Monday, November 5, 2012

The Digital Health Record Is Here

A cure for chronic paperwork.
It's easy to make the case for personal electronic health records: a health care system in which everyone has his or her full medical history in a digital format, stored securely in the cloud, where it's always accessible and readily shareable. Such a system would deliver quicker, safer, and higher-quality care than our current system, in which medical histories sprawl piecemeal in scribbled notes locked away in doctors' offices, hospitals, labs, and pharmacies. Consolidate the data in a single record, and there will be fewer errors, less redundant paperwork, fewer unnecessary appointments, and better coordination among providers, patients, and the family members who help care for them.

What's hard, it turns out, is building an electronic health record, or EHR, that people will actually use. Just ask Mohammad Al-Ubaydli. When the doctor/programmer founded the U.K.-based EHR company Patients Know Best four years ago, he had three main competitors: Google, Microsoft, and Britain's National Health Service. Google and the NHS have since pulled the plug; Microsoft's HealthVault hobbles on, although many analysts question how much more effort the software giant will put into the project.

But Al-Ubaydli believes he can succeed. "The big challenge is in lining up everyone," says Al-Ubaydli. "Google and Microsoft thought only patients mattered, so they built a product that was only usable by patients. A patient gets really excited about Google Health, spends three hours entering their data manually, then tries to show their doctor, and the doctor refuses to use it with them. That patient will never again use Google Health." Patients Know Best, by contrast, has been designed to be useful for patients and clinicians, he says. Another key challenge: trust. "Google and Microsoft spent a long time trying to convince people that they would not misuse, resell, or advertise around the data," says Al-Ubaydli. "Not many people believed them." Patients Know Best encrypts all data so that only the patient and whomever the patient chooses can decrypt it.

To get started with Patients Know Best, patients ask an institution, like a hospital network, to transfer their data into a personal account. From then on, the patient controls the record and can invite other providers to collaborate, adding reports, lab results, information on medications, and the like. It's free for patients. Hospitals and doctors in private practice pay subscription fees. "The hospitals pay, because by working with patients in this way, they either save money through efficiencies or make money by attracting more patients with better customer service," says Al-Ubaydli.

Patients Know Best is just getting started: About 20 hospitals in the U.S. and the U.K. use the platform. But Al-Ubaydli says the company is profitable ahead of schedule, and he expects that incentives for doctors to adopt electronic health records will help spur usage. "Every government is heading toward the same big trends of universal health care and payment by result, not activity," he says. "All the incentives are there to improve outcomes by sharing data."

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