| Frustrated with the hassle of repeatedly filling out form after clipboarded form at doctors’ and hospital admitting offices, some of us dream of a day when all our health records will be digitized, computerized, and continually updated in real time, eliminating, or drastically reducing, the headache and inconvenience of paper records. Fearful of Big Brotherly snooping by employers, insurers, hackers, or the government, some of us dread the day when all our health records will be digitized, computerized, and continually updated in real time, eliminating, or drastically reducing, what small degree of privacy and control we might still exercise over our personal health information. Like it or not, that day has arrived. Electronic health records are fast be-coming the norm, and some Kansas City interests are at the forefront of the trend. However, before getting too excited, or too concerned, about the positive or negative implications of this innovation, it’s best to establish some definitions. In a paper written for the Leawood-based American Academy of Family Physicians, authors Scott Endsley, David Kibbe, Anthony Linares, and Karen Colorafi define the characteristics of a variety of electronic personal health information formats. There are no standardized or universally accepted norms in naming these various digital records, but there are some identifiable differences between certain types. One is a digital summary of clinically relevant health information provided to patients as a read-only file. The file is owned and maintained by the patient’s doctor, hospital, or other healthcare provider. The information may include data such as lab test results or X-ray interpretations. Patients access the information via a password-protected Web site. Another version is a software program that patients load on their personal computers which allows patients to manage personal health information, such as weight, blood pressure readings, symptoms, emergency contact information, etc. The authors compare this form of electronic health record to the use of personal finance software or tax return software, which is also accessed, via the internet by a third-party, such as a doctor, hospital, or insurer. The value of this kind of program is dependent on the patient entering and maintaining timely information. Google and Microsoft have expressed their intent to offer such products. Finally, there is a portable, interoperable digital file through which clinical data is managed, secured and transferred. These records are portable via smart cards, PDAs, smart cell phones, and USB devices (i.e. “jump” or “flash” drives). They are interoperable in that they may be used and read by multiple parties, such as physicians’ offices, hospitals, pharmacists, health clubs, employers and insurers. These are the most useful and powerful of the various kinds of digital health information records. These could reasonably replace paper medical records with a comprehensive, accurate, timely, digital file—owned by the patient, but accessible and updatable by care providers and other relevant parties. The name generally ac-cepted by doctors, hospitals, insurers, and vendors, for this kind of record is electronic medical record, or EMR. “The development of these products is really quite exciting,” says Kelli Christman, spokesperson for Cerner, the Kansas City-based medical software giant, which has rolled out its own version. “These electronic records pro-vide convenient and instant access to current personal medical data and health information in any number of circumstances. But, because the file is owned and controlled by the patient, there is an assurance of security and privacy.” At the University of Kansas Hospital, Chief Information Officer Chris Hansen echoes that enthusiasm. “The advent of electronic records will really benefit everyone, primarily the patient. They increase efficiency, save time, improve service, and, we believe, they’ll empower patients by providing them with full access to their own health information.” Hansen says that the University of Kansas Hospital will begin offering an electronic record system to its physicians and patients next year. “This will actually improve and increase patient/physician communication and interaction. The information the doctor enters into the file becomes instantly accessible to the patient, because the patient owns that information.” Hansen concurs with Christman on the issue of security. “People express anxiety and concern over privacy when they learn about electronic medical records. For some reason they think paper records are more secure. But think about it—think about how vulnerable paper records are to theft, snooping, and damage. The truth is patients don’t even have actual physical possession of their medical records. They’re in a file in their doctor’s office somewhere.” Christman explains that a state-of-the-art EMR will allow patients to control who sees their medical data, and how much they see. “Individuals will be able to sequester information they want to keep private. For example, if I’m going to a dermatologist because I have a mole I want checked out, that doctor doesn’t need to see my OB/GYN information. No healthcare provider, insurer, employer, or commercial interest will have the ability to access your information unless you choose to allow them that access.” But, beyond speed and convenience, what value is there in all these techno bells and whistles? Consider this; you’re in Colorado for a skiing vacation when suddenly you take a tumble and the phrase “Christmas break” takes on a whole new meaning as you hear a sickening snap down in the area of your left tibia. When you arrive in the Breckenridge hospital ER, you hand your smart card—all loaded up with your EMR—to the doctor and with one swipe your personal medical data pops upon the doctor’s computer screen. And it’s a good thing, too. Because, as you drift in and out of consciousness, the doctor sees that you’re allergic to the pain medication usually prescribed in such circumstances. Or there’s this scenario: your elderly parents have been enjoying their golden years in a retirement village in Arizona, but lately your mother has been showing signs of Alzheimer’s. Your father is too old and frail to take charge of her care, so you arrange with her physicians to help manage her care with them via a secure interactive Web portal made possible by the EMR software. “The ‘Sandwich Generation’ is going to benefit greatly from this technology,” says Hansen. “It’s going to significantly improve the quality of care for elderly parents, and frankly, it’ll improve the quality of life for their children taking care of them.” As EMR products are introduced to the marketplace, a reasonable concern is compatibility between versions marketed by different makers. The classic BetaMax vs. VHS dilemma was costly and inconvenient to consumers and retailers. But the stakes weren’t nearly as high. When it comes to one’s health, one needs to be assured that a product delivers on its promises. Christman says that software and healthcare industry representatives have already begun to address this concern. “A bill has been introduced in Congress that would establish a regulatory body called the Independent Health Record Trust which will act in the way the FDIC does in the banking industry. It will assure that records are fully compatible across platforms and manufacturers. It’ll also insure that privacy and security safeguards are in place and standardized. There’s always a lot of hype attached to new technology. But EMRs really can help revolutionize the way healthcare is provided and managed.”
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