) company acquired vast amounts of data from patients without their consent in a very controversial partnership with a London hospital. And, as of yet, there are no clear policies, let alone talk of regulatory or legal reform in this area.

"We're going to need to create a new model of personal health data ownership, similar to banking records," Elwyn says. "But, even if we did that, there are still implications for privacy and cybersecurity; and the question is do we want to leave that solely in the hands of for-profit companies?"