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"Internet medical records"
http://www.ama-assn.org/sci-pubs/amnews/pick_99/biza1108.htm
> [AMNews] [American Medical News]
> ----------------------------------------------------------
> BUSINESS & TECHNOLOGY
Permanent record
Allowing patients to post their own medical records on
> the Internet is becoming big business.
> Markets
> [*]Opinion By Howard Larkin, AMNews correspondent. Nov. 8, 1999. -
>
> One Saturday afternoon was all internist Sam J. Sugar,
> [*]Business MD, needed to prove to himself that using an Internet
> & Technology site to store patients' medical records was a good idea.
> Over the summer, Dr. Sugar went to an Evanston, Ill.,
> [*]Health & emergency department for treatment of acute pain due to
> Science complications from recent surgery. "I was taking
> intravenous pain medications, and then they wanted me to
> E-mail alerts answer a bunch of questions about my medications,
> Past issues dosages, recent treatments," he recalled. "I was in no
> Reader condition to remember that."
> services
> Staff To make things worse, the staff at Evanston Northwestern
> directory Hospital, where he had had his surgery, couldn't find his
> Feedback paper chart.
> And Evanston Northwestern was the hospital where, at that
> time, Dr. Sugar was medical director.
>
> So Dr. Sugar reached into his wallet and pulled out his
> ID card for 4Healthylife.com, an Internet-based
> electronic medical records service based in Evanston. Dr.
> Sugar founded the site, which allows patients to enter
> their own medical histories. "Unwittingly I became the
> first beneficiary of my own system," he said.
>
> Ten minutes later the ED staff had Dr. Sugar's entire
> medical history, he says. "The nurse said, 'This is cool.
> Where did you get this?' "
>
> Birth of an industry
>
> Dr. Sugar's service, which became available to the public
> in October, is just one of many Internet electronic
> medical record services launched in the last few months
> or about to come online.
>
> Individual physicians, entrepreneurs and large
> corporations, including Internet medical information
> giant drkoop.com, are spending from thousands to as much
> as several million dollars rushing into this totally
> untested market.
>
> The founders of these sites believe that Internet medical
> records create a unique opportunity for physicians to
> learn more about their patients and then, on the other
> side, for patients to get more involved in their own
> care.
>
> The field is so new that no standards exist for how
> online records services operate. The early entrants vary
> widely in how much and what kind of information they
> collect, what purpose the information is intended to
> serve, how it can be accessed and whether physicians or
> patients maintain the record.
>
> In addition, fundamental questions about Internet
> security and reliability remain, despite the sites'
> claims that it's easier for some unauthorized person to
> fish your medical record out of a storage room than out
> of a Web site.
>
> Nonetheless, Internet medical records will be a big
> business, predicts Steve Savas, a health care and
> technology analyst for investment bankers Goldman Sachs
> in New York. One firm, PersonalMD.com, based in
> Pleasanton, Calif., claims it has signed on 50,000
> members since its March launch.
>
> "It's an emerging market, but down the road I think we
> could see annual revenues in the $3 billion range," Savas
> says.
>
> One reason is that universally available medical records
> could significantly reduce overall medical costs by
> eliminating redundant testing and unnecessary hospital
> admissions, Savas says.
>
> The search for a portable record
>
> The Internet may be a new place to store medical records,
> but the idea of having an easily accessible, portable
> record is not new.
>
> For years, military personnel have carried their complete
> paper medical history with them as they moved from billet
> to billet. "You had a lot of confidence that the doctor
> knew your complete history when you went into the doctor
> at a new station," says emergency physician Wayne
> Pasanen, MD.
>
> Dr. Pasanen spent three years as a medical officer in the
> Navy and is now medical director of Vitalworks, a
> Norwood, Mass.-based online medical records company; he's
> also chief of the ED and vice president of medical
> affairs at Lowell General Hospital in Lowell, Mass.
>
> Portable records are primarily used for emergencies.
>
> Since 1956, the nonprofit MedicAlert Foundation has
> provided bracelets and pendants alerting emergency
> personnel of patients' medical conditions. MedicAlert
> serves about 2.3 million members in the United States and
> has affiliates in 12 countries overseas.
>
> Other non-Internet emergency medical records systems
> entail simply carrying a card with medical conditions,
> medications and dosages, allergies, and a copy of an ECG
> in the wallet or in a pendant around the neck. Some
> communities, such as Sun City, Ariz., have portable
> medical information forms for seniors that include both
> clinical data and advance directives.
>
> Who owns the medical record?
>
> To those operating Internet patient record sites,
> expanding onto the Web is a natural extension of these
> earlier efforts. The Internet provides an easy way to
> update and view records, and having an online record
> available can cut down the time physicians spend asking
> basic questions about a patient's history.
>
> "What that does is it empowers the doctor to get timely
> information and empowers the patient to schedule his time
> more efficiently," Dr. Sugar says.
>
> Many of the new Internet record services focus on basic
> emergency information, but some go much further, adding
> information on diet, exercise and content on managing
> specific diseases. Dr. Sugar's site even has a place to
> keep your pet's health record.
>
> While many rely on patients to provide content, some
> request records directly from physicians. The most
> sophisticated systems get information directly from
> physicians' electronic medical records.
>
> Whether patients or physicians provide information for
> the record is a subject of often intense debate.
>
> Some, such as Dr. Sugar and emergency doctor Scott
> Cameron, MD, who operates Albuquerque, N.M.-based
> StatChart.com, argue that what patients can provide is
> sufficient, and may even be more accurate than doctors'
> notes.
>
> "From the ER point of view what we want is an old EKG and
> what medications he is on so I don't kill him," Dr.
> Cameron says. "We want to get enough information so it is
> usable, but not make it so complex that the patient can't
> enter it."
>
> Cardiologist Michael Kenner, MD, medical director for
> Phoenix-based MedRecsExpress.com
> (www.themedicalrecord.com), has a slightly different
> view. Even though his system is designed primarily for
> emergency use, he tries to get copies of original
> physician records to transcribe or scan into his system.
>
> "We can't verify that the test is correct, but we can
> verify that what we have in the record is what we
> received," Dr. Kenner says.
>
> Others, such as internist Blackford Middleton, MD, senior
> vice president for medical informatics at MedicaLogic, an
> electronic medical records firm based in Hillsboro, Ore.,
> believe that physicians must have primary responsibility
> for maintaining records if they are to be really useful.
>
> "As a doctor, accuracy is the critical issue," Dr.
> Middleton says. "If a patient brings in a ream of
> information, I read it, but it is not an authentic
> medical record. It is not a diagnosis."
>
> MedicaLogic is testing an Internet-accessible patient
> module for its electronic medical record. The record is
> automatically updated as notes and test results are
> entered by the physician. Patient notes also are
> included, as are notes from specialists who also use a
> MedicaLogic records system.
>
> No matter who it is that maintains the record, having the
> patient record available on the Internet represents a
> significant shift in ownership of the record from
> physician to patient.
>
> That's good, says internist Thomas Booth, MD, vice
> president of medical affairs at PersonalMD.com. "It makes
> patients more aware of health and more proactive in
> improving their health care," he says. "It allows
> physicians to do some preventive care instead of just
> intervening when something goes wrong."
>
> Analyst Savas believes that systems that link to
> physicians' records ultimately will become the standard
> because they will be more useful. But there are
> significant obstacles, not the least of which is
> physician resistance to using electronic records, that
> must be overcome before Internet medical record use
> becomes widespread.
>
> But is it secure?
>
> A perceived lack of security of Internet medical records
> may be another obstacle to widespread use. Yet those
> involved in Internet records believe that, if anything,
> they are more secure than paper records.
>
> Dr. Pasanen points out that Vitalworks goes to great
> lengths to protect its records, as do other systems.
> Identification numbers are required to access patient
> information, which is sent over the Internet in an
> encrypted form, meaning it would be garbled if somebody
> intercepted the information.
>
> Most systems also encrypt their databases so that if a
> hacker got in, they would still have to break the key to
> make sense of the information inside. Database encryption
> also prevents workers from accessing information.
>
> Still, some possibility exists for breaching Internet
> records. "The technology is getting better, but it will
> never be perfect," Dr. Middleton says.
>
> The other threat to security is through the record
> systems themselves assembling and selling data. All of
> those interviewed had policies not to sell or distribute
> patient information in any form, or only to allow access
> to records of patients who have expressed interest in
> participating in research through the records service.
>
> "We would be cutting our own throats if we released the
> information," Dr. Pasanen says.
>
> An old dog learns a new trick
>
> MedicAlert has its own concerns about the Internet. It
> wonders not only about confidentiality, but also about
> accessibility.
>
> "Now, any emergency responder can reach us," says Douglas
> Trigg, senior vice president of Trulock, Calif.-based
> MedicAlert. "You don't need Internet access, just a
> phone."
>
> But that won't stop MedicAlert from considering expanding
> its services to the Internet.
>
> As the world's largest supplier of emergency medical
> information, it hopes to give upstart Internet rivals a
> run for their money, Trigg says.
>
>
> ----------------------------------------------------------
>
> FOR THE RECORD
>
> An increasing number of companies are letting patients
> store their medical records on the Internet. A sampling
> of the strategies some companies use:
>
> 4healthylife.com
> Allows patients to input their own records. Also allows
> people to input records for their pets.
>
> MedicaLogic Logician
> Linked to MedicaLogic's electronic patient record system.
> Site is updated automatically as physician enters new
> information on a patient's record.
>
> Statchart.com
> Patients may input their own record. Designed primarily
> for use by emergency physicians when they have a patient
> who is unable to communicate.
>