Challenges facing patients adopting personal health records

by Kristina Fiore

They’re still there. Rows upon rows of number- and color-tagged manila charts, packed in so closely together that Fiore sometimes sticks to Fiori, or hides behind it.

None of my physicians has yet converted to electronic health records. I dream of the day when my PCP can pull up my chart on her iPad, accessing all of the important information (allergies, family history) before making a diagnosis.

That doesn’t look like it will happen any time soon. Despite many incentives — including about $40 billion of the $787 billion stimulus bill — doctors are hesitant to create EHRs. It takes a lot of time and money to convert tens of thousands of file-folder records into bits of electronic data. And perhaps patients complain about security issues.

I am not one of those patients. If I need to reference proof of my childhood allergies, I want to be able to do it right from my iPhone, right in my doctor’s office — rather than wait days for a release from my pediatrician.

So I’ve decided to take charge of putting all of my healthcare records — all the ones I can accumulate, anyway — into a PHR, a personal (electronic) health record.

First step: choose between Google and Microsoft. Google Health and Microsoft HealthVault appear to offer similar health-storing technologies. You can manually enter data on blood pressure, lipids, blood glucose, exercise, and allergies, based on your own data collection. Both ask that you enter your physician’s contact information.

Both have partnerships with myriad health providers, such as Blue Cross Blue Shield and Quest Diagnostics, that you can supposedly search for your healthcare information as long as your physician participates.

But neither appears to offer a dedicated virtual drawer for the paper files that I plan to scan and upload. Both allow for uploading of files, but Google warns of a four-megabyte limit per document, and HealthVault a 3.5 MB limit. I’m not sure my entire pediatric medical record will fit into such a small PDF file, and I am not keen on the idea of copying each page individually. Hopefully those limits aren’t overall storage limits, either.

Of course, there’s also the challenge of obtaining those paper records to begin with. I assume my pediatrician has long since put my files in storage. Even when I do get them, which could take months, how long will it take me to scan and upload every page? And then to have to do that for multiple providers? I can understand why physicians find the conversion task so daunting. (Perhaps every patient should be charged with converting their own!)

Security, of course, is one of my main concerns. While HealthVault’s name alone sounds more secure, both services “place the security burden on the user, and have specific language in their respective use agreements that hold them harmless for any breach of data caused by a compromise of a user account,” according to an InfoWeek story.

Those accounts do get compromised. I once had a hacker break into my Gmail account, and it took six days for Google to determine that someone had indeed hijacked my account and was using it to steal my Ebay and Amazon passwords.

Even more concerning would be if someone broke into my health vault to deny me a job or insurance coverage.

Ultimately, my support of technology and convenience outweigh my worry. Hopefully my work will one day benefit one of my physicians (and collaterally, myself). Though by the time I’m middle-aged, I hope many of them will have implemented their own EHR.