The New England Journal, Electronic Medical Records and Personal Health Records - Now For Something Completely Different

The April 17 New England Journal of Medicine has a pair of Perspective pieces (subscriptions required) on personal electronic health medical records or whatever they are called.

The 1^st is an eminently concise and readable review of ‘personally controlled online health data’ by Robert Steinbrook. Have you been as confounded as me about Dossia, Google and Health Vault? Look no further, because this summary describes the reality and theory behind the notion that consumers are going to take control of their medical history, drug lists, allergies, immunizations, insurance information and doctor visit records. According to Dr. Steinbrook, the major players are Dossia (founded by some large companies including AT&T and Intel), Microsoft’s Health Vault (already working with New York Presbyterian Hospital) and the not-yet-available Good Health (being test-driven at the Cleveland Clinic). Their business model is based on three sources of income: 1) revenue from ‘hospitals and health plans from the recruitment and retention of patients who want such [electronic] records’ and 2) advertising directed at patients while they perform on-line health information searches and 3) savings from coordinated care, disease management, worker productivity and wellness. Will consumers really manage this? Will proprietary systems owned by doctors and hospitals be allowed to format and ‘upload’ their data? Will doctors themselves get a grip on what is coming? Did anyone anticipate the explicit link to ‘disease management?’ Take a look at the article and decide for yourself.

The 2^nd is an even more readable and extremely contrarian view on the ugly downside of electronic records. How about physicians’ repeated use of cutting and pasting text, leading not only to plagiarism but the risk that wrong information is repeatedly and perpetually documented? Lab tests being dropped into physicians’ notes without any monitoring? Repetitive text being so voluminous in the name of documentation, it hobbles the physicians’ ability to discern what is really important? Imagine all these doctors staring at monitors, filling in templates and ignoring their patients. Drs. Hartzband and Groopman point out they are not Luddites, but ask us to pause and think about the difference between data and information, automaticity and efficiency, technology and thinking. Well worth the read.

In the meantime, the Disease Management Care Blog plans to sit back and wait for the medical IT bloggers to light up, especially those who hold fast to the notion that our brave new medical-digital world means higher quality, lower costs, better medical practice, saved babies, reversal of aging, a ban on whale hunting and a stop to Kristi Yamaguchi’s certain victory.