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Doctors put records in patients' pockets:

July 21, 2008

Arming patients with portable electronic medical records that physicians can access during emergencies is becoming more prevalent among health care providers.

The Heart Center of Indiana in Carmel, a partnership between St. Vincent Health and The Care Group Inc., the state's largest cardiology group, recently started the practice.

Community Health Network and Dr. Tim Story, who chairs the largest group of physicians at Clarian North Medical Center, are among others who have rolled out portable records systems.

The health information typically is stored on easy-to-carry devices such as credit-card-shaped compact discs, key fobs or magnetic-striped cards.

Policy experts say the adoption of electronic medical records is vital to improving quality of care and reducing spiraling costs in the national health care system. Retirees who travel or split time in another state, as well as takers of multiple medications, are among those who can benefit from the technology.

Story recalled one instance in which an elderly patient of his with a heart murmur visited an emergency room in Florida. Anyone not familiar with the patient's medical history would be alarmed to hear his heartbeat, Story said.

"They took one listen to his heart and they had cardiovascular surgeons paratrooping in," Story quipped.

But, after checking his portable medical records, which provided critical information on the murmur, doctors realized major medical procedures weren't necessary, preventing what could have been an expensive visit.

Despite the obvious benefit, the market for electronic medical records of any kind remains largely untapped. A 2006 survey by the Centers for Disease Control and Prevention found more than 70 percent of office-based physicians had yet to adopt the technology.

A benefits package WellPoint Inc. unveiled in July 2006 included an effort that enables its 34 million members to access their medical records online. The local insurer's initiative to make the records available electronically is but one example of a national movement, backed by President Bush, to make all medical records available online within 10 years.

The Indiana Health Information Exchange offers a service that provides patient records and test results via computer to hospitals and doctors around central Indiana. Dr. Marc Overhage, CEO of the locally b a s e d not-for-profit, views portable products as a complement to broader database services.

"It's always a good thing when you have an engaged, interested patient," he said. "There will be a segment of the population who will embrace it."

Comes at a price

In the case of The Heart Center of Indiana, Care Group physicians drove the MyRecord initiative that launched in late May. The card discs contain updated cardiovascular medical information and history that is downloaded from a computer program. An initial fee of $25 is followed by another $25 charge each time the card is updated.

Stored data includes medication lists, diagnoses, allergies, a discharge summary and diagnostic image reports, such as electrocardiograms and echocardiography reports.

Details of past electrocardiograms, or EKGs, are particularly important when treating patients with heart problems. An EKG that shows scar tissue from a heart attack can be viewed on the

d i s c ,

enabling a cardiologist treating a patient for chest pain to compare the information with a new EKG to determine whether the scar tissue is old or new damage.

"From our standpoint, in the cardiovascular world, it's important for our patients," said Dr. Michael Ball, a Care Group cardiologist. "They go to Florida for the winter or they're on vacation; we obviously want them to have the best care."

Story, at Clarian North, also is an owner of FirstLine Personal Health Care in Carmel that, for an annual retainer of at least $2,500, gives patients around-theclock doctor access, medical records they can carry on a key chain, and unlimited office visits.

Several patients followed him and his partner from their previous practice to First-Line, which they formed in early 2006. The two wanted to provide their patients a way I P h o J t o Ill u s t r a ti o n / R o bi n e r s t d a to carry records of the treatment they received from them while they're traveling, prompting the development of what is referred to as the "Med Stick."

The 3-1/2-inch key fob, which attaches to a key chain, contains medical histories that can be accessed by plugging it into a computer's USB port. Mike Sanders of

The Sanders Group, an Indianapolisbased advertising and media production agency, is a business partner of

Story's and recruited a few software professionals to develop the product. A patent is pending on the technology.

"Most of our patients are on a fair amount of meds," Story said. "To have the exact milligrams available is awful handy."

Community Health Network, meanwhile, unveiled its version, called My Community, about a year ago. Unlike a key fob or compact disc inserted into a computer, the card is swiped by a card reader to obtain a patient's medical history via an online database.

About 30,000 people are members of the free benefit, although not all actively use the card, acknowledged Dan Rench, Community's vice president of e-business. The service can be accessed only at Community's north location, although the network ultimately plans to have the service available at its other hospitals on the east and south sides of Indianapolis, as well as at Anderson and the Indiana Heart Hospital.

Patients using the cards outside the network in which card readers are not available provide date of birth or other personal information to log into the account.

Cardholders are responsible for inputting their health data into an online questionnaire and updating their own information. Unlike other products, information is not stored on the card and cannot be accessed unless an identification or password is provided.

"We want to maintain the highest level of security we possibly can so that the information is only available should the patient log in, or to someone they have given permission to," Rench said.

Security concerns

Federal privacy laws have led health care providers to use extreme caution when dealing with patient medical records, particularly in the case of electronic files that can be exposed to hackers.

At The Heart Center of Indiana, liability for lost compact discs is shifted to the patient, who consents to being responsible for the device and the stored information.

Story said he has yet to encounter any security breaches and is comfortable with the process they have established, though he acknowledged inherent risks in life exist and it's "patient beware" should a key fob become lost.

Taking everything into consideration, the benefit portable medical records provide is worth the risk, Overhage of the Indiana Health Information Exchange said.

"Hopefully, you're not pulling these things out every hour," he noted, "so it shouldn't be an issue."
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