Medical referrals can be defined as “The recommendation of a medical or paramedical professional”. In this new world of patient engagement, it’s time to re-think this paternalistic viewpoint.  In short, it’s time to think about referring the patient to themselves.

Eric Topol (@EricTopol) made a similar point in The Patient will see you now.  The information available to patients is greater now than ever in history and their ability to process this information is on the increase.  Yes, non-ambulatory patients, patients in severe pain, or patients in cognitive decline cannot reasonably be expected to manage their own care.  However, for the vast majority of patients, participation in, and taking responsibility for their care, is realistic and desirable.

So, what then is referring a patient to themselves?  It is the process of asking the patient to review their signs and symptoms in their daily life, potentially through the use of connected devices, internet knowledge stores, or by consulting with fellow patients on sites such as PatientsLikeMe.com.  It is the process of asking them to compile data, look for patterns, ask other non-professionals for support, and then use their care record software to generate their own continuity of care document that their provider can import into their EMR through a patient portal.

Recently I sat through Consolidated Data Architecture (CDA) training at HL7.  CDA is designed for healthcare data interchange and has a primary use case of moving data between clinicians.  It’s an awesome standard that has been pivotal in the Meaningful Use initiatives and the authors are fine people who know their stuff.  CDA focuses on the concept of attested content from providers but can the patient be their own provider in CDA?  I see nothing in the standard precluding this.   Having said that, I wonder what would happen if I turned up at my provider with a legally authored CDA and asked them to import it into their EMR?

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