More than a decade after the shift to PACS became firmly established in radiology, a national movement toward digitizing all medical information appears to be gaining traction. Google and Microsoft, two of the biggest players in the digital world, have launched efforts to provide free storage of personal medical records online.
Until now, the idea of the digital personal medical record has remained a victim of the highly diverse and fractious U.S. medical economy. Individual facilities, and sometimes even groups of them, may have digitized elements of the medical record and, certainly, the reports and images that occupy a PACS. But if you were to go outside that particular network, you might as well be in another continent. For most records, paper transfers still rule the day.
That situation began to change in 2006 when several major U.S. corporations announced plans to gather employees' medical records from medical groups, hospitals, insurers, and laboratories and store them online. Today the program, called Dossia, has a collective employee base that probably numbers several million.
Last year, Microsoft joined the fray with its own plan to provide free storage of medical records for all comers. Google announced an alliance with The Cleveland Clinic Foundation to store up to 10,000 patient records; it's expected that the program could eventually go nationwide. Other players include Revolution Health, started by AOL cofounder Steve Case, and WebMD, backed by Netscape cofounder Jim Clark.
A common theory holds that these types of services will never take off. In an era when identity theft has become a major concern, how willing will the public be to load intimate medical details into a bank of remote computer servers via the Internet, critics of these systems wonder.
But already we're backing up the hard drives of home computers, with many personal records on them, to remote Internet services. The same is true for digital photos, music, and financial records. Can medical records really be far behind?
With the weight of companies like Microsoft and Google, not to mention the members of the Dossia group, behind Internet-based personal medical records, they could soon become a widespread reality.
Certainly, there is much to be said for such an approach. A single medical record could guard against the risks of inappropriate drug combinations. It allows participating physicians to obtain a more complete patient history, a potentially huge advantage in some emergency settings where the patient is incapable of communicating. In radiology, it could allow physicians to know the potential cumulative dose exposure before recommending a scan for a patient.
Others note that databases like these could be used for data mining, research, and decision support, presumably in ways that would respect the privacy rights of individual participants.
To date, radiology is not yet playing a big part in these online medical record systems, but that can't last. Representatives for both Microsoft and Revolution Health say they are looking at bringing images into the records they keep online.
As that happens, leaders in radiology will need to confront the many issues that these systems raise. These online storage systems, for example, are apparently not covered by the Health Insurance Portability and Accountability Act and its federal privacy requirements. In the absence of the protections offered by HIPAA, what are the online systems' privacy policies and how are they enforced? Will they be used for marketing purposes? Could a group of women with positive mammograms, for example, be targeted for special offers or services?
The answers to these questions aren't clear, and the questions themselves pose challenges to radiologists and other physicians who contribute to patients' medical records.
