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Medical Records News
Researchers say increasing patient
control of health records could impact how medical research is conducted.
The New York Times (4/17, C11, Lohr) reports that in a New England Journal of
Medicine article, Drs. Kenneth D. Mandl and Isaac S. Kohane "warn that the entry
of big companies like Microsoft and Google into the field of personal health
records could drastically alter the practice of clinical research and raise new
challenges to the privacy of patient records." The researchers express concern
"that the medical profession and policy makers have not begun to grapple with
the implications of companies like Microsoft and Google becoming the hosts for
vast stores of patient information."
According to HealthDay (4/16, Preidt), the researchers said that "the shift to
personally controlled health records (PCHRs) will give patients and doctors
easier access to records during clinical care and will also have a major impact
on the conduct of biomedical research." According to the authors, "Giving
patients access and control over their medical records will unlock a whole new
world where researchers will suddenly be able to recruit hundreds, thousands,
possibly millions of patients from all over the world, and have access to new
data sets and populations."
CDC offers government panel recommendations on personal health record
adoption.
Healthcare IT News (4/16, Manos) reported, "Members of a federal healthcare IT
advisory panel workgroup considered recommendations Tuesday from the Centers for
Disease Control and Prevention on how best to push personal health records."
Agency officials told "the Consumer Empowerment workgroup of the American Health
Information Community (AHIC)" that they should "begin by conducting market
research to determine potential personal health record (PHR) user needs,
preferences and concerns." Additionally, CDC recommendations included "determin[ing]
who is actually using PHRs, us[ing] social media, or interactive online methods,
to engage existing and potential PHR users," and testing "PHR promotion plans on
blogs to find out public reaction."
Google, Microsoft health records
programs highlighted at health-technology conference.
The Washington Post (3/11, H1, Stoltz)
reports that "Personal health records, or PHRs, were
all the buzz at last week's health-tech conference in
San Diego -- especially recent entries by Google and
Microsoft that have the rest of the industry energized,
focused, and at least a little bit frightened."
Moreover, a number of other "companies presented online
products designed to make U.S. healthcare smarter,
stronger, and better looking," including a "plan to
offer online doctor consults at $1.99 per minute, a
provider search tool pitched as 'the match.com of
healthcare,' and an electronic medical record that made
you want to bask in the sheer beauty of ear infection
data." But Bill Reid, director of Microsoft's
HealthVault program, wondered if "the effort to
integrate information technology into personal
healthcare" would be a "long journey," and an exercise
in complexity. The Post notes that "[b]ased on the
conference...it may be both."
Aetna to unveil online patient
health record service.
The New York Times (3/12, C4, Freudenheim)
reports, "Aetna plans to announce Wednesday a new
service that draws upon a patient's own medical history
to help answer questions about symptoms and treatments."
The new SmartSource service, which "has been tested by
the company's 35,000 employees," will be offered free of
charge to Aetna enrollees. The insurer "hopes the
service can help it recruit and retain
employer-customers worried about the costs of care."
Currently, other offerings by WebMD, Google, and
Microsoft also "let consumers link electronic medical
records and online research." However, with all of the
services, a main difficulty has been "widespread
reluctance to share health information that might fall
into the wrong hands or be abused, affecting job
opportunities and insurance premiums." Health technology
analyst Mike Davis said, "The underlying challenge is --
'Do you trust the insurance companies?'"
EHR adoption still low among
physicians, hospitals.
The Baltimore Sun (3/2, Kohn) reported that over the
past twenty years, "electronic health records (EHRs)
have been the Next Big Thing in healthcare: a way to
simultaneously improve care and reduce waste in a system
clogged with paper and manila folders." To date,
however, "90 percent of U.S. doctors and more than
two-thirds of U.S. hospitals still use paper for patient
records." According to David Merritt, director of the
Center for Health Transformation, a think tank based in
Washington, "Healthcare is at least a generation behind
the rest of society in terms of technology." While
"almost everyone agrees that moving from paper to bits
will improve healthcare," progress in this area has been
hampered by "a colossal, inertia-filled health care
system, a paucity of good software, no incentives to
adopt new technology, and a lack of government
leadership." In addition, there is concern that
patients' personal data may be vulnerable to hackers.
Despite these concerns and drawbacks, Government Health
IT (2/29, Moore) reported that "New York City officials
said a two-year-old project to deliver electronic health
records (EHRs) now has 200,000 participating patients,
and aims to reach more than one million people this
year." According to Mayor Michael Bloomberg (I), "200
providers have signed on to use the EHRs, and more than
1,000 are expected to join by the end of 2008." Should
New York City meet that target, the city will have the
"largest community network of EHRs" in the U.S., Mayor
Bloomberg noted.
Florida high court widens patients'
access to records.
Modern Healthcare (3/7, Evans) reported, "Florida's
Legislature wrongly denied patients' access to
medical-error and incident records made available after
voters amended the state's constitution in 2004,"
according to a ruling by the Florida Supreme Court. The
ruling stated that "[p]atients may access records
created prior to Nov. 2, 2004, when the amendment became
effective." In the court's 4-to-3 ruling, the justices
"cited a lower court judge's conclusion that the
constitutional amendment: 'heralds a change in the
public policy of this state to lift the shroud of
privilege and confidentiality in order to foster
disclosure of information that will allow patients to
better determine from whom they should seek healthcare,
evaluate the quality and fitness of healthcare providers
currently rendering service to them, and allow them
access to information gathered through the self-policing
process during the discovery period of litigation filed
by injured patients or the estates of deceased patients
against their healthcare providers.'"
Study suggests trauma patients
treated in EDs may be exposed to enough radiation to
boost cancer risk.
Reuters (3/4) reports, "Trauma patients treated in U.S.
emergency" departments (EDs) "on average are exposed to
radiation equivalent to 1,005 chest X-rays each, enough
to raise their risk of cancer," according to a study
published in the Annals of Emergency Medicine. Dr. James
Winslow, of Wake Forest University in North Carolina,
and colleagues looked at the "records of 86 patients who
came to a level one trauma center over a three-month
period." The researchers found that while the "average
person living in the United States receives about three
millisieverts of background radiation" annually, the
patients in the study received an average of 40
millisieverts.
New York City announces plan to
help doctors use electronic medical records.
The New York Times (2/26, B3, Santora) reports, "After
two years of planning and a public investment of more
than $60 million, Mayor Michael R. Bloomberg (I) said on
Monday that New York City was ready to equip doctors
with computer software that can track patients' medical
records in order to provide better preventive care." The
new "software package [was] developed with $30 million
from the city and roughly $30 million from the state and
federal governments, [and] would let doctors do much
more than is possible with paper charts by integrating a
patient's medical history, lab results and current
medications into one electronic interface." According to
city officials, "the system will give up-to-date
information to doctors through a series of alerts, like
overdue dates on prescriptions or cholesterol checks,"
and will also "share data with other doctors and provide
information about the current best practices for
treating illnesses." The goal is "to have 1,000 doctors
with one million patients using it by the end of the
year."
Georgia seeks to be one of 12
regions to test electronic medical record system.
The Atlanta Journal-Constitution (2/21, Hendrick)
reports, "Georgia is seeking to be one of 12 'demo
sites' for a $150 million pilot federal program to
provide money to some physicians to set up electronic
health records systems." On Wednesday, Gov. Sonny Perdue
(R) appeared with Health and Human Services Secretary
Michael Leavitt, "who came to Georgia to explain the
program." According to Leavitt, the government is
seeking to "'make healthcare lower cost, better quality
and less [of a hassle]' and that making health records
universal and accessible would accomplish those goals."
He added that "the federal government will decide which
12 regions get grants by this fall," and every region
"selected will get between $12 million and $15 million"
to use for the electronic record system. The Bush
administration "has called for a universal electronic
medical system to be in place by 2014, a timetable many
analysts say is unrealistic."
Additional Links:
Transforming Health Care: The President’s Health
Information Technology Plan
Press Releases
You may want to search for
topics by keyword.
PDF:
MyMedicalHistoryOnline.com Announces Launch of Medical Records Retrieval
Service
A recent article in the New York Times
“Many Doctors, Many Tests, No Rhyme or
Reason” reminded me of the distorted
financial incentives that permeate the
practice of medicine in the United States.
In the article, the author, a NY
cardiologist states, “In our health care
system, where doctors are paid piecework for
their services, if you have a slew of
physicians and a willing patient, almost any
sort of terrible excess can occur.” He then
goes on to detail the evidence of excess
both at a national level and on an anecdotal
basis.
Unfortunately, I have
to concur with his bottom line conclusion:
“Doctors are doing too much testing and too
many procedures, often for the sake of
business. And patients, unfortunately, are
paying the price.”
This article reminded
me of my own early experiences in the
hospital. I remember as a third year medical
student I commented to one of my classmates
that my internal medicine hospital rotation
was so easy! All we did was call consults
every morning based on all the abnormalities
we found on the labs and imaging from the
day before. Okay – so I’m being a bit glib
and over-exaggerating. But I do remember the
conversation and sentiment very distinctly.
I felt like we spent a lot of time asking
for consults when maybe they weren’t
necessary. But then again – I was a naïve
third year medical student with no
experience. What did I know?
But I have to say, I’ve
had those same nagging feelings through the
years – that utilization of consults and
testing is driven by financial incentives;
maybe even “throwing a bone” to one of your
medical colleagues. Where I did my
internship, many of the medicine patients I
took care of on the wards were either
uninsured, underinsured or within an HMO
model. In that situation, where there really
wasn’t the willing patient (or matching
reimbursement) I felt we were a bit
judicious and restrained in our testing and
consults. But in other environments where I
have practiced, where patients were more
generously insured, I definitely have felt a
trend towards overutilization and
unnecessary testing.
So what is a patient
supposed to do in an environment of
distorted incentives for testing and
work-up? Some solutions will hopefully come
from our site,
MyDailyApple. Over the next several
weeks, we will be introducing a set of
content, features and tools on MyDailyApple
to assist patients with understanding the
world of medicine and to take action with
managing their health. Some of this is
already there and I encourage you to check
it out.
But even with all the
great Health 2.0 technology, it is probably
unrealistic to expect a patient to look up
information and search on the internet while
in the hospital. So how can an individual
advocate and maybe to a certain extent –
protect themselves within this environment?
Probably one of the first steps, in addition
to all of the technology out there, is an
old-fashioned Health 0.0 solution - engage
your provider in an honest discussion.
Someone has to start the process. And it is
always fair to ask, “Do I really need this?
What happens if we find something – then
what? What if there is a false positive
result? What are the alternatives? Is this
all necessary?” Physicians probably aren’t
used to such pointed questions. But times
are changing – and so should the nature of
the interaction between physicians and
patients. And perhaps this will start the
frank dialogue to understand the distorted
incentives that operate in the American
health care system.
I think one of the
final quotes from a hospital executive in
the New York Times article really sums up my
feelings on this one. “The hospital is a
great place to be when you are sick. But I
don’t want my mother in here five minutes
longer than she needs to be.”
     
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