Saturday, February 27, 2010

Traveling with your medical records

When you're packing up for a fun RV adventure, likely the last thing you're thinking about is getting sick and needing medical attention while on the road. But it can certainly happen, especially if you're traveling for a number of months, or are a full-time RVer. Worse yet, it could happen to a friend or family member who's traveling with you (and whom you might not know all the specific details of their medical history).

Up until recently, medical records were purely paper-based. So if you wanted to travel with them, you had to ask each of your doctors to print you out copies of the various chart documents they each had, and then you had to carry this pile around with you-- not very fun, and certainly not very secure. Got a leak in your tent? Or a gust of wind through your RV? There go your documents! Going on a cruise or airline trip? Good luck fitting that into your carry-on bag!

Well fortunately, medical records in the U.S. are finally on a fast-track to electronic conversion. I've earned my living for the past 10 years implementing electronic medical records (EMR) systems to physician offices. The early years were slow and painful to get doctors on-board. That all began changing 2 years ago when Medicare began "carrot and stick" reimbursements to providers-- those who sent prescriptions electronically would get paid a little more than those who did not. Momentum really exploded last year, though, when Congress provided billions of new incentive dollars in the Stimulus Bill for physicians to implement and fully use EMR systems within the next few years. Physicians will also be incentivized to provide patients electronic-access to their medical records. So, within the next decade or so, we should finally see all participants in healthcare (patients, doctors, hospitals, pharmacies, labs) be able to share health data electronically.

As an internet-aged information-savvy patient, you don't have to wait until your doctor goes electronic-- you can take control over your own records now! There are a couple of good, safe, and free options for maintaining your own electronic personal health record (PHR). Not only do these systems allow you to track your own health, but they also allow you to track other family members on the same account (i.e. your kids immunizations, your parent/grandparent's complicated list of medications and med histories, etc). PHRs are particularly valuable if you need to track a chronic condition such as diabetes or high blood pressure, or have a complex medical or family history.

The key to any good PHR is to ensure that it can import and export health information via the standardized data formats (such as CCR, CCD, or CED xml-based formats). This allows you to receive med list information from a pharmacy, results from a lab, or send your PHR information to a new doctor. It also allows a hospital emergency room to quickly view or download your chart info as well.

There are a number of PHR solutions on the market right now (a great independent website, myPHR.com gives a great list of all of these vendors as well as general tips for creating your own PHR). The 2 "big fish" in PHR-land are Google and Microsoft. Millions of us have online accounts with these 2 vendors already for our email and other online storage needs, so it's super easy to just add your health record to that mix.

Both vendors see their systems as "hubs" where the patient can control what health data can come into and go out of their PHR. Unfortunately, neither of these vendors have designed their front-end application to be a "one-stop-shop" for a typical patient to enter their information (although Google comes much closer to this than Microsoft). So, I've found the best approach is to use one of the smaller vendor PHRs to do most of your data entry/editing (since these vendors are much more healthcare-focused), and then link that record to your Google or Microsoft "hub" record for greater accessibility, integration, and backup.



The only PHR solution that supports both Google and Microsoft hubs is NoMoreClipboard.com. It offers a very robust, free, online PHR application that you can access via a laptop/PC or via your mobile phone's web browser. If also you're interested in storing scanned documents or photos to your PHR, you can purchase a premium subscription for just $10/year for an individual chart, or $30/year for a family of up to 10 people.

NoMoreClipboard allows you to enter just about every bit of information that you typically need to fill out via paper on a clipboard whenever you go to a doctor's office-- your med list, allergies, current and past medical history, past surgeries, family history, pregnancies, immunizations, and so on. You also can enter your basic demographics (address, phone, date of birth, etc), insurance policy info, other physicians you see (along with their address/phone), your preferred pharmacy and hospital, and your emergency contacts/persons you allow providers to discuss your health information with.

Another area NMC excels at is tracking common health metrics such as blood pressure, glucose, cholesterol, height/weight/BMI. You can easily enter this data via the web or your mobile phone and print a chart of all entries to bring along to your next doctor's office visit.

NMC provides a nice overall Patient Summary document to bring with you to the doctor's office (so you don't need to fill out their paper forms!), or you can even transmit it to them electronically or grant them access to view your online record. You can also print an even smaller summary card for your wallet.

While NoMoreClipboard can exchange PHR info with both Microsoft and Google, I find the Google Health integration better to use because you can inividually select/delete what data elements you wish to send/receive. With Microsoft, it's an all or nothing affair.


Once your NMC information is imported, Google Health can do some pretty nifty things with it. For instance, it will analyze your medication list and alert you to any drug interactions or duplicate therapies. Next, it provides great internet reference links for each of your active or past health conditions to allow you to further research and manage that disease. Google also integrates with a number of pharmacy and lab systems so that you can download information from those systems into your Google record, and then sync your Google record back to NoMoreClipboard to keep your medication lists and test results updated.

Google also offers (for free) some of the features that NoMoreClipboard makes you pay extra for --such as storing documents/photos, or graphing your common result data such as daily blood pressure readings.

While NMC and Google offer good data entry, printing, sharing, and online research of your PHR information, and also use the industry-standard CCD/CCR xml format to exchange information between each system, neither let you save or import that CCD/CCR file yourself (for instance, if you want to carry one of these files on a USB stick so that your electronic doctor's office can easily import it into their EHR, or the office wants to give you a download of their EHR's electronic file). For this situation, Microsoft HealthVault shines.

Microsoft HealthVault is clearly a "back-end" hub. It's design premise assumes patients are not at all interested in manually entering all their health information, and that they'd rather just have a centralized storage location for all their health information to be "exchanged" by the patient's desired electronic providers. HealthVault provides no way to share this information with non-electronic providers (such as a printed patient summary document or wallet card). However, if all of your doctors are using EMRs and would prefer to give or receive your data as a standardized electronic CCD/CCR file, then HealthVault is the ideal solution.

HealthVault is also the only PHR solution that integrates directly with a number of new-aged medical devices-- there's a growing list of web-enabled devices that capture blood pressure readings, glucose levels, peak flows, etc and transmit these readings directly into your HealthVault record. No manual data entry required! Telemedicine is an exciting future that hopefully will allow us to live independently of nursing homes much longer, and have better chronic care management from our healthcare providers.

So, there you have it! Another way to keep your important data with you wherever you might be-- whether it's sitting at home or camping in the middle of Yellowstone!

6 comments:

  1. Lynne, I found you on RV-Dreams Forum (Mobile Productivity Ideas). We are about 18 months away from starting our full time adventure. Being a techie, I am interested in technology on the road. Currently debating iPhone vs Droid. Like the idea of cloud storage to have access to important documents and get rid of paper stuff. Thanks for your research. www.waggintails.blogspot.com/ and www.creativepenworks.com

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  2. We need to learn more about this! How do I follow you on your blog?
    We are figuring out how to use Tricare and are carrying around folders of medical records....

    Randy and Pam
    www.warnerrvnews.blogspot.com

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  3. Hi Randy-- There should be a "Follow" button on the top left of the Blogger banner if you want to follow along via Google. If you'd prefer to use RSS, just click the Subscribe link at the bottom of my blog's homepage.

    Keeping the folders of records are easy, but as anything can happen on the road, think about either scanning/uploading them to a Google Health account (free), so you'll have a backup that's always accessible. I keep PDFs of all the detailed lab tests/reports/notes on the Google Health account, and then keep the summary-level info (current meds, allergies, immunizations, etc) updated on NoMoreClipboard (but Google Health does fine for this as well).

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  4. I received a question from a reader named Brenda but was unable to post it due to a Blogger error, so here's her very excellent question "Are there any security issues with these?"

    My short answer for these specific major-player solutions is "no", but technically, all of our online data is subject to some level of security risk--where it's bank records, medical records, credit card numbers stored at Amazon, etc. So you certainly do need to assess the online provider's reputation and weigh the risk/rewards. I think Google has a very good track record, for the most part, when it comes to security, and our own government has a very detailed set of regulations for all health providers to follow with regards to storage/safekeeping of patient medical information (HIPAA).

    A security risk often overlooked is the risk your printed paper records pose versus electronic data. If I carry physical paper records with me, they might get stolen or lost, or a simple gust of wind might blow them down the street! They also might be easily read and/or copied by snooping friends, family, or strangers.

    I honestly believe that you're far more prone to a security breach with physical paper records than you are to a hacker or rogue employee gaining access to your electronic or online information, but of course, that's based on taking care not to store information on unsecurred websites (Http web addresses rather than "Https"), and to avoid smaller fly-by-night providers unless they're affiliated with major partners. NoMoreClipboard.com is certainly not a household name and I normally would be weary, but the fact that they are a partner with both Google Health and Microsoft HealthVault gives me much more confidence, and the fact that I get a lot of value from their service, makes it worth the relatively minor risk.

    Hope that helps! Thanks for the question, Brenda!

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  5. Lynne, I'm writing a short article about Online Medical Records for www.blog.rv.net. Your article is much more complete and I'd like to link to it. Please let me know if that's not OK - and I'll remove it.
    Thank you for your great information!

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  6. Thanks Chris, what an honor!

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