iHealthcareweekly: Electronic Medical Records and Emergency Access Services

by Catherine Calacanis

PersonalMD.com, a destination health site providing content and an electronic medical record (EMR) service to consumers, said today that the company is adding several new features to its online services. Dr. Alan R. Zwerner, MD, JD, senior VP for strategic planning for the company, told iHealthcareWeekly, "We want PersonalMD.com to be the most robust online personal medical record, that is head-and-shoulders above the competition. We were the first out there with this type of product. We have the technical sophistication and capability, and we are focused."

PersonalMD.com was launched in July 1999. The site provides healthcare information for consumers, and also allows members to store and retrieve personal health information, including paper-based records such as EKGs and lab results. The company provides members with an emergency card showing the member's name, PIN code (if the member so desires), and fax identification number on the front. Information such as a contact physician and a patient's allergies and blood type can appear on the back.

The new services announced today include ER-call, medication reminders and a personal calendar. ER-call enables healthcare providers to easily notify emergency contacts, which have been entered into the EMR by the patient, while accessing the EMR. The member can input any number of contacts, including their phone numbers and/or e-mail addresses. While retrieving the EMR for a patient who is a PersonalMD.com ER-call subscriber, the healthcare provider, who must at this time declare that the situation is an emergency, will be given the option to provide a message verbally by fax-phone, or by using a computer keyboard.

If the Internet is used, the company's software converts the text to speech. The service then automatically dials the contact's number and plays the message from the provider. If the first contact is not reached, the system will automatically begin the process with the next contact until all contacts listed have been exhausted or one is reached. The cost of this service is $29.95 annually.

The medication reminder feature requires that the member have a beeper. Members can begin receiving medication reminder pages on their alphanumeric pagers as soon as they register for the service and complete the necessary information, such as the name of the medication and dosage time of day. Members can update their medication schedules as often as necessary; updates are automatically integrated into the member's EMR. The cost for this service is $9.95 per month. The Personal MD calendar service, which is free, sends the member an e-mail reminder for events scheduled on the member's personal calendar.

Over the past year, PersonalMD.com has formed a number of strategic alliances, which significantly augment its spectrum of available healthcare related services. These alliances have helped build a current user base of over 100,000, according to Dr. Zwerner. The company has alliances with two pharmaceutical companies, Drug Emporium and Phar-Mor.

Phar-mor, a brick-and-mortar pharmacy, promotes a co-branded PersonalMD.com emergency card in its retail stores. Drug Emporium will promote the same services at its retail stores and provide a PersonalMD.com link at its DrugEmporium.com site.

A strategic alliance with HealthAllies.com, a healthcare consumer advocate Internet company, allows HealthAllies.com members to utilize the services of PersonalMD.com; PersonalMD.com members have access to HealthAllies.com's purchasing power and negotiating team to lower their out-of-pocket medical expenses, whether or not they have insurance.

Another strategic alliance, with Healthaxis.com, allows PersonalMD.com members to review and purchase health insurance from the list of HealthAxis.com medical insurance carrier partners. An alliance with the Executive Health Group (EHG), which provides physical examination services to corporations, provides a co-branded emergency card to EHG clients. EHG will also, upon consent from the patient, establish an EMR on a co-branded PersonalMD.com/EHG website.

When asked about confidentiality issues with PersonalMD.com's EMRs, Dr. Zwerner noted that confidentiality and security of the information contained in the EMR is a priority for the company. "PersonalMD.com technology experts are experienced in encryption in online transactions, and employ the same type of encryption utilized by financial service companies," he said. "There are firewalls, and the information is encrypted on both sides."

Consultants attempt to hack the system on a regular basis to insure the integrity of security measures. Aggregate data is compiled; all of it is de-identified. Members are notified of any entries into their EMRs, even if the entries are read-only. Members' physicians also need the member's permission and a password to write in the EMR.

There are numerous issues and concerns centered around EMRs. The public is justifiably concerned about privacy and security issues, but there is also a good case for the benefits of EMRs, and we are sure to see more and more health-related information compiled in EMRs. Anyone with access to a member's PersonalMD.com emergency card--along with the PIN and ID numbers clearly displayed on the front of the card--has access to the member's EMR.

The inclusion of the PIN on the card is optional; however, without the PIN, the benefit of a provider being able to access vital information if the patient is unconscious, or otherwise unable to give information, is negated. Will paramedics and emergency physicians really take the time to go through a person's wallet to look for medical information? Are they trained to do so? Internet Healthcare Weekly went to the experts.

In 1995, New York City Emergency Medical Services (EMS) merged with the NYC Fire Department (FDNY). Currently, EMS is a bureau of the FDNY. According to David Billig, spokesperson for FDNY, "Our emergency medical technicians and paramedics, as part of their patient assessment, are trained to look for medi-alert tags in the obvious places on a patient, such as the neck or arms. We do not go through wallets or personal effects. In many instances, but not all, police are on the scene and we might ask the police, who would be looking for identification, to let us know if there is anything with medical information among the personal effects."

Dr. Jerry Neri is President and CEO of MedExcel, www.medexcel.com, an Emergency Department (ED) Contract Management Organization currently managing 11 ED contracts in New York, New Jersey and Florida. IHW asked Dr. Neri the following question: "What is the process by which Emergency Department personnel, physicians and/or nurses, obtain medical information about a patient who cannot provide that information for themselves?"

Dr. Neri's response: "ED personnel normally obtain information about patients who cannot provide information for themselves in the following ways: Medialert bracelets, personal belongings, old medical records, medical staff, family/friends, and EMS. When going through an unconscious patient's belongings, ED staff is specifically looking for medical information. However, as online services are not being widely used as yet, knowledge of the availability and existence of this type of card is not widespread."

The public and the healthcare professionals need to be educated to the fact that this new type of access to medical records is available. Subsequently, hospitals will have to develop policies, particularly for their emergency departments, to deal with the retrieval of medical information from the Internet.

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Susan Cossette
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