by Eric Brand

The issue of digital record-keeping has surfaced several times in the recent health care debates. At a recent lecture in Portland, a politically-active member of the TCM community approached me about discussing the issue of digital records. She said that there was significant resistance to the idea of digital record-keeping in TCM, and suggested that the topic should be further explored to examine the benefits that digital records can offer.

Throughout the period of time that I studied at hospitals in Taiwan, I was constantly impressed by their digital record-keeping system. Many hospitals in Hong Kong and mainland China also use digital patient files, but the system in Taiwan is particularly developed because it is highly integrated with the national insurance system.

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In Taiwan, approximately 90 million TCM patient visits were recorded during a recent three-year period. Such a large volume of digital records is a “dream come true” for data mining and evidence-based medicine. Researchers can work with Taiwan's national insurance organization to gain access to various parameters of the data, and large hospitals constantly conduct their own research and add innovations.

I used to study at Chang Gung Memorial Hospital when I lived in Taiwan. My teacher Dr. Chang Hen-Hong is the head of the Chinese medicine department at Chang Gung, and he has made Chang Gung's system particularly advanced. Chang Gung is a huge hospital system; they have branches throughout Taiwan and their central branch is the largest hospital in the world in terms of patient beds. Chang Gung recently finished building a new hospital in mainland China as well, in the city of Xiamen.

In Taiwan, patients use smart cards for insurance coverage and record-tracking. If a patient receives treatment in any department of Chang Gung, their file is updated with all the relevant information. Thus, in the TCM department, the attending doctor can see the patient's entire disease history, with details on everything from radiology, biomedical diagnosis, imaging, drug treatment, acupuncture treatment, herbal prescriptions, tui na treatments, and other any other relevant tests or reports.

The doctor can then type up notes about all aspects of the patient’s chief complaint, as well as ICD-9 codes, symptoms, tongue and pulse information, etc. Individual check-mark fields have been added for the tongue and pulse, allowing researchers to sort the data based on any parameter of the tongue and pulse as well as fields such as the ICD-9 code. This would allow a researcher to ask a question such as: how many patients suffering from gastritis have yellow tongue fur? And how many of those patients were prescribed Huang Lian? How many of the patients that were given Huang Lian were also given Mu Xiang? The number of ways that one can approach the data is nearly limitless.

In addition, Chang Gung is now incorporating digital photographs of the tongue, taken with standardized lighting and methodology. They can also incorporate machine-recorded information on the pulse. Adding this data to the patient file can thus allow researchers to assess questions such as whether or not dampness correlates with tongue fur and whether it responds to damp-drying medicinal therapies. It can also be used to assess the degree to which a computerized tongue image correlates with the attending doctor’s subjective diagnosis. In other words, digital records allow the knowledge of Chinese medicine to be easily assessed with the methodology of Evidence-Based Medicine, which is essential for the global acceptance of this ancient and effective system.

See this blog for more on EBM and TCM

See this blog for more on Chang Gung's tongue and pulse research

In other cutting edge research based on digital files, I mentioned Dr. Chang Hsien-Cheh’s groundbreaking work on medicinal use trends in a previous blog. Dr. Chang Hsien-Cheh’s team analyzed the prescription trends of 90 million TCM patient visits, all based on ICD-9 codes. This data allows one to see all of the herbs that were prescribed to patients with any given condition, such as allergic rhinitis. One can track tens of thousands of cases for a very advanced assessment that shows exactly how frequently something like Xin Yi Hua is actually prescribed for nasal congestion in everyday medical practice. It also illustrates the holistic nature of Chinese medicine, since we see that a formula such as Bu Zhong Yi Qi Tang has a very high prevalence in nasal disease (demonstrating the importance of treating the root as well as the branch).

Digital files may not be practical for individual practitioners in the US, but there is no doubt that they are a fantastic tool for medical research and data storage. Ideally, digital records within a given field such as Chinese medicine should have standardized fields to store the data so that we can eventually do research that combines de-personalized data from different practitioners together. If we had digital records, we could do endless amounts of evidence-based research with the resulting data. This would greatly increase the acceptance of Chinese medicine by the scientific community, and it would answer any number of fascinating questions about how our theory and textbook knowledge transforms in the dynamic reality of the clinic.

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