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Amid a growing emphasis on electronic health records, one patient tests online health services.
Makers of personal electronic health records, including Google and Microsoft, are partnering with a growing number of pharmacies, health-care providers, and online services in an effort to better integrate these tools with other aspects of patients' medical information. The push coincides with the recent $19 billion in federal stimulus funding designated for electronic health records. Despite the increase in activity, however, it's still not clear how the government incentives to digitize doctors' data will affect patients' efforts to collect and curate their own health records.
At present, most patients who want to create a personal health record have to get a copy of their medical records and then manually enter the information, including conditions, medications, test results, and procedures. However, last summer, my insurer, Blue Cross Blue Shield, became the first insurance company to sign on with Google Health, allowing me to directly upload medical records into the program. (As of now, this functionality is limited to patients at Beth Israel Deaconess Medical Center, in Boston; the Cleveland Clinic, in Ohio; and a network of physicians in Washington State.)
I decided to test the two best known programs, Google Health and Microsoft's HealthVault, to get a preview of what the growing number of users might face. (Today I'll focus on Google, and Friday on Microsoft.) Both are free applications that allow users to store, organize, and share medical information online. Both have collaborated with well-known medical centers--Google with the Cleveland Clinic, and HealthVault with the Mayo Clinic--to try to fine-tune their programs. And both partner with a number of pharmacies, allowing patients to download their medication regimens and search for potential interactions and alternatives.
In the case of Blue Cross Blue Shield insurees, the program uses medical insurance billing codes as a proxy for patients' conditions; unlike most medical records, billing codes are already computerized and thus much easier to import. But such codes can produce a confusing picture of a patient's health. Because each provider I have seen uses a different code, according to my Google Health record, I have lumbago (i.e., general back pain), unspecified myalgia and myositis (i.e., muscle pain and inflammation), and unspecified backache, as well as nonallopathic lesions in various parts of my spine (which appears to be a special billing code for chiropractors). It's not exactly a useful description of my back problems and the treatments that I've had to date, but perhaps a physician's trained eye would view it differently.
The data imported from my health-insurance record also lacks test results and health trends, including weight, cholesterol, and lipid levels. For someone with a chronic condition, such as diabetes or high blood pressure, seeing how these measures change over time is important, as well as a good motivator to keep one's weight or cholesterol in check. Google Health doesn't yet sync with personal medical devices, such as blood-pressure or glucose monitors, although the company has announced a partnership with IBM to develop this capability.
Guest (irrationality)
It's not exactly a useful description of my back problems and the treatments that I've had to date, but perhaps a physician's trained eye would view it differently.
What makes you so sure? There is much discussion within the medical community about the dangers, shortcomings, and frustration with present day health information technology solutions. There is consensus that although today's systems may support the billing needs of insurance companies, they do not support the analytical needs of physicians. Furthermore, today's systems are fragmented, designed to mimic old paper workflows, designed without much attention to usability and safety, provide little support for evidence-based medicine computer decision support, and distract physicians from the practice of medicine -- in other words, they generally fail to support patient care.
Examples:
http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=12572
http://www.pittsburghlive.com/x/pittsburghtrib/news/pittsburgh/s_613831.html
http://www.ihealthbeat.org/Features/2009/When-It-Comes-to-Health-Care-IT-What-Works.aspx
"I decided to test the two best known programs, Google Health and Microsoft's HealthVault"
After this statement, the entire article focused on Google Health -- what about the HealthVault evaluation?
"Today I'll focus on Google, and Friday on Microsoft."
Just fyi, and I think un-manage there are a lot of risk with the technology, but there are countless benefits as well. Regardless of a person having all the information collected on them, having a standard so that if you have to go to the emergency room they'd be able to get access to all of your data at a single spot, rather then some doctors using paper or using different codes, like spoken of in the article. I imagine the statistics could be quite useful as well, being able to track a flu epidemic, or something of the sorts, or just the raw medical data that could be obtained. It's definitely a slippery slope, but in this day and age, you'd have to be lottery lucky to find new technology that can't be abused.
Any database is only as good as the amount of data that is in it, so it is not too surprising that the current systems have limited capability/usage. But, the statistical benefits to a large database of health information are enormous. Consider, for example, the advantage of knowing what kind of side-effects are being experienced by users that are taking multiple drugs for similar conditions. Performing a scientific study would be impractical and expensive but real-world usage could provide insights into benefits and hazards that might otherwise go unnoticed for years.
In addition, it might allow patients to know how other people with a similar condition are being treated. Someone with diabetes, could see that x % of patients use Actos w/ insulin, while no one is taking Januvia, Actos w/out insulin. It gives the user the power to understand what the standard practice is and ask his/her doctor more questions about the effectiveness of their treatment.
But, all of this requires a massive database where there are enough patients to get statistics. For now, local benefits to diabetics might be limited to personal control -- knowing how much insulin they have taken, their current and past glucose control, weight, etc. Other benefits come down the road...
Agreeing with "biggerIssues", in my case, I don't want that companies such as google and microsoft have total access my clinic history. http://twitter.com/ESS_BILBAO
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4 Comments
On-Line Records
Does any one really want this type of information in anyone's cloud? Being the cynic I am, I wonder what data Google will glean from this type of information. I feel much more comfortable having a good relationship with my physician.
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