[Med-privacy] privacy & EMRs

[Peter Marshall]

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Medical records come to the Web
Firm touts benefits of patients putting health histories online

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By Sarah Rubenstein
The Wall Street Journal
May 15, 2005
  =A0

For all of modern medicine's advances, most physicians still rely on=20
pen and paper to record and track their patients' medical histories.

Although doctors often are painted as being computer-averse, there are=20=

even bigger reasons why the digitization of medical records is in its=20
infancy: entering mountains of bulging medical charts into computers is=20=

daunting and expensive. Many of the systems that exist don't talk to=20
each other. And while some patients want the convenience and safety of=20=

having all of their medical information in one accessible place online,=20=

that prospect makes others worry about privacy.

Now, a for-profit company affiliated with the American Medical=20
Association is offering a near-term step toward wiring up at least some=20=

of the nation's archaic paper medical system. Medem Inc. last week=20
unveiled an Internet-based "personal health record" that patients can=20
use to organize their family's medical histories, much as they might=20
electronically manage financial records or bank accounts.

Available free of charge at www.ihealthrecord.org and on participating=20=

doctors' Web sites, the program helps patients record emergency=20
contacts, insurance, and medical information such as conditions,=20
medications and allergies. Patients access their records online using a=20=

password, and they can provide access to doctors, hospitals or loved=20
ones: In case of an out-of-town emergency, for example, a husband could=20=

provide hospital staffers with his wife's password to expedite=20
treatment; patients seeking second and third opinions could provide=20
their password to new doctors to get them quickly up to speed.

Medem hopes that by stoking consumer interest in the system, patients=20
will encourage their doctors to switch from paper charts to computers.

The health care industry is under increasing pressure from the=20
government, insurers and patient advocates to go digital. President=20
Bush has called for all Americans to have electronic records in the=20
next decade, and many physicians believe the quality of health care=20
would improve, with fewer medical errors and less burden on patients to=20=

keep their own records.

Indeed, many doctors say they would welcome a tool to help patients=20
prepare for their first doctor's visit. "I'd love people to fill in the=20=

blanks before they came in to see me," says David C. Kibbe, director of=20=

the American Academy of Family Physicians' center for health=20
information technology. "It's much better than them bringing in a paper=20=

bag of bottles."

The push to go electronic

At present, a hodgepodge of sources -- from employers to insurers to=20
private-sector companies -- are experimenting with programs for=20
digitizing medical records. Among iHealthRecord's early rivals are=20
WebMD Corp.'s WebMD Health and Access Strategies Inc.'s FollowMe, which=20=

charge patients to maintain online personal health records. Some=20
employers, such as PepsiCo Inc., are offering secure, Web-based=20
personal health record programs to their employees.

But with so many new programs, no single format is yet attracting a=20
critical mass of users.

Beyond personal health records, which are maintained principally by=20
patients, an important goal of health information technology proponents=20=

is to convert doctors' offices to electronic medical records that let=20
them maintain detailed charts, notes, lab tests and other patient=20
information electronically. Ideally, EMR technology can communicate=20
with the computers of pharmacies, insurers, other doctors and=20
hospitals.

Right now, many hospitals and large health provider groups that own=20
both hospitals and doctors' offices are switching to electronic=20
records. But in most cases, differences in technical standards have=20
kept them from interacting with other providers outside their own=20
networks. For doctors, the costs of making the switch from paper=20
records can be prohibitively expensive; only about one-third of large=20
practices have EMRs, and fewer than one-tenth of small-group and solo=20
practices have adopted them, according to the Markle Foundation, a New=20=

York nonprofit that focuses on information technology and public=20
policy.

They are still pretty expensive, says the family-physician academy's=20
Dr. Kibbe. And "it still requires, in some cases, more time to use=20
these systems than it does to document on paper."

Medem, founded by the AMA and six other medical societies in 1999, may=20=

be in a position to gain a high level of awareness and trust from=20
doctors and patients. The service has hit the ground with 50 physicians=20=

promoting it to patients as part of a pilot run. About 90,000=20
physicians currently pay as much as $25 a month to subscribe to Medem's=20=

other services, which include Web sites for their practices and=20
doctor-patient e-mail capabilities. Medem plans to offer its subscriber=20=

doctors an iHealthRecord link for their Web sites at no extra charge.

Medem is offering some other perks to doctors and patients using=20
iHealthRecord. It will send patients information from the Food and Drug=20=

Administration, the Centers for Disease Control and Prevention and=20
other groups about drug recalls or other issues related to their=20
particular medications or health conditions.

Privacy concerns abound

Still, the service faces obstacles, not the least of which is assuring=20=

patients that their medical histories won't be accessed by hackers or=20
sold to employers or insurance companies. Privacy is "still a major=20
issue, and really, it's the largest obstacle in terms of trying to move=20=

into health information technology," says Emily Stewart, policy analyst=20=

for the nonprofit Health Privacy Project in Washington.

Unlike those controlled by doctors and insurers, third-party Web sites=20=

generally aren't bound by federal patient-privacy laws, says Paul Tang,=20=

chief medical information officer at the Palo Alto Medical Foundation,=20=

a large group practice in California that has its own electronic=20
record-keeping system and Web site, where patients access records, such=20=

as lab test results.

Edward Fotsch, Medem's chief executive, says the company has modeled=20
iHealthRecord's security measures on the financial-services industry,=20
encrypting data and hiring an outside security company to conduct=20
audits. Medem won't sell medical information to insurers, employers or=20=

pharmaceutical companies, although it may make aggregate data available=20=

to public health researchers. "That's not our business model," Fotsch=20
says.

Success may rest with M.D.s

Among other safeguards, the iHealthRecord site will indicate to=20
patients the time of their last log-in, making it easier for them to=20
tell if someone else has accessed their records. Later in the year, the=20=

site plans to send patients automatic e-mails telling them when anybody=20=

has logged on to their records.

Records maintained by patients are only as good as the information they=20=

put in. Ultimately, iHealthRecord's success may hinge on how easily=20
doctors can use their own electronic record-keeping systems to update=20
patients' records with the latest lab reports and test results. Only=20
one vendor of EMR systems, Chicago-based Allscripts Healthcare=20
Solutions Inc., has started enabling its technology to exchange data=20
with iHealthRecord; two others have said they plan to do so, Medem=20
says. Doctors could manually update patients' records, but until they=20
can electronically pour in such information, the usefulness of personal=20=

medical records may be limited.

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