By Ellen Perlman, Governing.com
Call it the Google lift or the Microsoft bump. This spring, these tech powerhouses announced they were entering the field of personal health records, and that has energized other players in the field. It also has set many in the health IT community to thinking: Will the presence of these Internet giants provide the oomph needed to turn the corner on converting patients' paper medical records into a digital system that connects hospitals to doctors and other providers of health care?
Electronic health records, those digital "medical folders" created and kept mainly by doctors and hospitals, have long been seen as the basic building block of such a system -- one that could wring billions of dollars out of health care spending and enhance its quality and efficiency.
But the quest to get medical practitioners beyond paper charts and records has been slow. In the past five years, pockets of physicians, hospitals and other providers have begun to convert their files, but most still need some arm twisting -- as well as a financial incentive and technological boost. At the same time, states have been toiling away at building health information exchanges -- the technological backbone that would facilitate the sending of a patient's electronic records among health care facilities and providers.
In all this, one key group has been overlooked: the patients themselves. It's into that void that Google, Microsoft and other entrepreneurs are marching, offering consumers a way to collect their own medical information and keep it online where they have easy access to it -- and where the patient, and only the patient, decides who else can see it.
The recent interest by these companies in patient-designed e-health records has "pushed us to think differently" about an electronic health record system, says Janet Marchibroda, chief executive officer of eHealth Initiative, a Washington, D.C.-based non-profit. "Things will run faster because of their presence. We will think in ways we've never thought about."
The presence of the giant Internet companies, in other words, should stir things up. While issues of privacy, standards and connectivity remain, many of the players working on EHRs may be inspired to see a way of sorting them out.
A Confidence Builder
The idea behind personal health records, or PHRs, is that they could enhance the accuracy of a patient's health information and make it portable.
Some major companies, such as AT&T, Intel, Pitney Bowes and Wal-Mart, make PHRs available for their employees, and many insurance companies do the same for their policyholders. Nationally, however, relatively few people use them. Only 2.7 percent of 1,600 people surveyed this May by the Markle Foundation have gone to the trouble of starting a personal health record -- even though nearly 80 percent saw benefits. The majority of those who failed to set one up cited worries about privacy and confidentiality.
Publicized hack-ins to large databases -- of businesses and government agencies -- make people wary of putting their personal information into a huge database. Those with employer-based options may worry about their bosses gaining access to personal information. Ditto PHRs with health insurance companies. Unfortunately, federal privacy protections do not extend to PHRs offered by private companies. Generally, only health care-related entities fall under health privacy laws known as HIPAA. Clearly, unless users feel their medical information is safe from prying eyes, they will not feel comfortable creating a personal health record.
Beyond questions of privacy are issues of standards and connectivity. While consumers enter much of the information into their own personal health records, they also depend on other sources, such as laboratories, to provide test results electronically.
The smooth flow of data, and standards for sharing that data, are still works in progress, but there have been several significant steps forward. In July, dozens of technology companies, providers, health insurers and consumer groups endorsed a set of practices for personal health records. The framework addresses technology and policy approaches for such things as how consumers will get and control health information about them; how they will authorize the way that information is shared; and privacy and security practices. Among those promising to use the practices were Dossia, a company that provides PHRs for private employees; Google; and the association representing health insurance plans.
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