Open Up and Say Online

The Baltimore Sun

Twenty-five years ago, ATMs were novelties. Ten years ago, online banking was only for the brave. Today, both technologies are as mundane as the phone or refrigerator.

Next up on the road from cutting-edge to routine: the PHR, or personal health record. By the time President Obama or McCain is wrapping up work - whether that's in four years or eight - PHRs will be ubiquitous, at least according to some experts.

A PHR is an online repository of your medical history. Tech enthusiasts say it will revolutionize medicine in the same way the automated teller machine transformed banking.

Instead of carting, mailing or faxing folders full of paper records from doctor's office to clinic to hospital - and inevitably losing something on the way - you'll be able to store the information in one digital location, and then share it with whomever you choose.

To keep in touch with the digital near-future, we decided to take two of the most-likely-to-be-huge PHR services for a test-drive. The short version: Both are legitimate contenders, and both are worth a look.

First, some background: American medicine remains surprisingly nondigital: 90 percent of doctors' offices still keep medical records on paper. Lots of other countries are far ahead of us, and some, like Denmark, are all but completely digital.

Now, with the help of huge corporations that want to make you healthier - and, oh yeah, reap big profits while they're at it - medical digitization is upon us. Within the past few months, both Google and Microsoft have unveiled PHRs.

Because very few consumers are using these applications so far, the market remains fluid. There are other PHR entrants with excellent pedigrees, including Revolution Health, from AOL founder Steve Case, and Dossia, which is funded by AT&T; and Wal-Mart, among others.

Several medical institutions, including the Cleveland Clinic and Kaiser Permanente, have set up proprietary PHRs, allowing patients to store and view their records online. In general, these applications are limited because they don't let you transfer the data to doctors outside the institution that sponsors them. But that could change: Last week, Kaiser and Microsoft announced a partnership that would allow some Kaiser patients to transfer data to Microsoft's PHR.

But most observers believe Microsoft and Google will likely dominate the PHR market. "It's like two planets circling the sun. There may be a few asteroids out there, but it's not the same thing. These are the two big planetary bodies," says Dr. David Kibbe, director of health information technology for the American Academy of Family Physicians.

Both Microsoft and Google are offering PHR services free of charge. To join, consumers must provide an e-mail address and create a password.

Google's PHR, called Google Health, is easier to navigate than Microsoft's, HealthVault.

That's not surprising - Google, the Web search leader, generally has a better sense of how to build Web applications. That's not to say HealthVault is confusing, just that Google Health is more intuitive.

HealthVault has some innovative features. It offers users the ability to invite others - doctors, relatives, anyone else - to share access to the PHR. Google Health has shared access, too, but only through the less elegant method of giving others your user name and password.

In HealthVault, you can also choose which types of information you want to share with whom. Among the categories: blood pressure, aerobic profile, allergy, insurance plan - almost 60 options in all.

Microsoft is also working with 16 partners - with many more to come - who offer a range of online tools that can be used with HealthVault. Among the offerings: a blood pressure management tool from the American Heart Association and the American Stroke Association, and several mental health help programs from a group called MySelfHelp.

Some of these tools are themselves PHRs, which brings us to a key point: Microsoft says explicitly that HealthVault is not a PHR, but a "platform" that helps consumers connect to PHRs and other online health management tools. In other words, Microsoft officials say, their product is a kind of staging area where patients can organize and manage their health records.

"Google is a PHR. We're trying to create a broad ecosystem of thousands of applications, a web of health applications," says Grad Conn, senior director of HealthVault's strategy. One of the gee-whizziest aspects of HealthVault is its ability to hook into external health gadgets, such as heart rate monitors and glucometers (they measure blood sugar levels). Patients can upload this information into HealthVault.

This capacity isn't surprising, because Microsoft has decades of experience writing software that connects computers to noncomputer devices such as video-game consoles.

Whereas HealthVault sees itself as a hub for a variety of online health tools, Google Health envisions itself more as a unified home for your health information.

Google Health asks you to enter your data manually, rather than upload documents. The process is cumbersome at first, but it pays dividends: Once you've entered information, Google Health integrates it into a single application. This turns it into a smart tool that reacts to your data.

For example, let's say you've told Google Health that you're allergic to penicillin. If you then enter information indicating that you have a sinus infection and are taking amoxicillin - an antibiotic in the penicillin family - Google alerts you. A red exclamation point appears beside the "Drug Interactions" category, warning you that "Amoxicillin Oral contains penicillins. This can cause a severe allergic reaction in people who are allergic to penicillins."

Kibbe says that of the two competitors, Google has taken the leap into truly digitizing personal health data. "Google is about what machines can do to organize the world's info," he says. "They are putting medical information into a language machines can understand."

Ultimately, the two products offer something different. If you want to hook up your medical gadgets or store your medical documents, PDF files containing test results or Microsoft Word documents listing medications you're taking, go with HealthVault. If you want a site that will take a bit more time to set up but will allow you to use the information more flexibly, go with Google Health.

Also, be aware that Google and Microsoft have already linked up with a host of major medical institutions and pharmacy chains. So if you want to digitize with existing health care or drug providers, you may not have a choice.

Another issue: Some critics say that using PHRs could endanger privacy. They worry that it might be possible for others to hack into personal health data and note that online health information stored in commercial PHRs is not covered by stringent federal laws that cover other medical information.

However, both Microsoft and Google have promised not to share information without explicit permission.

Personal health records

*Ninety percent of U.S. doctors and more than two-thirds of U.S. hospitals use paper for patient records, resulting, many say, in a disorganized health care system.

*An individual doctor or small practice has few incentives to switch from paper to digital, because conversion costs range from $40,000 to $60,000.

*Other countries are far ahead, including Denmark, where 90 percent of the health system is computerized. Germany has finished its health care digitization.

*Many experts say personal health record (PHR) sites such as Google Health and Microsoft HealthVault will speed up the process here.

*Some worry that PHRs will infringe on patients' privacy.

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