E-books. Digital magazines. Paperless billing. As everything else in the world has gone digital, it only makes sense that our health records would too.Nancy Sandman, a psychotherapist from Brookline, Mass., a suburb of Boston, jokes that she has a “basic trust” issue where computers are concerned. She doesn’t own an e-reader, and she only recently purchased a smartphone. So when Sandman’s family doctor told her that she could view some of her medical information electronically, she wasn’t very interested. Until one day when her insurance company called and labeled her a “newly diagnosed diabetic.”
“I went immediately online then,” she recounts, alarmed at the news. Within minutes, she was tapping computer keys, sifting through recent lab results and diagnoses, until she was reassured that her blood-sugar readings hadn’t appreciably changed. Sandman, who remains prediabetic, now regularly checks her lab work online and, since 2010, even reads up on her doctor’s progress notes. “It gives me control,” the 69-year-old says. “There are no surprises.”
Doctors around the country are finally moving into the computer age and shedding bulging cabinets of paper charts for software packages — a long-awaited shift that’s been accelerated in large part by a 2009 federal stimulus law tied to electronic-record adaptation that included as much as $27 billion in physician and hospital incentives. According to survey results released late last year by the Centers for Disease Control and Prevention, 52 percent of office-based physicians plan to take advantage of those incentives. For some patients, this computerized shift is already making it easier to stay on top of their own care — with a few keystrokes, they can schedule convenient appointments through a secure online system, request a medication refill or ask the doctor whether a nagging sore throat necessitates an office visit.
Boston’s Beth Israel Deaconess Medical Center, where Sandman’s doctor works, has even gone so far as to join forces with two other U.S. medical facilities to study what happens when patients are provided a virtually unrestricted online window into their own medical record through a “patient portal.” (The Star Trek–sounding term describes a secure electronic gateway through which patients can view, to varying degrees, their own medical information.) During the center’s one-year study, some 20,000 participating patients have been able to not only look up diagnoses and test results online but also review their doctors’ notes.
Other institutions have also significantly expanded electronic access. Kaiser Permanente, which has 3.7 million health-plan members registered with its online portal, rolled out a smartphone app earlier this year so users can access their records from anywhere. And Palo Alto Medical Foundation, in Northern California, which had at least 70 percent of its 470,000 adult patients using its online portal by late 2011, recently completed a study (the results of which haven’t yet been published) where diabetic patients transmitted blood-sugar readings from home glucometers via their cellphones to their electronic health record. During the three-year study, half of the 415 participants (those in the “intervention group”) monitored their blood-sugar patterns online to see how they were affected by diet, exercise and medication. “Seeing what happens with your own behavior is a powerful influence,” says Dr. Paul Tang, the medical foundation’s chief innovation and technology officer.
But even enthusiasts acknowledge that giving patients access to their own medical records will likely cause various ripple effects that could influence everything from patient knowledge to medical treatment itself. Among some of the questions and uncertainties: Will patients understand lab findings and other medical jargon? Will they freak out if they read something unsettling? Will doctors change what they write, knowing that their patients might read the information?
“I worry that if we start leaving those things out in order to make the medical record more understandable for the patient, we could potentially be leaving out important? information that would be understood only by other doctors,” says Dr. Russ Cucina, medical director of information technology at the University of California, San Francisco.