A week or so ago on the eWeek site, Weighing the Pros and Cons of Online Medical Records. He comes out in favor of keeping the records in the hospitals and clinics, where (in his opinion) they belong. I believe he's tilting at windmills here.
My question is whether or not Google in particular and the Internet in general can be trusted to safeguard our health records, arguably the most sensitive documents we possess.
But my concerns about Google Health are even more fundamental than that. Companies such as Google, Microsoft and AccessMyRecords.com want to encourage people to put their health records online. People are being asked to do what few people ever had the ability to do before, digitizing their personal health records and storing them in an online database ready for access at any time...
Health care professionals have certainly recommended that people assemble their health records and medical histories in folders or three-ring binders for reference as needed by the patient or emergency medical personnel. People have long had the ability to digitize and store their medical records on their PCs.
But now individuals have to make the same decision that has confronted enterprises when they consider whether to switch to SAAS (software-as-a-service) applications in which their proprietary data about customers, sales, finances or product specifications must leave their own data centers and move into the cloud...
I would ask whether or not the benefits of having personal medical records online in a central repository are worth the time and effort required to get them online. Then I would ask whether the benefits of having those records online are justified by the decision the patient makes to place them in the custody of a third party's data servers.
In that last sentence, I believe John meant it the other way round, whether the decision to put the records online is justified by the benefits. A good question.
As to the time and effort to get the records online, the patient keying in all their own data is about as likely to happen as the patient putting those same records into 3-ring binders or onto their PC - in other words, less likely than being struck by lightning or being involved in an airplane-bicycle collision. But that's not how it's going to work.
I think there will be two ways services like Google Health and
Microsoft HealthVault will be employed. First, the service will provide
a portal into existing health system data stores, as Cleveland Clinic
(CC) does with Google Health. In this case, the care provider's records
are the source of truth, and the portal merely mirrors the data on CC's
The patient can also upload data, either by typing it in, importing it from other sources that provide feeds, like pharmacies, and/or by feeds from devices like pedometers or other wearable Bluetooth-enabled sensor devices. It will be ideal to have the online service channeling data from one source to another, e.g., from the pharmacy to the hospital or clinic, and that will happen eventually. I don't know if patient-entered data on Google Health is visible in CC's Epic system, but I hope it does, and I know it will eventually if it doesn't yet.
I predict that the second way SaaS EHR services will be employed is
by small, cash-starved private practices and community clinics that
can't afford an EHR of their own. I think there will very soon be
add-on services that provide the other components of practice
management, such as scheduling, billing, and reconciliation with
In keeping with the trend for online SaaS coming from Google and
other major online service providers, I believe these services will be
inexpensive or perhaps even free to the primary care practitioners
(PCPs), except perhaps as a small surcharge against their insurance
billings. But the speed and accuracy such SaaS systems will provide
will more than make up for the surcharge. The automated link with other
players in the healthcare arena, such as the pharmacies, will raise the
standard of care by providing more evidence of a patient's compliance
with her/his medication regimen.
In either case, it will be a long time before the healthcare providers give up their own recordkeeping systems. If ever. And the big barrier to my second scenario is getting the patient's records into the EHR, whether in the physician's office or out in the computing cloud.
To me it seems like an awful lot of trouble and at least a little bit of risk for a modicum of convenience. Will having these records online really make me any healthier? Will the act of storing them in the cloud make me exercise more, lower my cholesterol, watch my blood sugar and control my blood pressure? I don't see why if I wasn't already following my doctor's advice.
Actually, the benefit would be that the doctor would have a fighting chance of knowing whether you actually are following her advice. Maybe not at the outset, but soon. And as pervasive biomedical sensor systems become more commonplace, she will know how you are doing between visits at a level that is next to impossible to achieve at present.
Will my doctors make better treatment decisions for me? That hardly
seems likely, since they already have their own copies of my records in
their files, whether they are paper or electronic.
The content of John's healthcare providers' records is overrated. First, just because it's there doesn't mean it's accessible, especially if we're talking paper-based recordkeeping. Moreover, if multiple doctors' offices are involved, as is often the case, there are multiple copies in different and often mutually inaccessible places. Good luck keeping them in sync.
But more importantly, Google Health and Microsoft HealthVault represent the dawn of an era in which someone finally provides the virtual glue that binds our fragmented healthcare system together. The likelihood that his healthcare providers - PCPs, hospitals, pharmacies, among others - share a common recordkeeping system is remote. Yes, Kaiser Permanente does have such a system, but they're an exception to the rule at this point.
If these SaaS systems can provide the nexus through which each of these can "see" the records of the others, or the pertinent parts thereof, we are on the way to a comprehensive healthcare system.
Dare I say "universal" rather than just comprehensive? Because ultimately, a universal system is the only one we will ever be able to afford.