Drkoop Goes Off the Record

SAN FRANCISCO (01/26/2000) - Drkoop.com has quietly pulled back from Chairman C. Everett Koop's promise to create an online "personal medical record for all Americans."

The Internet health company announced last February that it would develop an electronic medical record. Drkoop said in July it would provide the medical record to America Online's 20 million members as part of its $89 million deal to become AOL's featured source of medical information. In turn, AOL agreed to pay Drkoop.com $8 million to license the medical record.

But plans have changed since patients at a Florida hospital began testing the prototype medical record in June, according to Drkoop spokeswoman Stephanie Fulton. She says the reluctance of some patients to put their health information online contributed to a decision to reevaluate the project. Drkoop officials had previously announced that the personal medical record would be available in mid-1999.

"What we've been hearing is that Americans are not ready for it," she says.

"The issues of privacy, security and confidentiality are still high in people's minds. We have not stopped development of the personal medical record. We'll see how it goes."

Fulton says the change of course will not affect the AOL agreement. AOL spokeswoman Regina Lewis says the online medical records deal with Drkoop "is on track."

"We test things and test things and tweak them until they're ready for prime time," she says. "We're just making sure we get it right."

At first blush, the decision by one of the most popular consumer health Web sites to slow the development of an online medical record would appear to be a setback to the widespread adoption of such records. It would also seem to be a blow to Drkoop's plans to eventually offer health care services like medical monitoring.

But the more likely consequence of Drkoop's retreat is a showdown between the two types of online medical records offered today - those maintained by patients and those provided by physicians. As with much of health care, it will come down to a matter of trust: Will patients prefer to create and control their medical records on consumer health sites or would they rather access their "official" medical record through their doctor or health plan's online service? Or will a combination of the two prevail?

The outcome will influence the direction of online health care. Many in the industry see electronic medical records not only as an effective tool to keep consumers loyal to health care sites but also as the foundation for the delivery of health care over the Internet. Earlier this month Drkoop chief executive Donald Hackett told analysts at a Chase Hambrecht & Quist conference in San Francisco that "once you capture personal medical records, you can start to push therapy."

The online medical record essentially becomes a central repository for information about an individual's health and a conduit to connect people to their doctors, pharmacists and health plans. A person's medical records currently may be scattered in paper files maintained by several doctors and specialists. Each physician may not necessarily know the patient's complete medical history, medication use or how different treatments and drugs may interact. For instance, it may not come out during an eight-minute doctor's visit that a patient is taking an herbal remedy that can have a dangerous interaction with her blood-pressure medicine.

Now put all that information into an online medical record. When a patient with high blood pressure visits her doctor, the physician sees a complete treatment history and a list of her medications, past and present. The electronic medical record runs any new prescriptions through a drug interaction database, alerting the doctor to any dangerous side affects. The doctor also checks a section of the record where the patient keeps a personal health diary and learns that she recently began taking ephedra. Dieters use ephedra as an appetite suppressant but the herbal supplement can be hazardous to people with high blood pressure.

The doctor notes the patient's blood pressure in the medical record, which is programmed to send e-mails reminding her to take her medicine. The patient also signs up for a medical monitoring service that allows her to take her own blood pressure readings at home and download the readings into her record. If her blood pressure gets too high, her doctor receives an alert by e-mail or pager.

That's the ideal anyway. Integration of all these features remains under development. The few consumer health sites that currently offer online medical records - such as iVillage and WebMD - require that individuals record their health histories. That means it's up to the patients to obtain medical information from their doctors, pharmacies and laboratories, understand those diagnoses and enter the data into their online medical record. That's the case with the test version of Drkoop's Personal Medical Record, which is being developed by Health Magic of Winter Park, Fla.

"Consumers may or may not be comfortable about entering their medical records on the Web, just as they were uncomfortable about entering their credit card information online," says Craig Froude, chief executive of WellMed, a Portland, Ore., company that supplies electronic medical records to iVillage's Allhealth.com, and to corporations for use on company intranets. About 30,000 consumers currently use WellMed's online medical record, according to Froude.

PersonalMD of Pleasanton, Calif., also offers an online medical record through its site and a partnership with Internet health insurance company HealthAxis.

CEO Suresh Challa describes the PersonalMD online record as "a kind of an electronic shoebox for people to store medical information." He says confidentiality and security still concern consumers. But he points to the nearly 90,000 people who he says have signed up for the PersonalMD record as evidence that "people overcome their fears as long as they know benefits outweigh risks."

While consumers may benefit from storing all their medical information in one online location, it remains unknown whether physicians and other health care providers will accept the legitimacy of patient-created online medical records, particularly as they pertain to medical histories and diagnoses.

"The physician couldn't use it without talking to the consumer because the validity of it is in question," says MedicaLogic CEO David Leavitt, a doctor whose Hillsboro, Ore.-based company has Internet-enabled its electronic medical record for physicians. Patients whose doctors use the MedicaLogic service can access their medical records online at the company's consumer site, AboutMyHealth.net.

WellMed tries to make its online medical record more palatable to physicians by translating consumers' descriptions of their health conditions into medical terminology. PersonalMD allows consumers to fax paper medical records to the company, which converts them into digital form.

The online medical records industry remains in its infancy, but the trend appears to be toward combining the physician and consumer medical records.

WebMD, for example, promises that soon "health care professionals will be able to enter diagnostic and prescription information directly into [the patient's] health record."

Says WellMed's Froude, "We think the ultimate medical record is not the consumer medical record or the professional medical record. You need to pair up personal information with the clinical diagnosis that the doctor has provided."

Despite Drkoop's decision to reevaluate its online medical record, the number of online medical record companies likely will grow. In November, Alameda, Calif.-based Healinx unveiled its platform for allowing physicians and patients to share medical files and communicate over the Internet. A San Francisco company, MedicalRecord.com, began offering a consumer online medical record last fall.

Fulton, the Drkoop spokeswoman, says the company will concentrate for now on acclimatizing its members to entering their health information online by using health-risk calculators and health condition trackers.

Says a Drkoop executive who requested anonymity: "We've made a strategic decision to take a slower and steadier approach. Where we go will be determined where our users take us."

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