TN system gives patients access to health records

By Christina E. Sanchez • THE TENNESSEAN • April 19, 2010 Mary Ann Peugeot got her doctor to modify her medicine dosage without picking up a phone, visiting his office or shelling out a co-payment. With a few strokes on a keyboard and the click of the mouse, she sent him a message through a computerized warehouse of health information. She was fatigued, and her blood work, shown online, suggested the dose might be high for her. Her doctor agreed, he wrote back. "It allows you to be a partner in your own health," Peugeot said about online access to her patient records at Vanderbilt University Medical Center. "It is my body and they are my records and they are freely sharing it so I can be a better a patient and be healthier." Health experts are examining how to bestow to all Americans the access Peugeot enjoys to see her lab results, track health indicators and e-mail her doctor. They have to do that without violating a dense labyrinth of privacy issues. Tennessee is employing $11.7 million in federal stimulus funds to get health providers to espouse electronic health information technology and build an online medical record infrastructure, said Will Rice, executive director of the state office of e-health. "As we move in the digital world, patients want real-time access to lab results and other procedures," Rice said. "We won't have to carry physical films from one building to the next or wait three days for labs to arrive in the mail." Less than 20 percent of health providers nationwide keep electronic health records for patients, according to research published in The New England Journal of Medicine. The state's e-health office is probing what the acceptance rate is among Tennessee doctors. Electronic prescribing, a system in which doctors send patients' prescriptions to a pharmacy via a computer network, has been gaining ground in the state. About 1.78 million prescriptions in Tennessee were sent through an online network in 2008, about 4 percent of those that could have been sent electronically. That figure is on par with the national average. The goal under the Obama administration is to extend health record portability and access to every American by 2014, and more than $20 billion has been put toward the effort. VU system expands Vanderbilt's MyHealth system, launched about six years ago, is an example of what might be created on a larger scale. The health portal, accessed with a user name and password, began as an avenue for patients to send messages to doctors with whom they had appointments. It expanded later to include lab results, online bill payment, health tips and more, said Dr. Jim Jirjis, chief medical information officer for Vanderbilt and an internal physician. More than 100,000 people are signed up for MyHealth, and doctors find it a valuable communication tool, he said. "Doctors were worried it would overwhelm them," Jirjis said. "But they found it means our staff doesn't have to spend time licking envelopes, and they spend time engaging with the patient." The toughest sell for electronic records will be to skeptics who question safety and efficiency. Charles Jones, a Mt. Juliet resident, said if a health records system is designed with security protocol in place, it would be a useful tool. "Access to my own records would keep everything in one place and be easier to manage and update," Jones said. "Having them online could also make it easier for me to keep track of my health status, compare it against that of other people in my demographic group, identify food choices and other changes that may help me manage my health better." Privacy concern Not everyone is so sure. In a recent survey, about 59 percent of people said they were concerned about electronic records being kept private, according to an analysis from the Kaiser Family Foundation, the Harvard School of Public Health and National Public Radio. About 76 percent of people surveyed feared unauthorized people would gain access to the information. Rice, of Tennessee's e-health office, said an "opt-out" provision would be presented to patients, and there would be an audit measure in place to show patients every person who logged on to access their records. Redundancies avoided Electronic health records will cut costs because doctors could avoid duplicating tests already done in another health facility, said Dr. Clifton Meador, who sits on the board of Middle Tennessee eHealth Connect, a nonprofit working to electronically connect all hospitals, health clinics and ambulance services. Meador also is a member of the board of the Health Information Partnership for Tennessee, or HIP-TN, a nonprofit that is studying for the state how to implement electronic records. "You see patients who have a CAT scan done and when they get to another doctor get another CAT scan," Meador said. "Eventually, when electronic records mature, a doctor in any system could punch out your record in detail." He said patients could use computer health records to track their blood sugar levels if they are diabetics and check for any possible risky drug interactions on medications from different doctors. Eventually, doctors and clinics could pool health data to find successes and failures in treatment for certain conditions. "It makes medical information portable — wherever you go, there it is," Meador said. "Ultimately, we would have a much better informed public, and it would make health costs visible."