EMRs and the Elderly

Let’s talk about technology. Now, I’m not the most technologically savvy doctor in the world. In fact, computers are not my strong point. I can function reasonably well in modern society, but I have very low expectations of what I am able to do. I can accomplish all of the regular activities such as word processing, basic email and Internet use, and I’m not bad at creating PowerPoint^® presentations. I can even use my university electronic health record system. I probably lay somewhere in the middle with my four-year-old daughter on one side, who can instinctually use my smart phone and iPad and my 74-year-old father on the other, who is barely able to turn on the computer.

Given the level of complexity of current technology, I was not surprised to read a recent study in the Journal of the American Medical Association, which found low use of digital technology by elderly patients. At first glance, some of us younger folks may not find this to be all that significant. However, with the ever-increasing required use and reliance on electronic medical record systems, we in the medical profession must pay more attention to this problem.

The Facts

Let’s take a quick look at the study by Levine and colleagues¹. These researchers looked at Medicare beneficiaries 65 years and older drawn from a yearly survey of technology use (the National Health and Aging Trends Study) over a period from 2011 to 2014. Surveying 7,609 people with an average age of 75, they found the following:

	76% of seniors used cell phones
	64% used computers
	43% use the Internet
	40% used email and texting
	Less than 20% used Internet banking, Internet shopping, social network sites, and tablets

Regarding the use of digital health technology, the researchers found:¹

	16% obtained health information
	8% filled prescriptions
	7% contacted clinicians
	5% handled insurance online

Is it Getting Better?

The researchers also used this data to track changes over time. Between 2011 and 2014, they found the following:

	Seniors using any digital health information increased from 21% to 25%
	14% of seniors increased the number of digital modalities used
	10% of seniors decreased their use

Factors associated with decreased use included “older age; black; Latino; and other race/ethnicity; divorce; and poor health.” Factors associated with increased use included college education, higher annual income, taking medications, and more comorbidities.The authors concluded that seniors use digital health information at low rates and with small increases between the years studied.

“Seniors use of digital health information is very low”

I am not surprised by these results, but I am disheartened. The very patients who need our help the most are the very ones who do not use the ever more ubiquitous health technology. Additionally, our society’s most disenfranchised people may become even more marginalized by our conversion to digital health technology. Physicians are being pushed to convert their practices to using electronic health measures – and soon will be penalized for not doing so – while concurrently many of our most needy patients are being left behind.

Let me give you a quick example of how this issue is so pertinent to today’s medical practice. One of the important aspects of Meaningful Use and federal reporting is to allow patients access to their health information and facilitate additional means of communication with their medical providers. In my own practice patients have access via a” patient health portal.” The patient is given a login and password, and they can log into their account at any time and review various pieces of information about their health and send messages to their provider. Obviously, a patient who is illiterate in terms of Internet technology will be left out of this system. In a way we are creating a new class of functionally illiterate patients who may be denied access to their medical information in a way similar to a person who cannot read does not have access to many aspects of society.

“One of the important aspects of Meaningful Use and federal reporting is to allow patients access to their health information and facilitate additional means of communication with their medical providers.”

I don’t know the answer to this problem, but I am certain that we need to consider the ramifications of our progressive movement toward electronic health record use. As one provider who treats elderly patients, my first action must be to remain as available to all my patients as possible. At the very least, patients should have several methods to access their health records and caregivers. As the older generation moves on, and younger generations who are used to digital technology become older, this issue may become less of a problem. However, that is for the future and we must remain vigilant about the present.

Best wishes.
Jarrod Shapiro Signature

Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]

References

Levine DM, Lipsitz SR, Linder JA. Trends in Seniors’ Use of Digital Health Technology in the United States, 2011-2014. JAMA. 2016 Aug 2;316(5):538-540.

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