30 Mei 2009

Makers of personal electronic health records, including Google and Microsoft, are partnering with a growing number of pharmacies, health-care providers, and online services in an effort to better integrate these tools with other aspects of patients' medical information. The push coincides with the recent $19 billion in federal stimulus funding designated for electronic health records. Despite the increase in activity, however, it's still not clear how the government incentives to digitize doctors' data will affect patients' efforts to collect and curate their own health records. At present, most patients who want to create a personal health record have to get a copy of their medical records and then manually enter the information, including conditions, medications, test results, and procedures. However, last summer, my insurer, Blue Cross Blue Shield, became the first insurance company to sign on with Google Health, allowing me to directly upload medical records into the program. (As of now, this functionality is limited to patients at Beth Israel Deaconess Medical Center, in Boston; the Cleveland Clinic, in Ohio; and a network of physicians in Washington State.) I decided to test the two best known programs, Google Health and Microsoft's HealthVault, to get a preview of what the growing number of users might face. (Today I'll focus on Google, and Friday on Microsoft.) Both are free applications that allow users to store, organize, and share medical information online. Both have collaborated with well-known medical centers--Google with the Cleveland Clinic, and HealthVault with the Mayo Clinic--to try to fine-tune their programs. And both partner with a number of pharmacies, allowing patients to download their medication regimens and search for potential interactions and alternatives. In the case of Blue Cross Blue Shield insurees, the program uses medical insurance billing codes as a proxy for patients' conditions; unlike most medical records, billing codes are already computerized and thus much easier to import. But such codes can produce a confusing picture of a patient's health. Because each provider I have seen uses a different code, according to my Google Health record, I have lumbago (i.e., general back pain), unspecified myalgia and myositis (i.e., muscle pain and inflammation), and unspecified backache, as well as nonallopathic lesions in various parts of my spine (which appears to be a special billing code for chiropractors). It's not exactly a useful description of my back problems and the treatments that I've had to date, but perhaps a physician's trained eye would view it differently. The data imported from my health-insurance record also lacks test results and health trends, including weight, cholesterol, and lipid levels. For someone with a chronic condition, such as diabetes or high blood pressure, seeing how these measures change over time is important, as well as a good motivator to keep one's weight or cholesterol in check. Google Health doesn't yet sync with personal medical devices, such as blood-pressure or glucose monitors, although the company has announced a partnership with IBM to develop this capability. So far, much of the functionality of Google Health centers on prescriptions. Users can upload information from a number of pharmacies, and the program warns patients of potential drug interactions. "Making it easy for more people to access and control their prescription history is important because it represents an opportunity for people to better understand their medications and why they are taking them, and to make them more aware of safety issues that commonly occur as a result of drug interactions," says Roni Zeiger, a physician and a product manager at Google. He estimates that with the recent addition of CVS/pharmacy to the list, more than 100 million people in the United States can import a copy of their prescription records into Google Health. My online pharmacy hasn't partnered with Google, so I entered my current prescriptions by hand. I then had the option of using a number of online tools that can search for cheaper alternatives to existing prescriptions, create a prescription schedule, or alert patients to recalls or new drugs. To use these tools, you must grant the program access to your health record, which may be a security concern for some. (You can end that link at any time by changing the settings on your Google Health account.) Thus far, these services seem to have limited value. When I used one to search for cheaper alternatives to an inhaler I use for asthma, it returned a long list of options, including theophylline, a drug that I used to take as a kid and which physicians now rarely prescribe due to its jittery side effects. The service did not rate the different drugs according to their similarity to the existing medication, such as whether they are part of the same class of drugs, or according to the severity of potential side effects. One of Google Health's most recent features is the ability to share online medical records. "The sharing feature has been especially helpful because it enables a patient to communicate their medical history to caregivers and family members," says John Halamka, chief information officer at Beth Israel Deaconess Medical Center, one of the facilities that allows patients to import their medical records into Google Health. For now, the electronic

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