Does My Doctor Want To Know I Took My Lipitor?Does My Doctor Want To Know I Took My Lipitor?

Ask physicians what their main complaint is with their profession, and many will say it's the heavy burden of malpractice insurance. With legions of lawyers whose raison d'etre is to sue doctors, it's no wonder high-risk specialties, such as surgeons and ob-gyns, must spend tens of thousands of dollars a year just in case they wind up in the crosshairs.To doctors, liability is a massive, ever-present cloud that follows them everywhere. The last thing they need is a whole new avenue for esquires to reach them. But that's exactly what might happen if some policy makers get their way.

At a recent HIT Policy Committee workgroup meeting, software entrepreneur Paul Egerman said that pharmacy systems that can't provide medication compliance data back to the ordering physician are a problem that needs fixing--perhaps by the FDA.

Doctors want compliance data, Egerman said. "If a cardiologist orders a drug, he wants to make sure the patient is taking it."

Or does he? Right now, doctors are on the hook for prescribing the right medication, but the patient is responsible for actually taking it. Are we talking about changing that long-standing paradigm? Once a physician knows a patient hasn't filled a prescription, what's his responsibility? If none, fine. But I'm betting the aforementioned legion of lawyers will put that theory to the judicial test.

In America, we seem to have developed a problem with personal responsibility. If we take out a home loan for more than we can afford, it's the bank's fault. If we charge more than we can pay and get hit with late fees and exorbitant finance charges (which were clearly spelled out in the paperwork we signed), it's case of predatory lending. Are we going to say that if a doctor prescribes a medication--but we fail to take it--the doctor's at fault?

When I interview CIOs, I often ask what their role is in an IT implementation and exactly who's responsible for making sure the overall project is a success? When it comes to clinical applications, almost all say they can advise, support and guide, but not drive. Leadership, they say, must also come from the chief medical officer--the director of those who will ultimately use the medical software and devices.

When it comes to the health of an individual, who must drive behavior: the patient or the doctor? Of course it's the patient. And given that, we must be very careful about heaping information on physicians that they will no doubt be liable to act on.

And if it's deemed they must act, what action is sufficient to remain far from the witness box? If I don't fill my Lipitor prescription, am I entitled to a reminder email? Two emails? A phone call? Or is the physician responsible for coming to my home with the medication and pouring me a glass of water?

Of course, I'm taking this a bit far, but the core argument remains--where does the physician's responsibility end and the patient's begin? I suggest we find that point soon, because without it, I see problems looming.

Anthony Guerra is the founder and editor of healthsystemCIO.com, a site dedicated to serving the strategic information needs of healthcare CIOs. He can be reached at [email protected].

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