Monday, April 27, 2009

Pitfalls of PHR

from: THCB

Should You Keep Your Own Medical Records?

By RAHUL PARIKH, MD as written on "The Health Care Blog"


Personal Electronic health records raise doubt

Google service's inaccuracies may hold wide lesson

Dave deBronkart's records had wrong data.
Dave deBronkart's records had wrong data.

When Dave deBronkart, a tech-savvy kidney cancer survivor, tried to transfer his medical records from Beth Israel Deaconess Medical Center to Google Health, a new free service that lets patients keep all their health records in one place and easily share them with new doctors, he was stunned at what he found.

Personal health records, such as those offered by Google Health, are a promising tool for patients' empowerment - but inaccuracies could be "a huge problem," said Dr. Paul Tang, the chief medical information officer for the Palo Alto Medical Foundation, who chairs a health technology panel for the National Quality Forum.

For example, he said, an inaccurate diagnosis of gastrointestinal bleeding on a heart attack patient's personal health record could stop an emergency room doctor from administering a life-saving drug.

Google said his cancer had spread to either his brain or spine - a frightening diagnosis deBronkart had never gotten from his doctors - and listed an array of other conditions that he never had, as far as he knew, like chronic lung disease and aortic aneurysm. A warning announced his blood pressure medication required "immediate attention."

DeBronkart eventually discovered the problem: Some of the information in his Google Health record was drawn from billing records, which sometimes reflect imprecise information plugged into codes required by insurers. Google Health and others in the fast-growing personal health record business say they are offering a revolutionary tool to help patients navigate a fragmented healthcare system, but some doctors fear that inaccurate information from billing data could lead to improper treatment.


DeBronkart - who blogged about his Google Health experience on the website - has some simple advice for patients who use personal health records.

"Check it," he said. "See if it's accurate."

"Claims data is notoriously inaccurate and notoriously incomplete with respect to an expression of the problems a person has," said David Kibbe MD,  a senior technology adviser to the American Academy of Family Physicians

This fact negates the proposed effectivenss of a CMS' program of Pay for Performance, based upon claims data from physicians. For years Medicare has based cost containment on raw data regarding utilization from coding information on claims made without regard to the clinical data behind the claims.   Few of us are privy to their exact 'thought process'.

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