Now That EMR Is Mainstream, A Look Back

mhTo hear it from a couple of dozen enthusiastic vendors, the concept of putting personal health histories on a safeguarded Internet site is logical and laudable.

Providers get access to vital information in emergencies and better information in the everyday situations that call for all the clues they can get to diagnose a problem.

Personal medical records are appearing on the Internet in various forms and stages of development. The field, which scarcely existed a year ago, is exploding with activity. “It’s very early on, but in a couple of years, we’re going to look at this as (being as) common as the insurance card is now,” Mitchell Gold, M.D., says of personal medical records and other Internet uses that strengthen physician-patient ties. Gold is president and chief executive officer of Elixis, a Seattle-based vendor of software that allows physicians to develop medical records that patients can tap into via the Internet.

To skeptics, however, the usefulness of and demand for personal medical records is largely a matter of speculation, and the success of developers’ vision ultimately depends on buy-in from physicians and health systems as well as from consumers. There’s also a deep philosophical divide between proponents of consumer-maintained health histories and advocates of compiling an edited version of the electronic records created by medical professionals.

Nathan Kaufman, senior vice president in the San Diego office of Superior Consultant Co., doesn’t see a major impact from either type of record in the near term. Kaufman says physicians are adopting electronic medical records very slowly. They’re costly and complex, and they require changes in the way doctors practice. As for do-it-yourself sites, he hasn’t seen any evidence that consumers want to view their medical records or maintain their own versions of records.

“The only thing patients want is to see their doctors when they are sick, and if they are really sick, they want to see the best doctors around,” he says.

Power to the consumer. Intended to give consumers one place to store health records and call up information now in their physicians’ hands, personal medical records are an extension of the consumer-empowerment movement that’s hitting healthcare big-time. After all, healthcare consumerism already is being fueled by the vast and growing array of medical information made easily accessible by the World Wide Web.

At least 25 firms have been identified as developing or already marketing online personal medical records. And in recent weeks, the leaders have gone live on such prominent Web sites as iVillage’s AllHealth.

Developers in the Internet niche say personal medical records have the potential to become valuable health management tools, as well as valuable marketing tools linking consumers and providers.

A universal patient record, documenting a patient’s lifelong health history within and outside the traditional medical system, has been a dream of many healthcare reformers. They say such records would eliminate administrative inefficiencies and result in better medical care by facilitating the transfer of information between providers.

For some firms, however, personal medical records are part of a broader effort to use the Internet to improve healthcare. The health histories are a starting point for delivering targeted preventive health information to the personal Web pages of patients and for automating communications between patients and providers.

A handful of companies focus on the exchange of information between physician and patient. Companies making patient-provider communications a priority include Healinx Corp. of Alameda, Calif., and MediVation, based in Needham, Mass. (See related story, p. 50).

Among firms that focus aggressively on medical records, three types have emerged:

* Those that maintain only emergency medical information provided by the consumer. Security measures vary. Typically, consumers receive wallet-sized cards with a telephone number, a Web site address and, in some cases, the security codes that enable access to the information.

Emergency medical technicians, trained to search patients’ wallets, can call to have the emergency information faxed or access it online if the security code is available on the card or provided by the patient. Most companies charge consumers a nominal fee for the service.

* Companies that maintain a full personal health history provided by the consumer, as well as emergency information. Consumers can print portions of the record, such as a child’s immunizations, or give their providers a security code allowing them direct access to the record.

In some cases, providers can upload information into the record through the providers’ information systems. Many developers market the records as part of a package of consumer-interactive tools to Internet portals and to health plans and provider systems. Generally, they charge licensing fees or have revenue-sharing models.

* Electronic medical record firms offering to make a version of the physician-maintained record available online for consumer review. Such records respond to new federal requirements that patients have easy and immediate access to their records and to an audit trail of people who have reviewed their records.

In this case, physicians must be using the larger electronic record and generally must pay a monthly fee to make a version of it available online to patients. These records also often have an emergency information section and are tied to electronic communications, such as online scheduling or prescription refills.

The money is in the second two categories.

The leaders in consumer-maintained health histories include Portland, Ore.-based WellMed, which has deals with eight of the 15 major Internet portals, including iVillage, and hopes to raise up to $25 million in a current round of financing. Columbia, S.C.-based HealthMagic is another top company, with clients such as Walt Disney Corp.’s town of Celebration, Fla., and drkoop.com, although a launch date hasn’t been set for HealthMagic’s debut on the former U.S. surgeon general’s Web site.

HealthMagic argues that its patient record is unique because it can already import data from external systems at hospitals, physician offices and pharmacies. The company is backed by Adventist Health System, which has contributed $35 million to its financing.

Among electronic medical records companies, Hillsboro, Ore.-based MedicaLogic might be the best positioned for growth, with its electronic record in use at 40 of the largest integrated delivery systems and group practices. A pilot program at four healthcare systems, including Houston’s Baylor Health Care System, has been giving patients online summaries of their records, active medical problems and medications.

The company is marketing the product nationally after early data showed that the system appeals to patients and appears to reduce administrative costs with online scheduling, for example, says Christine Egli, MedicaLogic’s director of Internet marketing.

An electronic edge? Electronic medical records companies contend they have an edge over firms marketing consumer-controlled personal medical records.

Elixis’ Gold says physicians will use only records that are tied to their systems, because they don’t trust other information. What’s more, only documents drawn from physicians’ records fulfill legal requirements requiring providers to give patients easy access to their own records. Such requirements are part of the Health Insurance Portability and Accountability Act of 1996, the details of which are expected to be ironed out in the next year to 18 months.

Industry analysts agree with Gold. “To be used for any real medical purpose, a personal medical record has to be related to the actual medical record,” argues Stephen Savas, a vice president at New York-based Goldman Sachs. “Are you going to rely on a cancer patient to tell me what strain of chemotherapy he was given a year ago?”

For their part, companies marketing consumer-controlled records argue that theirs is the way to go. HealthMagic and WellMed, for example, have a long-term goal of drawing medical information directly from providers and consumers. The information will serve as a central repository and will supplement provider-based records.

“If a lifelong record is controlled by a healthcare organization, it can never be a lifelong record,” says Calvin Wiese, CEO of HealthMagic and former chief financial officer at Adventist. “Those types of records will be enterprise-centered, which means they’ll have the same problems we’ve always had,” he says.

“If you build a record that is an extension of a healthcare organization record, it really doesn’t fundamentally change the way information is being managed and maintained.” It won’t be as universally accessible and won’t typically seek out and accept information created outside the boundaries of the organization maintaining the record, he says.

Not only is HealthMagic trying to work with Internet portals, it also has agreements that will bring it to health plans and providers. For example, Pittsburgh-based Managed Care of America has made the HealthMagic record part of its suite of offerings to employers, purchasing groups, providers and insurance companies.

Wiese acknowledges the limitations of a medical record organized by patients. HealthMagic’s long-term goal is to make sure that providers submit information to the record as well, which then can be viewed and used by multiple organizations with the consumer’s permission. He says the company has a strategy to do exactly that but declines to discuss specifics.

WellMed CEO Philip Marshall, M.D., says his work with the electronic medical record for providers convinced him that a consumer version was necessary. Working with Kaiser Permanente on its implementation of an outpatient medical record, Marshall was impressed by how difficult it is to get physicians to adopt such records.

Because the cost of full electronic medical records is so high and the length of time for adoption so long, a consumer-controlled version seemed to represent a faster way to take advantage of the administrative savings possible in having an electronic version available, Marshall says.

“What we are providing is to fill that time gap,” he says.

He argues that a consumer-controlled medical record is as valuable as the provider record if it has the same ability to affect decisions made in the physicians’ office. That will become increasingly true as consumers grow more used to making decisions about their own healthcare based on information that once wasn’t accessible to them. What’s more, the company has spent many years building a system that can easily translate consumers’ information into medical terms that are acceptable and useful to physicians.

In the long run, WellMed wants to be able to have physicians add information directly to its records. Its current focus is on developing a link allowing e-mail communications with doctors to be directly imported into the record.

So far, it’s won some supporters. For example, General Electric Co. is piloting the WellMed product among a sampling of employees as a preventive health tool. National HMO Health Net, based in Woodland Hills, Calif., also has begun making the record available to all its members through its national Web site. The record, which incorporates a health risk assessment and information targeted to the risks, builds on Health Net’s emphasis on wellness programs, says Cindy Keitel, director of health improvement and wellness for the program. “A lot of what we are looking at is providing members with knowledge and giving them more control,” Keitel says.

Of the marketplace in general, she says, “This is a brand-new tool. But the proof is in the pudding. If consumers find it valuable, it will be adopted.”

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