Security Is Key
This brave, new, medical world can only evolve, however, if there is trust — trust between consumers and the e-commerce companies wooing them with everything from cheaper health insurance to lockbox protection of their medical records.
The Internet has a long way to go in that arena. Looming above all else is the fear that medical records will fall into the wrong hands, dooming parents and their children to a lifetime of job and insurance discrimination. That makes it Super Bowl time for the companies that can find the best way to encode medical records so that theyre easy for the right people to access, and impossible for the wrong people to see.
In February, 60 percent of 13,000 U.S. adults surveyed by the Pew Internet and American Life Project said they dont want doctors, health maintenance organizations or insurance companies using the Internet to keep track of their medical records.
"People are scared," said Harrison Rainie, the director at the Pew Internet and American Life Project. "Its the modern version of the right to be left alone."
Health records must be shielded from employers. "Were seeing the equivalent of Swiss bank accounts being established for genetic information," said Brad Bowman, founder of WellMed, a provider of online consumer health management tools, referring to projects launched by DNA Sciences and other companies that use Web sites to gather genetic information to help fight disease.
One key to the success of cyberspace medicine will be the federal Health Insurance Portability and Accountability Act (HIPPA), which requires that health plans have complex systems in place by next year to ensure the privacy of online medical records and protection against employment discrimination based on disease history. The companies working to provide that security through VPNs and next-generation firewalls are likely to get a big chunk of the e-health pie.
Catholic Healthcare West has turned to Certicom, which uses elliptic curve cryptography to provide security for handheld wireless devices and VPNs. "Were trying to hit a delicate balance, using these new modern wireless devices and still complying with the Health Insurance Portability and Accountability Act," said Jim Sanderson, systems engineer at Catholic Healthcare, which provides health care for the needy.
Catholic Healthcare is a member of the Mobile Health Care Alliance (MoHCA), which espouses standards for mobile data management to ensure patient privacy and compliance with HIPPA. Among its other founding members are AvantGo, ePocrates and Palm. The aim is to ensure the security and interoperability of medical information beamed to mobile devices.
Privacy cant be allowed to trump everything, though. If it did, people with high genetic risks could use that confidentiality to purchase gold-plated health plans from unwitting insurers. After all, if 1,000 genetically risky but savvy consumers all flock to the most generous health plan, all youll end up with is a health insurer that has gone bankrupt.
So, there has to be some flexibility in who gets to see encoded versions of genetic medical records — and incentives for companies to go after the people whose genetic markers are most risky.
Mark Tierney, chairman of eBenX, which uses the Internet to ease transactions among corporations, their employees and their health plans, said plans should specialize to help, say, the elderly, or those with certain genetic diseases — but only if more money follows the consumers with more health risk.
"You cant have all the people who know they have a propensity for coronary heart attacks go to a health plan that is specializing in it, and pay them what the average person pays. That company will go out of business," Tierney said. "Organizations that are taking the risk and creating the integrated delivery system have to have the opportunity to make money."
Although consumers would be willing to pay more for these personalized services, analysts and Internet health-care companies are convinced they will demand less waste and more efficient use of their health dollar. Any company that wants to survive in 21st-century medicine, they said, will have to deliver.
"Were wasting a third of all health-care dollars," said Mark Leavitt, chairman of Medscape, which has created clinical data and knowledge to doctors and consumers and has created digital health records for 13 million people.
Medical reports take days, record transfers take weeks, and more than a third of a doctors time is taken up finding, recording and transcribing information. According to Leavitt, medical errors kill 50,000 to 100,000 people in the U.S. per year, and lost, misread or illegible notes and medical records are to be blamed for many of those deaths.
In other words, if airline pilots were as technologically bereft as doctors, they would rely on monthly weather reports, rather than minute-by-minute updates, Leavitt said.
That should change, soon. While just 59 percent of doctors own computers — the same percentage as two years ago — most of the 15,000 medical school students who graduate each year are Net-savvy, Leavitt said. Doctors will be coaxed into the digital age, convinced that entering information once into a handheld device or an electronic tablet can save time and money and prevent errors.
"Truck drivers are on PalmPilots," Leavitt said. "Doctors cant be far behind." Some 7,000 doctors per week are adopting Medscapes mobile handheld devices that send and receive information over the Internet, he said. "Well reach critical mass in 2001 or 2002."
ParkStone Medical Information Systems, a start-up in Weston, Fla., is one of the companies that put software in handheld devices, letting doctors look up and prescribe drugs, then send the order to the patients neighborhood pharmacy. The companies make money by partnering with pharmaceutical companies to put their pills at the top of the physicians choice list, or with HMOs to put low-cost generic pills at the top of the choices.
In three years, one doctor in five will use a handheld device to make notes, order prescriptions and capture charges while talking with patients, predicted Josh Fisher, WR Hambrecht & Co.s e-health-care analyst. That will generate $2 billion in sales for the handheld device companies, and save billions of dollars more in lost billing and redundant paperwork. Some handheld devices now contain a medical dictionary and pharmaceutical tools, but soon they will hold complete medical records and best-practice treatments.
"Eighty-five percent of health-care costs — choices about labs, drugs and hospitals — start with the stroke of a physicians pen," Fisher said. "A handheld device for a physician brings powerful value."