March 10, 2009

UCSF Expert Points Out Potholes on the Road to Digitized Health Records

With a newly approved $19 billion boost from the federal government, electronic medical records may soon become the norm in the United States – a development advocates say is long overdue. But considerable technical and policy barriers still exist between the current recordkeeping systems and what patients say they want and need, according to UCSF health policy expert James S. Kahn, MD.

James S. Kahn

In an article in the March/April issue of the journal Health Affairs, Kahn argues that the relatively slow adoption of personal electronic health records (PHRs) is largely due to the fact that up to now, consumers have “had PHR options but no PHR that did everything they needed to manage their health and wellness.” That must change, Kahn said, as PHRs are “an important part of the health information technology backbone of this country.” The ideal PHR would receive health data from multiple sources automatically and would self-update regularly, Kahn said. It would be a user-friendly, interactive storage system for information such as medications, immunizations, allergies and insurance coverage. In addition, he said in a recent interview, PHRs must “give people value for having information in the system.” “If you’re a smoker, for example, your PHR should be able to direct you and help you to stop smoking,” he said. “It’s a way to help patients stay self-motivated by giving them information and directing them down pathways that are most appropriate for their individual needs.” Of course, not all of the problems standing in the way of a fully electronic health records system are related to design. Many patients have infrequent access to the Internet and, therefore, a low level of computer competency. Those patients are also disproportionately low income and poorly educated when it comes to their health, Kahn said. Solving that problem will be difficult, but not impossible, Kahn said. “At the very least, if we can teach people how to use the Internet and get every patient an email address to access their health information, then we will have made some pretty major changes,” he said. He also noted that mobile phone use is much higher than Internet access in underserved communities, so mobile phones may serve “as an important entry point for consumers to access their PHRs.” “Let’s say a primary care exam with a patient generates $100 in revenue, and thanks to PHRs, you need two less in-person visits with that patient over a couple of years,” he posited. “Maybe with that $200 savings, you buy the patient a cell phone that provides access to their online health records, so they can derive greater benefit from their Internet connection.” A PHR that adequately addresses these concerns will “provide extraordinary value for consumers and will accelerate the changing of patients into partners for health,” Kahn concludes in his article. His enthusiasm is shared by many health policymakers at the state and federal levels. In 2004, President George W. Bush called for all Americans to have access to PHRs by 2014, and he established the Office of the National Coordinator for Health Information Technology to help achieve that objective. President Barack Obama has also been an outspoken advocate of PHRs, and the economic stimulus package he signed on Feb. 17 has set aside $19.2 billion to help speed up the move from paper to digital medical data. Kahn said he was “hopeful” that the Obama administration would make the policy decisions necessary to advance PHRs, but he said he worried that “big players might squash the little players” when it comes to designing and marketing new recordkeeping systems. “These technologies are still in the development stage, and I’d hate to see codification that snuffs out the innovation of emerging PHRs,” he said. Kahn himself is a “player” in the PHR game, having recently directed the development of myHERO, a PHR linked to the web-based medical records system used at San Francisco General Hospital’s AIDS ward. The site is a one-stop shop for patients to access all their past health information, and they can add their own updates – such as blood pressure, weight and glucose level. The myHERO service also offers “learn more” links next to users’ various medical conditions, taking them to the National Library of Medicine’s comprehensive MedlinePlus website. Kahn said he views PHRs as a blank canvas, full of exciting possibilities. “It’s a great opportunity for us to provide better service to our patients,” he said. “In the future, these kinds of interactive tools will serve as ‘clinician extenders,’ bringing health care to patients wherever they are.” Kahn is a UCSF professor of medicine, associate director of the UCSF Positive Health Program based at San Francisco General Hospital, and staff scientist at the AIDS Research Institute. He also serves as director of the mentorship program at the UCSF-Gladstone Institute of Virology and Immunology Center for AIDS Research. Photo by Susan Merrell

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