PHRs - Miracle or Mayhem?

You may have caught some of the recent press around personal health records or PHRs.  Both Microsoft and most recently Google have entered the market of providing individuals the ability to enter their personal health information in an on-line medical record.    And in the case of Google, individuals have the ability to import their medical records from pharmacies, labs, hospitals and insurers.  (Full disclosure – MyDailyApple is a Google Health service).

A lot of commentary on Microsoft HealthVault and Google Health has focused on the advantages of accessibility and patient control.  The PHR allows the patient to take their medical records anywhere and provide access to anyone at anytime – since it’s all on line.  The major disadvantage that has been mentioned revolves around issues of privacy and security.  Do you trust Microsoft or Google to safeguard your medical information?

I agree that accessibility and portability are major advantages of PHRs and that security is a major concern.  But I think most commentaries have missed some of the other major advantages associated with an on-line PHR and some of the major pitfalls.

For instance, from a patient perspective, consider some of the following additional advantages beyond portability and accessibility:

1.       Now you can review your records to see how your doctor thinks.   You can see their decision making, how thorough they are and what other diagnostic possibilities they are considering.

2.       You can see if your physician is compliant with the latest guidelines regarding screening, testing and treatment.

In short, as a patient, you can now get some insight into whether or not you are getting high quality care.

But on the flip side, from a physician perspective, there are some serious concerns with opening up medical records so easily:

1.       Does this expose physicians to additional liability?  What if a patient finds something wrong in their medical record or an omission of care?

2.       Can you imagine a HealthVault or Google Health service provided by lawyers – “We’ll see if there is evidence of negligence in your PHR and get the money you’re entitled to!”  Okay – some of you might think I’m being a paranoid doctor.  But seriously – I saw an ad on the TV asking women who had an emergency c-section to get immediate legal counsel.

Bottom line: Are providers really going to rush to provide easy access to medical records to on-line PHRs if it means they might get sued?

On-line PHRs contain the aura of another miracle for what ails the US healthcare system.  And certainly, greater transparency, portability and accessibility or records and patient empowerment are all important goals – furthered to an extent by the PHR.  But there could be problems – and a great deal of reticence beyond issues of patient privacy – before there is widespread adoption. 

Google Health and HealthVault are not going to be enough to fix the problems in US healthcare.  It’s going to take a couple of additional “mini-revolutions” beyond on-line PHRs – like in areas of medical tort reform and malpractice; easily understood and validated quality measures; financial incentives towards prevention and wellness and not just disease treatment – till this patient starts to get better.

Special thanks to my father – whose conversations with him helped shaped much of my thinking for this current blog.