Technology Consult

Inexpensive software that allows people to create their own medical records has been around since the late '90s, but consumer response has been tepid. Americans who turn on a computer to access their chart probably number no more than 500,000, says David Lansky, director of the healthcare program at the nonprofit Markle Foundation, which studies the potential benefits of information technology. And most of those, he says, are merely looking at data stored in their doctor's EHR as opposed to a record they compiled themselves.

Nevertheless, a physician Web site service called Medem aims to put the PHR on a fast track to popularity. In May, it introduced the iHealthRecord, a free service that patients can use to list conditions, medications, past surgeries and tests, physicians, insurance data, and pretty much anything else that could help in an emergency. The iHealthRecord supplies patients with educational materials based on their conditions, reminders to take their particular medications, and alerts regarding FDA recalls of them.

Will pill-skippers maintain their own health records? Medem, a for-profit company created by the AMA and six other medical societies, has created practice Web sites for roughly 100,000 physicians, and it hopes this raw number represents a critical mass for the iHealthRecord. The idea: patients will create their personal chart by clicking on a link at their physician's Medem site. True, they also can go directly to http://www.ihealthrecord.org, but Fotsch says the new service's success depends partly on established doctor-patient relationships. "Patients don't want a PHR from a stranger," says Fotsch. "They want it from their doctor." And there's real synergy between iHealthRecord and a Medem Web site, which allows patients to request a prescription refill, pay a bill, or ask a clinical question with encrypted, password-protected secure messaging.

The iHealthRecord isn't a sure-fire thing, though. The number of physicians with a Medem site hasn't grown much over the past two years, and only 14 percent have turned on any of the secure messaging tools.

There are other challenges that face not only the iHealthRecord but competitors such as WebMD's Health Manager, FollowMe from Access Strategies, and the CapMed Personal Health Record from Bio-Imaging Technologies. Sure, the typical patient may want easy access to his records, as the Markle Foundation discovered, but will he bother to compile and update his own? "There's no indication that people will do that in large numbers," says David Lansky. "Some patients are motivated enough, but it takes a lot of self-discipline."

And if patients actually type in the names of the doctors they've seen, the diagnoses made, and the meds prescribed, will that help anyone render better care? Patients can give their doctors permission to view their PHR, but the information may not be reliable-think about a patient entering lab results, for example. St. Louis internist John Costello also worries that doctors will need to constantly review PHRs to avoid malpractice suits. "If the patient enters that he has a particular disease, or symptoms like chest pain, but the doctor never sees the information, is the doctor liable if the patient takes a turn for the worse?" asks Costello, CEO and president of a small EHR company called Medical Office Online.