Departments: The Waiting Room
Four years ago, when neurologists Robert Cowan, M.D., and Alan Rapoport, M.D., sat down to talk shop, the subject of headache naturally came up. They are both headache specialists.
“At the time, there were 350 board-certified headache specialists in the United States but an estimated 60 million people living with headaches,” recalls Dr. Cowan, clinical professor of neurology and neurological sciences at Stanford School of Medicine, president of the Headache Cooperative of the Pacific, and Fellow of the American Academy of Neurology (AAN). “The numbers didn't add up,” he says. “How could 60 million people be adequately served by 350 specialists?”
The two friends wondered, “What if patients could provide their primary care doctors with the kind of detailed medical history used by headache specialists?”
Drs. Cowan and Rapoport set about developing a free, not-for-profit website called ProMyHealth ( promyhealth.org) to provide this kind of medical history. By using decision-tree analysis (in which answers to questions determine the follow-up questions), ProMyHealth allows a patient to create a detailed report that can be printed, saved, and sent to a doctor, who can then store it as an electronic medical record. Doctors can also modify a report to include any additional information gathered during the visit.
The report is not meant to make a final diagnosis, Dr. Cowan stresses. “The idea is that a patient can go to the website and answer a series of carefully chosen questions—anywhere from about 80 to 340—and share it with his or her doctor. For example, one question might be, ‘Do you have trouble sleeping?’ If the patient answers yes, the next question might be, ‘Do you have trouble falling asleep or staying asleep, or both?’ The questionnaire also asks about exercise habits, any history of trauma, and various headache triggers for each individual patient, such as red wine, barometric changes, and menstrual cycle.
Most primary care doctors—and even many neurologists—don't have the hour or two that it would take to get this kind of detailed history, according to Dr. Cowan. He believes the model can “reduce wait time and the number of referrals, hopefully to a point where headache specialists don't have a nine-month wait to see patients.”
What's interesting about ProMyHealth is that it's geared towards patients, says Alison Weathers, M.D., medical director in the department of information services at Rush University Medical Center and member of the AAN. “Most of these kinds of tools for making a medical diagnosis are created with only the doctor in mind,” she says.
However, it's important to be cautious about new healthcare technologies, she stresses; online tools such as ProMyHealth should never replace the face-to-face consultation. “A lot of how the patient tells their story is what guides us as neurologists, and if we're letting the computer get that story for us, we might miss something,” Dr. Weathers says.
To listen to the extended interview with ProMyHealth cofounder Robert Cowan, M.D., visit: http://bit.ly/AkhPNV