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Posted on Mon, Jul. 04, 2005 The push toward medical smarts: Standardized high-tech portable records By Esther Landhuis Mercury News As the federal government`s push for digitized medical records gains momentum -- a move advocates say will cut costs and save lives -- information technology companies in Silicon Valley and elsewhere are itching to get a piece of the action. The obstacles they face are huge, but not technological. Instead, the fragmented nature of the health care system itself presents the biggest hurdle. ``One of the biggest challenges is that health care is still very much a cottage industry,`` said Sam Karp, chief program officer of the Oakland-based California Health Care Foundation. ``There are a lot of players. It`s a disconnected universe.`` Patients are switching health plans more frequently, accumulating reams of data in many places. A handwritten prescription in Mom`s purse. A lab test result on a clinic`s database. An X-ray in another hospital`s radiology department. Gathering a complete patient record becomes an administrative nightmare. Yet the same technology brought to bear in online banking and other industries could be applied to the health care universe. Companies like San Jose-based StorCard are coming up with possible solutions. StorCard has developed a microchip-magnet combination that can store 100 megabytes of encrypted information on a credit card-sized format. With a flexible, rotating magnet inserted inside the card, StorCard offers more than 1,500 times the storage capacity of typical ``smart cards.`` Data is transmitted to and from the card using a special reader, StorPod, which plugs into any device with a USB port or wireless connection and reaches transfer speeds up to 5 megabytes a second. ``Imagine the ability to have all your medical information in your hand, in a secure fashion, when and where you need it. With minimal cost, we can add very high storage capacity to something everyone carries in their pocket today,`` said Shail Khiyara, StorCard`s vice president of marketing and business development. StorCard has lined up about 40 potential customers, including three to five medical groups that will pilot the system in the fall. Providers that purchase the system would decide whether to charge patients for the service, as well as determine what type of data is stored on the card and who gets access. Much like a computer hard drive, the card can be divided into multiple partitions, each with distinct access privileges. For instance, emergency physicians might only get to see basic information while doctors could access the complete medical history. National standards Parts of the card could store authentication elements such as fingerprints, iris scans or other biometric data, Khiyara said. Expected to hit the market next year, 100-megabyte StorCards will cost about $10 apiece, the readers $50 to $70. But for all its potential benefits, some warn that a system like StorCard`s can only be useful with widespread deployment, a prospect stymied by a lack of national standards for how data is formatted and transmitted. Smart cards ``would at least alert caregivers to information that they couldn`t previously access,`` said David Garets, president and CEO of Chicago-based HIMSS Analytics, market research subsidiary of the Healthcare Information and Management Systems Society. ``But we still have to establish a data dictionary so that the information we exchange means the same thing to the receiving system as it does to the sending system.`` Legislation addressing these and other infrastructure issues were recently introduced in the U.S. House and Senate. Of particular note was a bipartisan effort by Sen. Hillary Clinton, D-N.Y., and Senate majority leader Bill Frist, R-Tenn., who joined forces June 16 to tout a new bill that would hasten the nation`s transition to digital medical records. The bill would establish standards for electronic exchange of health data and fund local efforts to implement systems that aid this process. The 10-year goal: a national network of digital medical records that boosts quality of care and cuts costs while ensuring that patient information is secure and protected. Though it will take about $276 billion to digitize the nation`s medical records, according to a January study by the Boston-based Center for Information Technology Leadership, the potential savings should dwarf the costs. By preventing unnecessary procedures and speeding the handling of referrals and charts, electronic medical records would save the nation $74 billion a year, nearly 5 percent of current health care spending, according to the report. Fragmented systems A key barrier to these benefits is the incompatibility of existing electronic medical records software. Most of the 40 to 50 EMR systems that have come to market in the past decade cannot talk to each other. The same blood test results are coded differently by different systems, for example. Hampered by the fragmented data systems, revenue for hospital-based EMRs has grown 10 percent annually since 2000 to reach $850 million in 2004, according to Steve Tobin, a health care industry analyst for Frost & Sullivan. Yet the vast majority of doctors still record patient data with pen and paper. Only 10 to 15 percent of U.S. physicians use EMRs, most of them at large hospitals and medical groups. These systems cost $10,000 to $20,000 per doctor -- a steep price for smaller practices without information technology staff to help with setup and training. Besides the daunting costs, many doctors fear they`ll invest in a product that might become obsolete once nationwide data standards are established. ``Most vendors will tell you it`s one part technology and two parts knowing how to use the technology to benefit your practice,`` said Carolyn Clancy, director of the Agency for Healthcare Research and Quality, the health services research arm of the U.S. Department of Health and Human Services. In May, San Francisco-based Medem launched a Web-based ``personal health record`` that patients can use to store emergency contacts, insurance information and health data such as conditions, medications and allergies. Offered to patients on participating doctors` Web sites or at www.ihealthrecord.org, the free service allows people to share their electronic records with anyone they allow access to the password-protected site. ``This service is a clipboard-killer,`` said Medem CEO Edward Fotsch. More than 100,000 physicians nationwide have signed up for iHealthRecord, paying up to $25 a month. Through the site, patients can communicate with their doctors using a secure messaging system and access information specific to their medical condition. Those taking medications that get recalled by the FDA will receive a warning notice by e-mail. To some, though, the convenience of such services cannot offset fears that their private health records could be hacked. A Harris Interactive survey released in February found that 70 percent of Americans are concerned that their medical information could fall prey to weak data security, with nearly half saying privacy risks outweigh expected benefits. Greater security ``I don`t think the word encrypted means a lot to consumers anymore,`` said Emily Stewart, policy analyst for the Health Privacy Project, a Washington, D.C.-based non-profit. But experts say data is more secure in electronic systems than on paper. Only authorized individuals can access digital records, whereas paper records are handled by clerks and many intermediaries, said Paul Tang, chief medical information officer at the Palo Alto Medical Foundation, which implemented electronic medical records in 1999. ``When someone looks at your information in an EMR system, we keep audit trails of who has seen what at what time,`` Tang said. As an added layer of protection, providers who access patient records off-site must enter an extra password -- a six-digit number on a smart card that changes every 60 seconds. No matter how security is beefed up, experts say, occasional breaches are inevitable. ``Health care organizations are going to have to make their policies very visible,`` Clancy said. In the meantime, health information technology companies will continue battling for market dominance. ``In the long run, the personal health record products likely to bring the most value to patients are those that accept data from many sources and create a unified, long-term collection of data for a patient,`` said Wes Rishel, research director at Gartner, an IT research firm in Stamford, Conn. |
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