Rethinking medical professionalism: the role of information technology and practice innovations.
BACKGROUND
Physician leaders and the public have become increasingly concerned about the erosion of medical professionalism. Changes in the organization, economics, and technology of medical care have made it difficult to maintain competence, meet patients' expectations, escape serious conflicts of interest, and distribute finite resources fairly. Information technology (IT), electronic health records (EHRs), improved models of disease management, and new ways of relating to and sharing responsibility for patients' care can contribute to both professionalism and quality of care.


METHODS
The potential of IT, EHRs, and other practice facilitators for professionalism is assessed through diverse but relevant literatures, examination of relevant websites, and experience in working with medical leaders on renewing professionalism.


RESULTS
IT and EHRs are the basis of needed efforts to reinforce medical competence, improve relationships with patients, implement disease management programs, and, by increasing transparency and accountability, help reduce some conflicts of interest. Barriers include the misalignment of goals with payment incentives and time pressures in meeting patients' expectations and practice demands. Implementing IT and EHRs in small, dispersed medical practices is particularly challenging because of short-term financial costs, disruptions in practice caused by learning and adaptation, and the lack of confidence in needed support services. Large organized systems like the VA, Kaiser Permanente, and general practice in the United Kingdom have successfully overcome such challenges.


CONCLUSIONS
IT and the other tools examined in this article are important adjuncts to professional capacities and aspirations. They have potential to help reverse the decline of primary care and make physicians' practices more effective and rewarding. The cooperation, collaboration, and shared responsibility of government, insurers, medical organizations, and physicians, as well as financial and technical support, are needed to implement these tools in the United States' dispersed and fragmented medical care system.
Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ 08901, USA. mechanic@rci.rutgers.edu
David
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Mechanic
D006801:Humans; D007256:Information Systems / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D016347:Medical Records Systems, Computerized; D010819:Physician's Role; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000458:organization & administration / Q000639:trends*