Personal Health Records: Just Say No

In the coming months, you will probably hear and read a lot about personal health records, as two technology heavyweights roll out initiatives designed to spur the mass consumerization of health information. The race between Google and Microsoft to apply the resources of the Internet to personalized healthcare might be great for consumers, but how will physicians benefit, if at all?

Apersonal health record (PHR) enables individuals to keep track of their own health and medical history. Th is information can be stored online and can be accessed by anyone who has the necessary electronic credentials to view the information. Content can range from simple identifi cation and demographic data to a complete medical history, physical fi ndings, and test results, gathered from multiple sources. In theory, this makes great sense. It empowers consumers by allowing them to provide doctors with valuable information that can help improve the quality of care they receive. The PHR can help reduce healthcare expenditures by eliminating duplicate tests and also allow people to receive faster and safer treatment in an emergency. Consumers have several choices when it comes to PHRs. Some are paper-based, some are PC-based, but most use the Internet to collect, store, and share health information. Revolution Health was one of the first companies to off er a free online PHR.

Microsoft HealthVault, currently in beta testing, is a free Web-based platform claimed by Microsoft to have enhanced security and privacy measures. However, given Microsoft’s poor track record with first-release software and security, I would advise patients to stay away from this service until the kinks have been worked out.

Perhaps the biggest player will be the last one to the party: Internet search giant Google. Rumors about the launch of Google Health have been swirling for months, and a beta version is expected to arrive this spring. Google has a very strong track record of releasing easyto-use, powerful software with an uncluttered interface that appeals to consumers.

It remains to be seen whether any of these online services will gain serious traction with consumers. So far, very few people have actually signed up for an online PHR, mainly due to a lack of understanding about their potential benefi ts and concerns about privacy and security.

In my mind, however, the most serious problem with the entire concept of the consumer-focused personal health record is that it will create more work for physicians. More importantly, who is going to pay for the time, energy, and legal risk involved? Are we truly going to take on yet another task without adequate compensation? If so, it means we are about to allow ourselves (yet again) to get “shafted” by the healthcare system.

Agreeing to uncompensated support for PHRs would be worse than naive, given the way physicians are consistently treated by thirdparty payers. If we make PHRs part of our patient care regimen it will soon become the standard of care, and we will have lost another opportunity to receive adequate compensation for our time and eff ort. While we certainly want to support our patients in taking more control of their healthcare decisions, we must demand that it be done in a way that doesn’t just add to our workload. Simply put, patients need to begin paying physicians directly for our time and knowledge. And while it is too late to easily make this happen for E&M offi ce visits, it is not too late for us to refuse to adopt new technologies that will just end up being more work and just another expected piece of healthcare required by insurers.

So while PHRs will (and should) end up being a critical part of the medical record, we must say “No, we are not willing to participate” until we fi nd a reasonable solution to the payment problem. One solution might be that physicians share in PHR-related revenue. Surely Google, Microsoft, and others see the advertising dollars and other associated revenue in PHRs, hence the reason for their foray into the fi eld. We should demand a piece of that revenue be paid to us before we agree to play any role in this new technology. A modest payment from revenue the PHRs will surely generate for many of these profi table businesses, over thousands of patients, can add up to a signifi cant dollar amount for struggling small practices, and provide a valuable incentive to physicians. In this model, consumers win, doctors win, and PHR companies win. So what could be better?

Dr. Bertman is Physician Editor-in-Chief of MDNG: Primary Care/ Cardiology Edition. He is also a Clinical Assistant Professor of Family Medicine at Brown University and president of AmazingCharts.com, a leading developer of electronic health record (EHR) software. He also is the founder and president of AfraidToAsk.com, a consumer website focusing on personal medical topics. He is in private practice in Hope Valley, RI.