Socialized Medicine: How Personal Health Records and Social Networks Are Changing Healthcare

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Healthcare in America is changing. At the heart of the transformation is the electronic medical record (EMR). By pulling together all of a patient's information, from lab test results to billing history, into a single electronic record, healthcare organizations can dramatically improve quality of care while at the same time lowering their costs. Some are pinning their hopes on the EMR to save the healthcare system. President Obama has gone so far as to promise that his administration "will make the immediate investments necessary to ensure that, within 5 years, all of America's medical records are computerized." An ambitious goal, but understandable considering the potential benefits of universal adoption. An emergency room in Philadelphia would have immediate access to your full medical history from your home hospital in Los Angeles. Your pharmacy would know all of your medications and allergies and automatically detect potential problems. Your insurer would be able to resolve billing issues directly with the care provider. Such a frictionless environment for information exchange among healthcare institutions puts vital health information at the fingertips of everyone who needs it. Everyone, that is, except the patient.

Electronic medical records are designed by hospitals for hospitals. They are intended to make life easier for healthcare institutions rather than healthcare consumers. Even if your doctor has moved all your information into an EMR, there is no guarantee that you will be able to access it, at least not without jumping through some significant hoops. Once you do get access to your information, you certainly can't share it. In the age of Facebook and Twitter, consumers will clearly not be satisfied with such a closed solution. If I can manage my entire financial life online, with all of my bank accounts, bills, and credit cards linked to each other, why do I have the results from my colorectal cancer screening and my kid's immunization records piled in a shoebox under the bed? Online consumer solutions are beginning to emerge in the form of personal health records (PHRs), and as might be expected, Google and Microsoft are leading the charge.

Personal Health Records
A PHR differs from an EMR in that it is owned and controlled by the patient, not the clinic. It also lives on the web rather than in a hospital's data center.

As a result, the consumer decides what is included, where it comes from, and who can see it. For example, the family health manager (aka mom) could upload her husband's annual physical data to his PHR and grant his life insurance provider access to the summary. After a morning run, she logs her time and distance in her own PHR knowing that her personal trainer will be checking up on that portion of her record. After receiving an email from the school that her daughter is missing a required vaccination, she updates her daughter's PHR to reflect the last visit to the pediatrician and forwards the record to the school nurse. Finally, the elder care facility caring for her father has noted on his record that one of his medications seems to be losing its efficacy. The pharmacy has been notified of the situation and recommended an alternative that is cleared by his insurance-it just needs an online authorization to request the new prescription.

Facilitating this type of health information ecosystem is the driving impetus behind Google Health and Microsoft HealthVault. While more than 60 web-based PHRs have emerged over the past few years, mostly through employers and health plans, these have generally not been concerned with the portability of a user's health information. A user may be able to access and even edit the information in his or her record, but in most cases he or she cannot share it with other services and individuals.

If you leave the institution providing the service, say to switch jobs or to seek out-of-network care, your record doesn't move with you and your new organization cannot access it. These "tethered" models are a step forward in giving consumers access to their health information, but they are still focused on the institution rather than the individual. The Microsoft and Google offerings, by contrast, move the consumer to the center of the model and focus on providing a platform for information exchange rather than just an application for institutional data.

Google began experimenting with "personal health record services" in 2006. Those efforts culminated in a 2- month pilot with the Cleveland Clinic in 2008 involving 1,600 volunteer patients. Google Health is now available to the general public as a free service. Users can manually enter their health information or import it from a growing number of partners such as Anvita Health, Inc.; Beth Israel Deaconess Medical Center; CVS; and Walgreen Co. If a user has health information he or she wishes to have included in the record that does not come from a Google partner, there are alternatives to manually entering all those cholesterol tests. Fee-based service providers such as MediConnect, Inc. will gather all your medical records from all sources and add them to your Google profile.

The Google Health record is based on the Continuity of Care (CCR) record, a standard health record specification developed by a consortium of healthcare advocacy groups, providers, and regulators. This increases the likelihood that your PHR will contain the data your doctors will need in addition to the information you want to track. It also makes it easier for organizations to access and integrate with your record. Beyond making Google Health attractive to potential partners, this standardization goes a long way to ensure the portability of your record. Like a Gmail account, your Google PHR stays with you even if you change employers, doctors, or insurers. This is also the chief advantage of the HealthVault solution, though in true Redmond fashion, Microsoft has its sights set on more than just the web.

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