How many times have you gone to a doctor and been handed a clipboard of forms to fill out before you take your place in the waiting area? Sometimes you have to do this repeatedly, every year in fact, often reproducing the exact same information as you provided the previous year. Wouldn’t it be better if we could lose this antiquated approach to gathering medical information and move into the 21st century?
We’ve all been hearing for years about a future where electronic health records will revolutionize and streamline medical care. Chief information officers from large hospital systems to single doctor practices are in various stages of implementing electronic medical record systems with the hope of cutting costs and improving patient outcomes. The adoption of information technology in the medical industry has certainly been slow in coming, but it is finally becoming the standard rather than the exception.
Many primary care physicians now type notes directly into a computer during a checkup, and wound care clinics keep digital images to track healing progress. Even dental X-rays are often captured as digital images these days. Within large hospital systems and managed care organizations, it can be easy for one doctor to pull up a vast amount of information and history on a person because these organizations use their own integrated systems. For example, if your health care is provided by a health maintenance organization like Oakland-based Kaiser Permanente, there is a great benefit to you and the provider in terms of efficiency and quality of care. As a patient, if you are referred to a specialist, that doctor has immediate access to your history, lab test results, other test results, X-rays, medications and other information that could prove highly beneficial to choosing a course of treatment. How all that information is used by a specific provider has a lot to do with quality of care as well, but it is a major improvement upon the practice of filling out the paper questionnaire.
So what if you aren’t covered by an HMO or healthcare system with integrated electronic health records? There are options to take control of your own records, but they aren’t necessarily simple, and the benefit is hard to quantify. Personal health records are different than EHRs in that they are controlled by the patient rather than the provider. Google launched a PHR system called Google Health in 2008, but canceled the project in 2011 due to lack of user adoption. Microsoft launched their own free PHR service in 2007, called HealthVault, which is still alive and kicking (and accepting data transfers from Google Health) in 2012. Another PHR service, Dossia, is an employer-led service supported by companies like Walmart, Intel, and AT&T in the United States.
Large employers can encourage providers to integrate directly with systems like Dossia, but don’t always have direct economic leverage. Few providers are set up to automatically integrate with any PHR system even if they already have their own EHR system in-house. You can take it upon yourself to collect your records from all your providers and upload them to a system like Microsoft HealthVault or enlist a company to do so for you, but what is the benefit? If you buy in to the adage that “knowledge is power,” having your own records in one place makes it easier to do research and to presumably make better informed decisions, but the process of creating the system may not be worth it.
Zweena Health provides a service which will contact your medical providers on your behalf — after you fill out several release forms — to gather your digital or paper records and upload them to HealthVault. The service starts at about $200 for up to four medical providers, but they pass along any records reproduction fees from the provider, which can be as much as $1 per page. This method, as with the self-collection method, uses the time-consuming and unwieldly process of gathering paper records from providers, scanning them, and then uploading them to the PHR system. Of course the ultimate solution would be for all of our various healthcare providers to offer the option to upload records to the PHR system of your choosing. Then when going to a new provider, you could simply grant access to some portion or all of your records.
In the U.S. the ideas are in place, but implementation will take years. The Patient Protection and Affordable Care Act has many provisions for providers to use EHRs, but a widespread path to implementation isn’t clear. Another related law, the HITECH Act, was adopted as part of the American Recovery and Reinvestment Act of 2009. According to healthit.gov, HITECH will “build the foundation for every American to benefit from an electronic health record, as part of a modernized, interconnected, and vastly improved system of care delivery.” An initiative by the National Health Service in the United Kingdom to implement an EHR system was started in 2005, but was dismantled in 2011 with little to show for the effort.
So, are we there yet? No, it seems like we are a long way from integrated EHR/PHR systems that span providers, allow for better options for people to switch doctors, and give providers better information to improve outcomes. For now, I plan to press forward building up my own personal health records, with the hope that they will be useful in the near future. If it all proves to be an act of futility, I’ll certainly let you know.