Health care may be the fastest growing industry, but it has been slow to adopt the use of technology. While orders at fast food chains are now entirely automated, most physician offices and hospitals still maintain their records on paper.

In a new position paper released today by the American College of Physicians (ACP) at www.acponline.org/advocacy, the nation's largest medical specialty organization says that collaboration among physicians, patients, technology developers, and policymakers must occur if e-health activities like electronic communication between physicians and their patients, remote monitoring of patients, personal and electronic health records, and patients seeking health information online are to transform health care in the U.S.

"E-health activities have great potential to improve the quality of patient care, reduce medical errors, increase efficiency and access to care, and achieve substantial cost savings," says David C. Dale, MD, FACP, president, ACP. "Furthermore, e-health is a critical part of the patient-centered medical home model of care, which in coordination with the other components, is the future of the U.S. health care delivery system."

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Background: USB (universal serial bus)-based personal health records enable patients to easily transport their health histories to physicians for review. These small, handheld devices (sometimes called "thumb drives" or "flash drives") contain a database to store personal health information and a software program to display and edit the contents of the database. They are rapidly gaining popularity (1) and have drawn the attention of the popular press (2) and U.S. Congress (3). Recently, they were distributed to Hurricane Katrina victims in New Orleans as part of the city's Health Recovery Week (4). These devices sell for less than $100 and are often given free to patients by insurers, employers, hospitals, and health systems. However, USB-based devices may pose a security threat that could be used to access sensitive data from a physician's computer. By simply inserting the device into a USB port, a provider may put all data on that computer, and potentially all data on the network to which the computer is connected, at risk for theft or corruption.

Objective: To determine whether USB-based personal health records pose a security threat to provider data.

Methods: We identified 5 major USB-based personal health records: the E-HealthKEY (MedicAlert, Turlock, California), Personal HealthKey (CapMed, Newtown, Pennsylvania), Med-InfoChip (Med-InfoChip LLC, Boynton Beach, Florida), MedKey (MedKey Corp., San Diego, California), and The Bartlett (PEHR Technologies, Salt Lake City, Utah). We obtained 3 of these devices (MedKey Corp. and PEHR Technologies did not supply a sample of their device), analyzed them to determine their structure, and attempted to modify the software program on each device to perform actions of our choosing. No device was manufactured with protections against this.

Findings: We modified the programs on the devices so that, when connected to a computer, they gave the appearance of normal operation but surreptitiously searched for and copied data from the computer to a hidden location on the USB device.

Discussion: The security threat posed by existing patient-controlled USB devices is serious. Depending on how a USB-based personal health record is modified, the programs on the device could tamper with data (for example, to enter unauthorized prescriptions); spread computer viruses; corrupt the hospital or practice network to which the computer is attached; leave harmful software behind that could, for example, capture usernames and passwords and send them to the person on an ongoing basis; and copy financial or health data -- all while the physician is viewing the patient's health record on the device. Each of the devices we reviewed contains a program that must be used to view the patient record, and no reliable mechanism can verify the integrity of these programs. The only certain way for providers to avoid this type of attack is to avoid accepting such devices. Web-based personal health records, which are also available, are a safer alternative. Because they are viewed through a Web browser and require no special software to run, they are not subject to this type of attack.

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An electronic tracking system improved processes of care and some clinical markers for patients with type 2 diabetes, a Canadian study found.

The trial included 46 primary care providers and 511 of their patients who were randomized to either usual care or the electronic intervention. The intervention gave patients and physicians access to a Web-based diabetes tracker that provided monitoring values and targets for 13 diabetes risk factors and brief advice messages. Patients were also sent a color-coded tracker page by mail, and they received automated telephone reminders.

After six months, patients in the intervention group showed some (although statistically insignificant) improvement in processes of care. The patients who participated in the electronic tracking also had statistically significant declines in blood pressure and glycated hemoglobin. Physicians and patients noted difficulty accessing the Web portal as the major shortcoming of the system. The study was published in the July 7 Canadian Medical Association Journal.

The study was unusual in that it tested an electronic monitoring system outside of a large institution, so technology support was less available and the system had to work across different, non-interoperable electronic medical records. It was limited by patients' lack of access to the Web. At baseline, about half of patients used a computer. Therefore, it's difficult to isolate the effects of the computer system from those of the telephone and mail reminders, which encouraged patients to see their physicians.

Although researchers favored the creation of patient-centered electronic systems to facilitate clinical management, it's not known yet what innovations will result in durable improvements in diabetes care, concluded the accompanying editorial.

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Common mistakes include converting too fast and underestimating how much time and training offices need.

Over the past year alone, physician salaries have shot up 30% at the four-physician Evans Medical Group in Evans, Ga., a suburb of Augusta. New revenue-producing strategies should boost that to an 80% increase next year--due in large part, said a physician member, to its electronic health records (EHRs) system.

Sidebars:

• Wave of the future: personal health records on the Web?
• One physician puts EHR savings to work by hiring pre-med students

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From Healthcare IT News

Online diabetes management programs may lead to improved patient knowledge, engagement and accountability, as well as better communication between patient and doctor, according to a new study by the Center for Connected Health, a division of Partners HealthCare. The study is published in the March issue of the Journal of Diabetes Science and Technology.

Based on the results of the pilot study, which examined a program called Diabetes Connected Health, the Center for Connected Health has initiated a randomized clinical trial involving 200 patients from six primary care practices affiliated with either Massachusetts General Hospital or Brigham and Women's Hospital.

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The importance of personal health records (PHRs) and other technologies that can help patients and physicians improve health care was underscored today by the American College of Physicians (ACP).

ACP's statement came in reaction to an announcement made by a group of large employers. Yesterday, the initial group of employers -- Wal-Mart, BP America, Intel, Pitney Bowes, and Applied Materials -- unveiled Dossia, a system the employers say will enable individuals to control their own medical data from multiple sources and to create and utilize their personal, private and portable electronic health records.

Representing primary care medicine through a membership of more than 120,000 members, ACP is the nation's largest medical specialty society. ACP emphasized that employers' efforts will only succeed if they are integrated into clinical practice at the point of care as part of an ongoing relationship between the patient and his/her physician.

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General Comments on Personal Health Records (PHRs):

• ACP supports the use of PHRs as one mechanism of creating patient-centric repositories of clinical information.
• PHRs should be secure and adhere to all current privacy and security standards.
• Clinical information and guidance provided by the host or creator of the PHR program should comply with the relevant URAC standards for web-based clinical content (http://www.urac.org/consumer_standards.asp).

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The American Health Information Management Association (AHIMA) and the American Medical Informatics Association (AMIA) advocate empowering individuals to manage their healthcare through the use of a personal health record (PHR). The PHR is a tool for collecting, tracking and sharing important, up-to-date information about an individual's health or the health of someone in their care. Using a PHR will help people make better health decisions and improves quality of care by allowing them to access and use information needed to communicate effectively with others about their healthcare.

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From the American Health Information Management Association (AHIMA), patients can take this guided tour to learn more about how their health information is collected, where it goes, and how it is used.

This and other PHR resources from AHIMA help patients learn the basics of the PHR concept and get started using one, which can improve the effectiveness and efficiency of their self-management.

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From the American Health Information Management Association (AHIMA), this site contains a variety of resources for patients to assist them in taking a greater role in managing their care through the use of personal health records (PHRs).

PHRs allow patients to provide doctors with valuable information that can help improve the quality of care. A PHR can help reduce or eliminate duplicate tests and allow patients to receive faster, safer treatment and care in an emergency.

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From the American Medical Informatics Association (AMIA), this paper explores the transformative potential of Integrated Personal Health Records (iPHRs) and the key barriers to the full realization of that potential. AMIA defines iPHRs as electronic records that are capable of true data exchange and full integration with health care information systems (i.e., provider-based electronic health records and other relevant sources of personal health information). They extend the definition to include uses for public health as well as biomedical research studies. This paper examines the background and context in which personal health records (PHRs) have risen in prominence on the health care scene, paying particular attention to their potential to improve the continuity of care, to foster patient participation in their care, and to enhance patient-provider communication. This paper also explores the notion that iPHRs must exchange data with other parts of the health care system to stimulate transformative change in clinical practice, self-care, and wellness.

Topics covered include:

• Historical Context of PHRs
• Characteristics
• Key Stakeholders and Potential Benefits
• Models
• The Capabilities Underlying iPHRs' Transformative Potential
• National Initiatives
• Key Barriers to Adoption
• Steps Toward Realizing the Full Potential of iPHRs

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From the New York Times (December 3, 2006)
Powerful forces are lobbying hard for government and private programs that could push the nation's costly and inefficient health care system into the computer age. President Bush strongly favors more use of health information technology. Health insurance and medical device companies are eager supporters, not to mention technology companies like I.B.M. and Google. Furthermore, Intel and Wal-Mart Stores have both said they intend to announce plans this week to embrace electronic health records for their employees. Others may soon follow. Bills to speed the adoption of information technology by hospitals and doctors have passed both chambers of Congress. But the legislation has bogged down, largely because of differences over how to balance the health care industry?s interest in efficiently collecting, studying and using data with privacy concerns for tens of millions of ordinary Americans -- not just celebrities and victims of crime. Advocates of such legislation, including Representative Joe L. Barton, the Texas Republican who is the chairman of the House Energy and Commerce Committee, said that concern about snooping should not freeze progress on adopting technology that could save money and improve care.

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From Modern Healthcare (January 2007)
If there is a next big thing in healthcare information technology in 2007, it will be the role of consumers in this sector of the industry, according to a consensus of experts.

In 2006, coalitions of major employers and payers both unveiled ambitious plans to try to empower their employees and plan members with personal health records (PHRs), continued development of data-dependent quality improvement programs, and private and public sector pay-for-performance schemes, and all will have an impact on the healthcare industry, IT experts say.

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