On the Road to Electronic Health Records


Last month, I wrote about Google Health and Microsoft's HealthVault and the questions such services raise about interoperability of record formats, e-health records ease of use, and the value of a repository of personal health information to patients.


After reading about the efforts of the Healthcare Information Technology Standards Panel (HITSP), I agreed that interoperability was the place to start if any of these health record repositories were to be of any long-term value.


In the intervening weeks, I have had the opportunity to gather information from Microsoft and Google about their respective projects, as well as to talk with Dr. John Halamka, the chairman of HITSP about the interoperability specifications the group has set out for personal health records. And from what I understand, everyone is indeed on the same page -- or at least on their way.


The HITSP has recently certified a national standard for personal health records, called the Continuity of Care Document, or CCD. (Its predecessor was the Continuity of Care Record, or CCR.) Halamka, who also serves as the CIO and Dean for Technology at Harvard Medical School, says Google Health and Microsoft HealthVault are providing customers with "containers" in which they can compile a consolidated record of their medical histories, from each of the different vendors and providers they have used over the years.


Microsoft's HealthVault currently supports the CCD standard, a Microsoft spokesperson told me in an e-mail. Google does not yet support CCD, but it does support its predecessor, the CCR. According to a Google spokesperson, the company is "working toward supporting other interoperability standards such as CCD... Google Health is an open platform and will support several interoperability standards in the near future."


Of course, not every health care provider or pharmacy is "digitized" quite yet, and Halamka says it will take another two to three years before everyone is on board. For instance, in the private hospital community and the private doctor's office community, HITSP standards are not yet required. But the certifying organization in the private sector, the Certification Commission for Healthcare Information Technology (CCHIT), is working on personal health records standardization now, and is expected to certify personal health record functionality in 2009.


In the meantime, for the providers who are still using paper records, both Google and Microsoft have workarounds. Google has integrated with online health services that will scan users' paper records so that they can be uploaded to Google Health accounts. Similarly, according to a Microsoft spokesperson, for a small fee HealthVault users can obtain a fax number that will connect directly to their HealthVault accounts, so that their paper records can be faxed in.


And perhaps the most important detail: Nothing will be taken from or added to a user's account without the user's permission. As Halamka put it:

You can, at any time, delete that information, disconnect those links, or "dis-enroll" .... You are in total control of your information.

Yes, I think they're on the right track.