Paperless Rx For Better Health

Millions of Americans are using the web to pay bills and monitor the health of their investment accounts, but when it comes to our own health, most of us are stuck in the paper age.

At the consumer level, for many patients, access to medical records hasn't changed in generations. The doctor writes your prescription on a piece of paper which you then give to a pharmacist. If you need lab work, the requisition is handed to you on a paper that you carry with you to the lab.

And when it's time for the results, your doctor gets a fax or a printout and sticks it in your chart. If there is something out of the ordinary, you will probably get a call to come in for treatment or further tests but it's possible that you may never know how the tests came out.

Contrast that to the online reports we get from our banks and brokerage firms. I can find out exactly how my investments are doing and if I need to transfer money from one institution to another, that too can be done online. Why don't we have the same level of digital access to our health records?

Thanks to a new service from Microsoft and some initiatives from health providers, this may change.

On October 4, Microsoft announced the beta launch of HeatlhVault.com, a free service that will let consumers "catalog existing health records, receive test results, or monitor current physical readings."

The service is designed to interface with health care providers and devices. Providers, with the patient's permission, can upload health records to the site for use of the patient or other health care providers designated by the patient. The site can also interface with consumer health monitoring devices including heart rate monitors from Pulsar and blood pressure monitors from Omron.

The project has so far announced partnerships with the Mayo Clinic, Johnson and Johnson, MedStar Health and New York Presbyterian Hospital.

The site is open to the public now but after trying it out, it's clearly not yet ready for prime time. No doubt that will change as the site matures and more partners come online. The key to success is having health providers make their systems compatible with HealthVault so you can populate your personal database with your own health records.

The biggest concern with any online health system is privacy. People worry that their health records might fall into the wrong hands. To its credit, Microsoft does have a strong privacy policy which has been praised by the non-profit Patient Privacy Rights Foundation.

"You control what goes into your HealthVault record," says George Scriban, Microsoft's product manager for the consumer health platform. "You control what information you share and we don't do anything with that information without your explicit opt-in."

HealthVault is not just about medical records. One of Microsoft's partners, MedHelp.org, is providing a forum in which physicians from leading institutions around the country will respond to general consumer questions. The service, according to Dr. Enoch Choi, a Palo Alto physician and MedHelp product manager, "provides both expert help and community." In addition to interacting with doctors, patients can also learn from each other.

The idea of having medical records online is not without precedent. In fact, mine are already online thanks to a program by the Palo Alto Medical Foundation, a full service medical clinic where my family goes for basic care.

The medical facility, which is an affiliate of Sutter Health, has a website where patients can make or change appointments and access results from lab tests, x-rays and other medical tests. A few days after a test is taken, the data is released first to the patient's physician and, unless the physician decides to temporarily withhold it, it's then presented to the patient when they log on to the service.

Physicians, according to Dr. Paul Tang, the Foundation's chief medical information officer, can decide to contact the patient directly to present findings if the doctor feels it is better to deliver the information on the phone or in person. In other words, it might not be such a good idea to deliver really bad news via the web.

While most test results are posted online some are withheld based on state or federal law. These include on HIV-AIDS tests and reports of substance abuse and hepatitis. They are also prohibited to report results of tissue sample tests which include pap smears.

One nice feature of PAMF online is the ability to graph results over time. For example, I just got the results of my second annual lipid tests since I started going to the clinic. I can now see how my cholesterol has changed over time, giving me a basis for making lifestyle decisions that can affect those levels.

This type of information, as well as detailed numerical data on all the tests, allows me to take much more responsibility for my own health. No doubt my doctor would call if any test result was off-the-scale, but by seeing the results numerically and graphically, I can get a more fine-tuned sense of how I'm doing , just as I can with my online banking and broker reports.

As good as the Palo Alto Medical records are, they are only accessible to me and my doctors at this one facility. If I were to move to New York, those electronic records wouldn't travel with me unless health providers were to begin working together to offer both interoperability and the right for patients to have their data stored in a way that would make it accessible to themselves or those they designate.

For that to happen, there needs to be a great deal of cooperation and participation within the health care industry. "It is a bootstrap issue," said Microsoft's George Scriban. "If none of your doctors are using it, then you wouldn't be using it. It's our job to create an ecosystem around the platform."

The company did announce 47 partners that are creating HealthVault applications but Microsoft has its work cut out to - as Scriban put it - "build an application that allows the industry to interoperate."

Given all the security concerns around Microsoft Windows, one hopes that the company will nail it when it comes to HealthVault. Scriban says that "we layer a number of different security measures on top of one another. All of our data is housed in secure facilities and even within those secure facilities, HealthVault systems run in locked cabinets."

Let's hope that Microsoft does a good job keeping those cabinets off-limits to hackers.