PHR Pitfalls

April 16, 2009

Personal health records, designed to help patients keep all of their medical records in one place and make it easier for doctors to access patient files, may actually lead to inaccurate information and, as a result, improper treatment, some doctors fear.

Personal health records (PHR), designed to help patients keep all of their medical records in one place and make it easier for doctors to access patient files, may actually lead to inaccurate information and, as a result, improper treatment, some doctors fear.

Those who are worried about the wrong information being supplied to doctors fear that it will come from improper billing records. Insurance data is already computerized and easy to download, according to the Boston Globe article, but also “prone to inaccuracies, partly because of the clunky diagnostic coding language used for medical billing, or because doctors sometimes label a test with the disease they hope to rule out.”

"Claims data is notoriously inaccurate and notoriously incomplete with respect to an expression of the problems a person has," said Dr. David Kibbe, a senior technology adviser to the American Academy of Family Physicians, in the article.

The article uses the example of Dave deBronkart, a kidney cancer survivor, to show what can go wrong with PHR. DeBronkart transferred his records from Beth Israel Deaconess Medical Center to Google Health and was “stunned” at what he saw. The Google health record stated that deBronkart’s cancer had spread to either his brain or his spine, news he had never gotten from his doctors, and it listed a number of other conditions that deBronkart was not aware he had. Though the problem was soon uncovered—the incorrect information had been drawn from billing records, which sometimes uses codes to import data. It’s this type of situation that some doctors fear will lead to the wrong treatment regimen.

"The problem is this kind of information should never be used clinically, especially if you don't have starting or ending dates" attached to each problem, said Daniel Z. Sands, deBronkart's primary care doctor and director of medical informatics at Cisco Systems (as well as an MDNG editorial board member).

According to the article, questions for Google Health were directed to Dr. Roni Zeiger, a product manager for the company, who said that the information for the PHR are collected from a number of places, including “partner hospitals, pharmacies, laboratories, and claims data.” Zeiger “acknowledged that such billing information can sometimes be inaccurate,” but added that the overall gain is beneficial and that the system will get better with time.

Dr. Paul Tang, chief medical information officer for the Palo Alto Medical Foundation, who chairs a health technology panel for the National Quality Forum, says that the “risks to patients” need to be further examined. “Probably for some patients, it’s a net benefit, and for others, it’s a risk,” Tang said. “We need to know what the risks are so we can mitigate them better.”