By SARAH RUBENSTEIN
THE WALL STREET JOURNAL ONLINE
Subscribe now to The Wall Street Journal and get up to 8 weeks FREE
May 9, 2005

For all of modern medicine's advances, most physicians still rely on pen and paper to record and track their patients' medical histories.

Although doctors are often painted as being computer-averse, there are even bigger reasons why the digitization of medical records is still in its infancy: entering mountains of bulging medical charts into computers is daunting and expensive. Many of the systems that exist don't talk to each other. And while some patients want the convenience and safety of having all of their medical information in one accessible place online, that same prospect makes others worry about privacy.

Now, a for-profit company affiliated with the American Medical Association is offering up a near-term step toward wiring up at least some of the nation's archaic paper medical system. Medem Inc., today unveiled an Internet-based "personal health record" that patients can use to organize their family's medical histories, much as they might electronically manage financial records or bank accounts.

Available free of charge at www.ihealthrecord.org and on participating doctors' Web sites, the program helps patients record emergency contacts, insurance, and medical information such as conditions, medications and allergies. Patients access their record online using a password, and they can provide access to doctors, hospitals or loved ones: In case of an out-of-town emergency, for example, a husband could provide hospital staffers with his wife's password to ease treatment; patients seeking second and third opinions could provide their password to new doctors to get them quickly up to speed.

Medem hopes that by stoking consumer interest in the system, patients will encourage their doctors to switch over from paper charts to computers. The health-care industry is under increasing pressure from the government, insurers and patient advocates to go digital. President Bush has called for all Americans to have electronic records in the next decade, and many physicians believe the quality of health care would improve, with fewer medical errors and less burden on patients to keep their own records, if information moved more efficiently through the system.

Indeed, many doctors say they would welcome a tool to help patients prepare for their first doctor's visit. "I'd love people to fill in the blanks before they came in to see me," says David C. Kibbe, director of the American Academy of Family Physicians' center for health-information technology. "It's much better than them bringing in a paper bag of bottles."

At present, a hodgepodge of sources -- from employers to insurers to private-sector companies -- are experimenting with programs for digitizing medical records. Among iHealthRecord's early rivals are WebMD Corp.'s WebMD Health or Access Strategies Inc.'s FollowMe, which charge patients to maintain online personal health records. Some employers, such as PepsiCo Inc., are offering secure, Web-based personal health record programs to their employees.

But with so many new programs, no single format is yet attracting a critical mass of users. "This is kind of the Darwinistic phase," says David J. Brailer, who last year was appointed the nation's first health-information technology coordinator, at the Department of Health and Human Services.

Beyond personal health records, which are maintained principally by patients, an important goal of health information technology proponents is to convert doctors' offices to electronic medical records that let them maintain detailed charts, notes, lab tests and other patient information electronically. Ideally, EMR technology can communicate with the computers of pharmacies, insurers, other doctors and hospitals.

Right now, many hospitals and large health provider groups that own both hospitals and doctors' offices are making the switch to electronic records. But differences in technical standards have kept them from interacting with other providers outside their own networks in most cases. For doctors, the costs of making the switch from paper records can be prohibitively expensive; only about one-third of large practices have EMRs, and fewer than one-tenth of small-group and solo practices have adopted them, according to the Markle Foundation, a New York nonprofit that focuses on information technology and public policy.

They are "still pretty expensive," says the family-physician academy's Dr. Kibbe. And "it still requires, in some cases, more time to use these systems than it does to document on paper."

Medem, founded by the AMA and six other medical societies in 1999, may be in a position to gain a high level of awareness and trust from doctors and patients. The service has hit the ground with 50 physicians promoting it to their patients as part of a pilot run. About 90,000 physicians currently pay as much as $25 a month to subscribe to Medem's other services, which include Web sites for their practices and doctor-patient email capabilities. Medem plans to offer its subscriber doctors an iHealthRecord link for their Web sites at no additional charge.

Medem is offering some extra perks to doctors and patients using iHealthRecord. It will send patients information from the Food and Drug Administration, the Centers for Disease Control and Prevention and other groups about drug recalls or other issues related to their particular medications or health conditions.

Still, the service faces obstacles, not the least of which is assuring patients that their medical histories won't be accessed by hackers or sold to employers or insurance companies. Privacy is "still a major issue, and really, it's the largest obstacle in terms of trying to move into health information technology," says Emily Stewart, policy analyst for the nonprofit Health Privacy Project in Washington, D.C.

Unlike those controlled by doctors and insurers, third-party Web sites generally aren't bound by federal patient-privacy laws, says Paul Tang, chief medical information officer at the Palo Alto Medical Foundation, a large group practice in California that has its own electronic record-keeping system and Web site, where patients access records, such as lab test results. "A third party doesn't necessarily have that same mission-bound responsibility and accountability, and that's a concern," Dr. Tang says.

Edward Fotsch, Medem's chief executive, says the company has modeled iHealthRecord's security measures on the financial-services industry, encrypting data and hiring an outside security company to conduct audits. But unlike with online bank accounts, hackers who access health information can't so easily make money with it, he says. Medem won't sell medical information to insurers, employers or pharmaceutical companies, although it may make aggregate data available to public health researchers. "That's not our business model," Dr. Fotsch says. "There is no current plan to sell any data of any kind for any reason."

Among other safeguards, the iHealthRecord site will indicate to patients the time of their last log-in, making it easier for them to tell if someone else has accessed their records. Later in the year, the site plans to send patients automatic emails telling them when anybody has logged on to their records.

What if a child or other unauthorized person in the household finds a password and snoops around? "From that standpoint, it's no different from having a manila folder at home with a printed record," Dr. Fotsch says. "If you have a personal health record, be it paper or electronic, you ought to take reasonable steps to keep it out of the hands of people you don't want to see it."

Records maintained by patients are only as good as the information they put in. Ultimately, iHealthRecord's success may hinge on how easily doctors can use their own electronic record-keeping systems to update patients' records with the latest lab reports and test results. Only one vendor of EMR systems, Chicago-based Allscripts Healthcare Solutions Inc., has started enabling its technology to exchange data with iHealthRecord; two others have said they plan to do so, Medem says. Doctors could manually update patients' records, but until they can electronically pour in such information, the usefulness of personal medical records may be limited.

"I think the Medem approach is a pretty clever way to take a stab at [digitizing medical data], but it's not a slam dunk by any means," says David Lansky, director of health at the Markle Foundation.

.

Subscribe now to The Wall Street Journal and get up to 8 weeks FREE