Online Medical Records: 
Are They the Future of Healthcare?

Some morning in the near future, Alice will log onto the Internet and access her own medical records from her physician Dr. Carroll.  She will note that her records show she has high blood pressure and will click on a link to a patient education article about managing high blood pressure through medication, diet, and exercise. Dr. Carroll has left an online prescription for Alice’s medication, and she will click on another link to order her prescription to be filled. Later that day, Alice will begin to receive e-mail from drug companies offering her discount coupons for hypertension medicines they sell. Alice worries about who else has access to her medical records. And, after reading all the drug company e-mail, she wonders whether Dr. Carroll has chosen the best and least expensive medication for her. Will  Alice have wandered into a Wonderland of more control over her own health, or will she have fallen down a rabbit hole where she has no control over the privacy of her own health information and is more confused about her choices? In this article, we will briefly look at the issue of online medical records and how these new Internet services affect the availability and privacy of health care information.

Who keeps the health records -- Doctors or Patients? 

 Internet sites for storing health records are of two types: (1) patients enter and maintain their own health information or (2)doctors store health records that the patient may read in any Web browser.  While some believe doctor-maintained medical records will be more accurate than those entered by patients, there are several reasons why sites offering patient-controlled data may be the most widely available type online.

 First, physicians have been slow to use electronic systems to capture medical records.  Also, many physicians are reluctant to provide patient access to these records because of the extra work involved in uploading the data to the Internet and answering e-mail from patients who don’t understand the records or who want more information.  Donald Kackett, chief executive of drkoop.com, says that it is better for the patient to be responsible for entering and maintaining data because “If you wait for your doctor to do it, it will never happen.” (Wall St. Journal, 08/16/99, B1).  Advocates for patient-maintained records say that patients who are concerned about their health are likely to update their files regularly. Moreover, when patients maintain their own records, they can also include alternative medicines or non-prescription drugs they are taking, as well as treatments by all their physicians.

 Personal Health Records Software Alternatives

Where does health records software for personal computers, such as Health-Minder,  fit into this future of online medical records? Obviously, a printed copy of a Health-Minder medical summary could be faxed to sites such as PersonalMD.com which store such files as part of a user’s online database.  Health-Minder could, in future versions, also store downloaded medical records once the form these records will take is known.  But these two options provide mere redundancy in records, not adding any new benefit to patients or doctors, and presenting problems of keeping both sets of records current and in synch.  

 Are there any advantages to maintaining offline Health-Minder records once online services are widely available?  Yes, for both technical and substantive reasons.  From a technical viewpoint, most users who access the Internet via 28.8 modems and telephone lines will find data entry to be a slow and tedious process, thus limiting the amount of data you will want to enter and update. Typically, one to three questions are asked per Web page, and after pressing SUBMIT, the user must wait for that data to be stored and a new Web page to be presented. Entering or retrieving a whole family’s medical information will be even more onerous.

 As to record content, none of the online medical records yet allows storage of as wide an array of information as Health-Minder does: work health history, symptom diary, dietary and exercise habits, and more.  Nor do the online programs (or even other offline software programs) link a diagnosis to all its relevant tests, treatments, prescriptions, and various health care providers. Online services, unlike Health-Minder, do not handle medical expense data or insurance claim information.  In general, then, online information is far less comprehensive and useful. These content issues are not easily resolved by online services because of the slowness of gathering and providing information online, the large databases that would be required for each online user, and because the information from each individual is kept encrypted and isolated from that of other individuals, even those in the same family.

  Is privacy of online medical records a concern?  

The companies providing these online services promise to use secure technology and encrypt the data so that even their own employees can’t read it. They also promise not to sell member lists, but will ask members if they want to be put on lists to receive information on new products, clinical trials, or new treatments relating to their conditions.  The services will earn money by signing up patients for these lists and by selling ad space from drug companies and other health services.  Legislation that would effectively enforce these promises has yet to be enacted at state or federal levels. (See the sidebar for links to web sites devoted to privacy issues.)

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WebSites for Online Medical Records