Weighing the Pros and Cons of Online Medical Records

A week or so ago on the eWeek site, John Pallatto posted an article entitled 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 Epic system.

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 third-party payers.

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.

John again:

 

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.

 

Comments

[Scott Smith]

I read with great interest your blog about Patient Health Records (PHRs). MyMedicalRecords.com (MMR) is an advanced PHR and an Integrated Service Provider on Google Health.

Using MMR, complete patient records can be easily faxed, voiced, or uploaded into a password-secured, web-based account. An emergency log-in feature also allows access to your critical medical information in the event of an emergency, and it has a drug interaction database for prescriptions, as well as many other features.

Perhaps you and your readers would like to test drive MMR by signing up for 30 days free using the promotion code TRYMMR.
Scott Smith
Director of Public Relations
MyMedicalRecords.com
ssmith2@mmrmail.com
10100 Santa Monica Blvd #430
Los Angeles CA 90069
888-808-4667 ext. 123

[Dirk Van Slyke]

Great dialogue on personal health records. We are a manufacturer of medical ID jewelry, which is intended to provide the most important information necessary in an emergency to first responders. It is low-tech, yet highly reliable since first responders are trained to look for medical IDs. This is critical for many who live with chronic diseases like diabetes, heart disease or allergies, or who may be taking delicate medications like a blood thinner. Prompt diagnosis and treatment is critical to reduce the chance of errors or long term complications.
However, we feel that personal health records are a valuable tool for any individual who wants to take control of their health. Currently you may have health records residing in many places, from your primary care physician, to your health insurance provider, to your employer to any clinic or ER you have visited. Most of these do not coordinate or “speak to each other”. And over time, as people change jobs, change health care providers, change physicians as they move or see specialists, these files rarely travel with you so you start over each time. There is a tremendous value in being able to put all your health files into one location, where you control what goes into it and you control who sees it. And it is incredibly valuable to your health care providers because they can get a more accurate picture of what’s going on with your health, and can view what is happening over time.
The next question is of course who should house these records. From many surveys I have seen, people do not trust the government to provide them, or their employer, or even their managed care providers. Even Microsoft and Google want to do it because they want to sell advertising.
We offer a personal health record application, our Online Medical Registry, free for life for our customers that purchase a medical ID for us, or for a one-time fee. This is a great option to store your records in one location that can be accessed easily. Lots of other options exist, such as the paper binders, but what if you don’t have that binder with you in an emergency? And a medical ID in coordination with a PHR is a great way to make that information accessible in an emergency.
We often get asked why we do not charge a monthly fee, like most of the providers out there. Basically, it’s not that expensive to house the information once the system is built. But foremost, we believe that a medical ID is the first line of defense in an emergency, and a PHR is a wonderful option that should be used as a secondary tool, and carefully due to patient safety and security.

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[Adam]

Many individuals do not realize that there are many benefits of obtaining medical records and immunization records. Medical records and even immunization records can give you, and various types of medical professionals, an accurate snapshot of your medical history. By obtaining a copy of immunization records, you can easily benefit in that you know exactly what diseases and conditions you have less of a chance of developing. It is important to also keep up with the updates in order to ensure proper defenses from various types of medical conditions, as well as infectious diseases. EMR's are becoming very popular nowadays.