Should the patient have access to her electronic health record?
Many consumers not only look forward to EHR—they want access
The $19 billion allocated in the stimulus package to help jump start advances in health information technology has whetted many providers’ appetite for electronic health records (EHRs)—but they aren’t the only people looking forward to streamlined recordkeeping. Consumers, too. are eager for the switch to EHRs and other online tools and services, according to a recent survey by the Deloitte Center for Health Solutions in Chicago (www.deloitte.com/dtt/section_node/0,1042,sid%253D80772,00.html).
Although only 9% of consumers surveyed have an electronic personal health record (PHR), 42% are interested in establishing one that is connected online to their physician. Fifty-five percent want the ability to communicate with their doctor via email to exchange health information and get answers to questions. Fifty-seven percent would be interested in scheduling appointments, buying prescriptions, and completing other transactions online, provided their information is protected. And nearly half (47%) like the idea of technologies that can facilitate consumer transactions with providers and health plans, such as integrated billing systems that make bill payment faster and more convenient.
“Consumers are increasingly embracing innovations that enhance self-care, convenience, personalization, and control of personal health information,” says Paul H. Keckley, PhD, executive director of the Deloitte Center for Health Solutions. “Consumers want a bigger say in their health-care decisions. Consumer demand for health information technology and its potential impact on reforming the system has never been stronger.”
Which patient-accessible model will prevail?
Consumer demand prompts a fundamental question: Which PHR model will prevail? The options include:
- a stand-alone, Internet-based model such as the type developed by Google, Microsoft, RevolutionHealth, and WebMD
- an integrated record that extends the physician’s EHR.
4 options for Internet-based, stand-alone EHRs
RevolutionHealth Health Records
WebMD Personal Health Record
The first model often begins with data that are imported from pharmacy records and administrative claims; some can also accept information from the physician’s EHR. The second model begins with the health-care provider but is designed to allow the patient at least some access to data and communication with the health-care team.
In a recent article in the New England Journal of Medicine, Tang and Lee come down soundly in favor of the integrated model. “We believe that the more access provided, the stronger the partnership that will be cultivated between patients and clinicians,” they write.1 “For example, integrated PHRs offer a convenient way for physicians and patients to create a shared patient record and formulate a shared treatment plan. PHR tools can help patients collaborate with their health-care team in tracking and managing their own chronic conditions.”1
Tang and Lee also point out that integrated PHRs are already a reality—used by millions of patients. “For example, among the 250,000 patients in the San Francisco Bay area who receive primary care at a region of the Palo Alto Medical Foundation, 50% of adults use the group’s PHR,” they write.1
A stand-alone record may not be as accurate as an integrated record. In Boston, for example, Beth Israel Deaconess Medical Center recently sent insurance claims data to Google Health to provide information on patients’ medical histories—but halted the move after complaints arose. Claims data are notoriously prone to errors, noted an article in the Boston Globe, particularly for patients who have complex health conditions.2
Some consumers worry about security issues—but women less than men
Many patients are concerned about exactly how this technology is being implemented. In the survey by the Deloitte Center for Health Solutions:
- Nearly four in 10 (38%) respondents are very concerned about the privacy and security of personal health information
- Another 24% said they have no reservations about it
- Women older than 65 years and men between 18 and 24 years are the least worried about privacy and security
- Women are more likely than men to seek online access to physicians, medical records, and tools. They are also more interested in using secure Web sites and slightly more trusting of the information they locate about care and treatment through independent health-related Web sites, the study revealed.
The survey of more than 4,000 US consumers 18 and older was released early last month at the Healthcare Information and Management Systems Society annual conference in Chicago. It is the second annual study exploring health-care consumers’ attitudes, behaviors, and unmet needs.
“Is it time for electronic medical records in your practice?” by G. William Bates, MD, MBA (July 2007) www.obgmanagement.com/pdf/1907/1907OBGM_Article4.pdf
“Do electronic medical records make for a better practice?” by G. William Bates, MD, MBA, B. David Hall, MD, Frank O. Page, MD, Don Shuwarger, MD, and Mark A. VanMeter (August 2007) www.obgmanagement.com/pdf/1908/1908OBGM_Article5.pdf
1. Tang PC, Lee TH. Your doctor’s office or the Internet? Two paths to personal health records. N Engl J Med. 2009;360:1276-1278.Available at: http://content.neim.org/cgi/content/full/360/13/1276. Accessed April 21, 2009.
2. Wangsness L. Beth Israel halts sending insurance data to Google. Boston Globe. April 18, 2009, page A14. Available at: http://www.boston.com/news/nation/washington/articles/2009/04/18/beth_israel_halts_sending_insurance_data_to_google/. Accessed April 27, 2009.