I recently read an Op-Ed article in the Wall Street Journal by Bill Gates. In the same issue there was an article about how Microsoft is creating a Web portal called HealthVault.com to store people's medical information.
The Op-Ed article was right-on (IMHO) in its conclusion that primary care and prevention are the keys to reducing medical care costs and improving health care outcomes. Note that healthcare costs are the highest in the US when compared to all industrialized nations while healthcare outcomes are far from the highest--meaning that the US pays much more money for lower quality healthcare.
I question, however, whether or not HealthVault is what we need. I certainly agree that a person's patient information is their property, however, it is not clear to me that HealthVault anything beyond a storage mechanism for healthcare data. The marketing hype for HealthVault talks about sharing patient data with a variety of medical providers by having the medical provider interact with HealthVault.
I believe that this strategy (or perceived value) is flawed in a number of ways:
1. Physicians do not have time to learn how to use HealthVault and its competitors. My primary care physician has 15 minutes for my visit and is often 1 hour late--there is no time.
2. There is no physician reimbursement model for the effort of using such programs.
3. A physician's expectation will be that the information in a patient managed repository will be complete. More often than not the information will not be complete, meaning the physician is unable to rely and depend upon the source material.
4. Obtaining and entering medical information into an online system is a huge burden and a technical challenge for most people. For example, how would a person handle a DICOM image coming from a Radiologic investigation? Does HealthVault support this imaging format? Can I get these digital files from my health care provider? If the image is in physical form, how do I digitally scan a film that is physically larger than most scanners? The questions and limitations go on and on.
My mother always told me that if I do not like something then I suggest a solution and not just whine about it. So here goes...
Objectives:
1. Put patient's in charge of their healthcare information.
2. Enable patient's to obtain a copy of their healthcare information so that they can seek healthcare from a different provider.
3. Improve the patient-doctor relationship.
4. Do not increase the physician workload of providing healthcare.
5. Keep it as simple as possible for the physician and the patient so that, as a team, they can focus on the health of the patient.
Solution:
1. Encourage Electronic Medical Record (EMR's) vendors to provide a patient center portal to the product that their physician already uses to manage healthcare information. Hopefully, there is an economic incentive to encourage companies to do this. If patients and physicians yell for it, it will likely come.
2. Establish a universal, open output (export) format for medical information. Indeed there are standards currently in existence like HL7 (health level 7) that is used as an exchange format between EMR applications. This way a patient could request an exported copy (through the portal in 1 above) of their health care information, bring it to another provider and either give it to them for review or, even better, for import into the new provider's medical record system. Wow, seamless!
The biggest challenge to this is the support from EMR vendors. The commercial marketplace does not encourage cooperation. In other words, EMR vendors want customers (patients/physicians) to become dependent on their solution and therefore discourage the ability to move data from one system to another.
It is hard to imagine what a person can do. One small step is to begin asking your physician for a copy (hopefully in digital form) of your healthcare information at each visit. Train them to give you the information. This will encourage physicians and EMR vendors to make it easier to hand over the information. And, of course you get a copy of YOUR information.
