Florida internist Ken Ponder learned the lifesaving value of online medical records in January, when the Food and Drug Administration warned that a new heartburn drug, Propulsid, could put some patients at risk of heart attack. Ponder, who uses MedicaLogic's Logician Internet online medical record, called up his database to quickly identify his patients who use Propulsid, then brought them in for an electrocardiogram. "Before Logician Internet I had no way to tell which patients were on Propulsid. It would have taken a manual review of literally a thousand charts."
Molly Coye, a former director of the California Department of Health Services, sat on the Institute of Medicine committee that wrote the medical errors report. "There was no question in the committee's review that electronic media and Internet technology will transform the issue of safety," says Coye, a physician who's now a senior VP with the Lewin Group, a health-consulting firm. "It has the potential to reduce the errors associated with just being human. The problem is that most [health care] providers are practicing in a cottage-industry setting. They haven't even gone though the Industrial Revolution."
Online medical records are likely to get a boost from national health care provider Kaiser Permanente's plan to give each of its 9 million members a digital medical chart. But it's still common for a person's medical records to be scattered in paper files kept by several different doctors and specialists. As a result, different physicians may not know a patient's complete medical history, medication use or reaction to different treatments and drugs. For instance, it may not come out during an eight-minute doctor's visit that a patient is taking an herbal remedy like ephedra, which might interact dangerously with her blood-pressure medicine.
Mistakes made in the prescription and use of medications are among the most common medical errors, according to the Institute of Medicine report. It found that the death rate from medication errors more than doubled between 1983 and 1993, and the problem is likely to worsen as Americans age and use more prescription drugs.
"Every individual elderly patient has multiple diagnoses, sees multiple caregivers and carries around a bag of pharmacopoeia," noted Stan Pappelbaum, CEO of San Diego's Scripps Health, at a medical conference in February. "It's a setup for medical error. The Internet is the ticket for reducing that."
Medication errors usually happen when a medical record fails to list all the drugs a patient uses or to give a complete medical history. "Physicians do not routinely screen for drug interactions, even when medication history information is readily available," the Institute
of Medicine report found. Fatal mistakes may also occur when patients don't take their medicines or take them improperly.
Online medical records can help avoid such problems. For instance, Internet health care companies Allscripts and CareInsite (which has agreed to be acquired by Healtheon (HLTH)/WebMD) have developed online prescription services that list patients' medication histories and alert doctors when one medication would cause problems if used with another.
The online medical records offered by Elixis and MedicaLogic are located on the companies' respective servers and allow doctors to record a patient's medical history from any computer. The records also provide physicians with the proper billing codes for various procedures and treatments to ensure they get the right payment from insurance companies. Elixis is targeting specialists such as cardiologists; MedicaLogic's online medical record is tailored to general practitioners.
Other online medical record companies like WellMed and PersonalMD offer consumer products that require individuals to obtain medical information from their doctors, pharmacies and laboratories; understand those diagnoses; and enter the data into their online medical record themselves. Some industry analysts question whether physicians and other health care providers will accept the legitimacy of patient-created online medical records, particularly as they pertain to medical histories and diagnoses.
At a Providence Family Medicine clinic in Wilsonville, Ore., physician Karl Magsarili uses an intranet version of MedicaLogic's Logician. The clinic, located in a strip mall about 30 miles south of Portland, has a computer in each examining room. When Magsarili examines patients he can call up their medical records and enter their vital signs, complaints and conditions simply by pointing and clicking. "It checks for drug interactions and will alert me if there's a potential allergic reaction to medication I'm prescribing," Magsarili says.
