The push for online medical records is on. The government, insurers and employers want your medical information in electronic form. Hospitals, doctors and yes, patients also have an interest in the process. But, who will (or who should) control your health care information — you ? your doctor ? your employer ? your insurance company ? the government ? Or all of the above ? And what form will the electronic system that records and stores (and then regurgitates..) your data take? The potential benefits are many, but the risks are also substantial, both for the individual, and for the society as a whole.
The health care industry has been one of the last holdouts in the electronic age. How do you objectify the degree of pain in your shoulder and compare it to your neighbor’s. Doctors as a group are viewed as Luddites when it comes to embracing electronic medical records, but the reason is simple. There has yet to be developed a system that records and presents medical information in a form that is useful to the way physicians use information. The government wants coded data that Medicare can use to decide whether or not to pay for a medical procedure, insurers want to be able to compare physicians as far as ‘cost effectiveness’ and patients in terms of actuarial risks, and employers want data that can help them track which employees are potential health (and therefore job) liabilities. Since those groups ‘pay’ for health care, they want the record structured for their information needs.
Unfortunately, that does not often track with what a doctor or patient needs to adequately monitor and improve health status. Many of the currently available electronic record systems require that the health care providers become a data entry clerks, and even if the motivation of ‘reducing medical errors’ is the rationale, the available systems are burdensome and time consuming to the health care provider. Many may not improve the quality of the care delivered. Also, patients are not able to review or correct errors in the record either.
These are a few reasons why health care has been difficult to bring into the electronic age. The groups that benefit (the government, insurance industry and employers) are not directly concerned about care of the patient, and the health information systems they want is not of direct benefit to either the doctor or the patient. What is being held out as the ideal electronic medical database by those in government and industry has little to do with what you or your doctor need to truly improve your health.
So what are alternatives? What about a doctor and patient focused electronic record?
Several months ago, Google gave some hints on its personal health intentions when some screenshots of a prototype were inadvertently released. While nothing shown is dramatically different from ideas which have surfaced previously, the shear scope of what might be accomplished through a private, personal Google health websites is intriguing.
Imagine if you had personal health pages on iGoogle . iGoogle is a service which allows consumer to create a personalized webpage. But iGoogle is rapidly becoming much more than that, and is on its way to becoming a fully functional software platform. With iGoogle you can create a number of individual tabs which can become a topic specific environment where one can add various “Gadgets” of one’s choosing from a vast library within the iGoogle Gadgets site.
For example, if one has a chronic condition such as diabetes or heart disease, tabs might automatically be generated for ‘gadgets’ as diabetes news/research feed, a diabetes monitoring application that retrieves data from a glucometer, a nutritional guide for cardiac diets, a drug interaction alert tab, etc. A mother could track her children’s health. Tabs could represent each child or family member and within each tab, many more services could be offered beyond usual templates of a medical history. Tabs could also include advice on dealing with a teenager’s emotional swings, or alerts you when family when vaccinations are due, or when a husband’s colonoscopy should be considered. Home monitoring of blood sugar levels, blood pressure readouts, daily weights and exercise logs could be entered or automatically generated.
The individual could allow their doctor access to the pages so that he/she could review the data. The health care provider could then add recent laboratory results and specialty consultations, or make health recommendations, suggest web links, and even referrals or prescriptions could be generated. Feedback provided in an ongoing, interactive fashion would be a benefit for both patient and doctor.
Another effort in this direction is the Dossia project. Dossia was started by an industry consortium trying to produce a Web-based infrastructure that automatically provides an electronic summary of an individual’s medical history from many sources – doctors, pharmacies, employers and insurance companies to name a few. The thrust of the project is a personally controlled, private, secure and portable health record. The individual alone is able to include or exclude that information in the Dossia database and can decide what information may be shared with others. An individual’s record may include problems, medications, procedures, tests, allergies, family history and many other types of health information. The idea is to create a centralized record that will be constant regardless of changes in physician, employer or location. Watch a video about Dossia.
And of course, Microsoft has it’s hand in nearly every venue. The Microsoft HealthVault project offers similar web-based health records options, but has the additional perk of having software device drivers for a number of home monitoring devices, so your data can be directly uploaded to the HealthVault site. Since personal entry of data is both time consuming and prone to errors, such technology facilitates the accuracy and ease of use of the site. Watch a video about HealthVault.
Certainly a major concern with all of these efforts is privacy and data security. You may not want your employer to know that you had a hospitalization for a serious episode of depression a few years ago, or that you are currently taking Campral. Preventing unauthorized access to records is a formidable, but not insurmountable problem, and will need solutions before such efforts can be trusted for general use. One thing is certain – things are bound to change, because the present paper based health care system cannot survive in its present form.