The e-Health Revolution

How a bipartisan bill from Hillary Clinton and Bill Frist could help jump-start a new kind of health-care reform

By Bill Saporito Monday, June 20, 2005
    • PHOTO-ILLUSTRATION FOR TIME BY C.J. BURTON

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    It's not surprising that a big urban practice such as Bosch's would get wired. Most health care in the U.S., however, is delivered by small practices with fewer than 10 doctors, and these physicians don't yet see any payoff. That's because so far there is none. The cost is high, about $10,000 to $12,000 per doctor, and most of the benefits accrue to other players in the system, such as hospitals, employers and insurers. Doctors in small practices, many experts believe, won't link up unless their patients demand it. At least that's the assumption behind a company called Medem, which introduced a website in May called iHealthRecord.com The site lets you store all your family's medical information--prescriptions, allergies, health histories, etc.--and share them with physicians, as long as the doctors are on the system. You can also download vital information onto a smart card to carry with you. The software is free; Medem charges doctors who get the benefit of the record keeping. Linked to insurers, these so-called personal- health-record systems could also pave the way for "mouse calls," arrangements by which doctors can consult patients over the Net for a fee. "It's so much better than our main competition," says Medem CEO Ed Fotsch, referring to the data-collection device still used by the vast majority of doctors: the clipboard.

    There are risks involved in computerizing anything, of course. Privacy advocates are especially concerned that once patient records are online, it will be that much easier for sensitive information to fall into the hands of, say, insurance companies or potential employers. "It's not about being scared of technology; it's about the appropriate safeguards," says Marc Rotenberg, executive director of the Electronic Privacy Information Center. To Rotenberg, the push to automate is running way ahead of the legal protections. Even Newt Gingrich, a longtime champion of health-care reform, sees the need for updated legislation to protect medical privacy as technology evolves. But, he adds, it's important to keep the relative risks in perspective. Should you get into a car wreck, he says, "if you're an absolute privacy addict you can always say, 'I'd rather die.'" Identity, in fact, could be a far bigger issue than security, given the vast number of Americans with common names such as Smith, Sanchez and Lee.

    The growth of regional health information organizations (RHIOs) is another step at dispelling the Big Brother scare. Although only a few RHIOs are operating, some 500 locally controlled information networks are being built, and the Clinton-Frist bill would put money on the table to help get more of them up and running. In New York's Hudson Valley, the Taconic Health Information Network and Community serves 600,000 patients along with area doctors, hospitals, labs, pharmacies, insurers, employers and consumers. If a resident makes an emergency-room visit on a Saturday, the ER doc can pull the patient's records from his personal physician.

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