Don’t you want more than a “porthole” view of your healthcare?

At times over the years I’ve been surprised to see patients arrive for their appointments carrying a shoebox. Inside the box are piles of paper, old doctors’ notes and CDs for images. Typically these folks have been so frustrated by the system that they’ve taken their medical records into their own hands. Occasionally they will push the box towards me, hoping I’ll open it, review the contents, and come up with a better diagnosis for what ails them.porthole

Given the state of technology in America, this is simply shameful. How is it that the NSA can track almost every phone call we’ve ever made but the various hospitals and clinics we go to for care can’t or won’t share our records? The fact is that historically there’s been no reason to share. It has been easier, and in many cases more lucrative, to simply redo lab work or x-rays. However, times are changing.

Portals are for Cattle

The Accountable Care Act disincentivizes expensive over-utilization. Additional federal provisions give the patients, aka the consumers, right to their own data. In response, most hospitals have set up a “portal,” a website you can visit to download information about your last hospitalization or clinic visit. Sadly, this web record typically represents a very limited view of your care experience.

Why is that? I have previously made the point that portals should be for cattle while personal health records should be for people. The portal as it exists now is too limited in the data it captures. It reflects a healthcare system that takes no responsibility to present a comprehensive record of your journey to wellness, incorporating records from all the hospitals and all the clinics you’ve been to in an organized way. As medicine becomes ever more specialized and complicated, that is a critical failing. Not only would updated and complete information vitally assist the patient in navigating an illness, it is what I need as a physician to quickly diagnose the problem and make certain that the treatment I prescribe is the right one. However, at a recent medical meeting (HIMSS 2015), I saw a glimmer of hope.
A Mint for Medicine

Medfusion, a technology company based in North Carolina, was the most interesting innovation I saw at the show. Medfusion got their start building portals for physicians, essentially replacing fax and phones with a website interface that allows patients to easily interact with their doctors. Numbers testify to their success. Over the years, 10 million patients have registered with Medfusion.
Recently they’ve gone one step better, enhancing their technology to offer a portal of portals, essentially a one-stop destination that brings all of your medical records together in one place. Here, Medfusion has clearly followed the lead of “Mint,” the finance app. While the service is free for patients, other software vendors can pay to integrate into Medfusion, providing a powerful resource that quickly brings all the information needed to care for a patient together in one place. Imagine it: you go to your primary care physician’s office, tap into your Medfusion account, and your entire medical history—drug prescriptions, allergies, previous hospitalizations—populates into your doctor’s EHR.

Medfusion still lacks some fundamental functions. In particular, the company hasn’t figured out how to make imaging part of the record. And the application does not allow for patient input or self-reporting, a flaw that constrains the disease-specific information available. Limiting the information to hospital and clinic records paints only half the picture. For example, if your primary issue were back pain, it would be great if the app could send out periodic reminders to you to record how bad your back pain was during the day. The good news is that Medfusion has already integrated into Apple’s HealthKit. I expect to see improvements in the coming months.

Who Owns Your Data?

At the heart of this innovation is a transformative change. Traditionally hospitals and clinics have taken responsibility for (and in many ways owned) your information. They’ve also limited access to your health record. In contrast, personal health records are owned by the patient, with hospitals and clinics participating to keep records updated. Medfusion’s new software, and applications like it, put the power in the hands of the patient, ultimately providing a critical missing piece for better healthcare at a lower cost.

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