A Hospital Is Offering Digital Records

April 6, 2009
A Hospital Is Offering Digital Records
By STEVE LOHR
http://www.nytimes.com/2009/04/06/technology/companies/06health.html?_r=1&hpw=&pagewanted=print
Online personal health records — controlled by patients themselves, not by hospitals, doctors, insurers or employers — have been available for years. Yet only a small percentage of Americans have digital personal health records today, analysts estimate.

A major obstacle to adoption has been getting useful medical and patient information into personal health records. Typing one’s personal health information into an online form is time-consuming, mind-numbing and error-prone.

To overcome that challenge, Microsoft and Google have announced partnerships in recent months with large health care providers like Cleveland Clinic, Mayo Clinic and Kaiser Permanente to explore transferring patient data automatically into personal health records.

NewYork-Presbyterian Hospital, whose centers and clinics provide about 20 percent of the health care in New York, is the first large institution to move beyond the pilot stage this week as it begins to offer consumer-controlled health records for patients, and its experience will be closely watched in the industry.

NewYork-Presbyterian has been working with Microsoft for more than a year, not only on technical matters but also ease-of-use concerns with patients. The introduction will be gradual, beginning with heart patients, who will be told of the potential benefits of personal health records when they visit a NewYork-Presbyterian hospital or outpatient clinics.

Initially, patients will be given on-site help signing on and setting up passwords, and access to the Web portal for personal health records, myNYP.org, will be controlled.

But the goal is to scale up the introduction over months. “We view this as widely applicable to all our patient population,” said Dr. Steven J. Corwin, chief operating officer of NewYork-Presbyterian.

NewYork-Presbyterian has had its own computerized records for patients for years, and Dr. Corwin says the use of electronic medical records to track care inside the hospital system has saved money and improved outcomes, for instance, reducing medication errors considerably.

Seeking similar gains across the health care system, the Obama administration plans to spend $19 billion over the next few years to accelerate the adoption of electronic health records in doctors’ offices and hospitals.

The government’s plan has no incentives for consumer-controlled health records. But Dr. Corwin says the personal health record is a “powerful additional tool for improving health care” and one that offers added benefits because “the data is controlled by the patient, not tethered to an institution.”

One significant benefit is the mobility of information and ease of access to an online personal health record, said Dr. Mehmet Oz, a heart surgeon at NewYork-Presbyterian.

Many of his patients are referrals from outside the NewYork-Presbyterian system. When they arrive, Dr. Oz said, they typically come in with incomplete paper records and patchy recollections of past care. When they leave the hospital, he added, they get paper records of their care and a check-list of reminders.

“The paper-based system is sort of ‘Here, and good luck,’ ” Dr. Oz said. “It’s cumbersome and dangerous.”

Nationally, 20 percent of heart-surgery patients are readmitted to the hospital within 30 days, often for preventable conditions like fluid buildup in the lungs, which can be easily monitored and prevented. The online personal health record makes efficient communication and continuity of care far easier, Dr. Oz said. It can be accessed by the patient and, with permission, relatives and a patient’s personal physician,

Personal health records, experts say, hold considerable promise, but much depends on how complete the information is in them. “Something like what NewYork-Presbyterian is doing is a great step, but it’s only part of the answer,” said Dr. David J. Brailer, former national health information technology coordinator in the Bush administration.

If a patient gets all or nearly all his or her care in one health system, then the personal health record will be rich in information, and very useful, Dr. Brailer said. But if some doctors or clinics put information in and others do not, it will be less useful. The ideal, he said, is for most patient information to be in digital form and, with safeguards for privacy, be collaboratively shared by health providers and patients.

Still, Patrice Daly Cohen, 50, who had heart-valve replacement surgery in February at NewYork-Presbyterian, is impressed by the benefits of the personal health record, which she has used in the pilot project. When she needed the report of her operation for her physician, she went online and printed it out.

When she was home recovering in West Caldwell, N.J., Ms. Cohen read over the daily reports from her hospital stay, which had been automatically dropped into her personal health record.

“It was almost too much information,” she said. “But I am someone who likes to be in control. I think it’s great.”