Accessibility Issues

A pilot program promoting electronic medical records gets off to a slow start

The federal Centers for Medicare and Medicaid Services (CMS) in January launched a one-year, $2 million pilot program in Arizona and Utah, intended to encourage seniors to use online personal health records (PHR).

The project has gotten off to a rocky start.

"Between 400,000 and 500,000 (fee-for-service Medicare recipients) in Arizona were eligible," explains Kaihe Akahame, health insurance specialist at CMS. "(More than) 1,000 have signed up in Arizona and Utah, most in Arizona," he reports.

At the local level, the Tucson Weekly contacted eight Medicare recipients about their knowledge of the pilot program. Of those, only two had even heard about it.

As for the others, their interest in a PHR ranged from substantial to nonexistent. One wondered of the Medicare material she receives in the mail: "If it's not a bill, why pay attention to it?"

Akahame admits the pilot project needs more publicity. "It's apparent we need to do more to reach out to individuals," he says, indicating that planning is going on now regarding more outreach efforts next month.

Akahame says a mailer was sent out in January, and information provided by the four private-vendor companies involved have been the primary methods used to advertize the program. He also mentions a road show last month to five communities, including Green Valley.

"We had just a few people show up," acknowledges Brad Tritle, of Arizona Health e-Connection, about the Green Valley event. Tritle's organization, an advocacy group for electronic medical information, was brought into the pilot program's publicity process only a few months ago.

Even though there was low turnout in Green Valley, Tritle emphasizes: "Those who did come were very interested."

Participants in the pilot will have their Medicare claims from the last two years, as well as future claims, placed into an electronic PHR. Plus, according to the program's Web site——enrollees "can add other personal health information, such as medications, allergies, contact information for your doctors and dentists, and information about your family health history."

There are several advantages to doing this, according to the site. A duplication of health tests may be avoided, it says, plus, "A PHR can also make a big difference in a medical emergency."

Akahame says the main goal of the pilot program "is to educate people on electronic health records and have them become more computer-savvy. That way, they'll be able to manage and keep track of their health records."

Another possible advantage of an extensive PHR program is the amount in medical savings to the nation. According to a report prepared last November for the Center for Information Technology Leadership, if 80 percent of the U.S. population had a PHR, up to $21 billion annually could be saved.

This report also states: "Overall, this ... analysis demonstrates that PHRs will have value to the health-care system through reduction of waste and error, decreased administrative costs, and decreased clinical care costs."

Google funded this study, in part, and Google Health is one of four vendor companies participating in the Medicare pilot program. In addition to supplying Web space for the claims information, each vendor provides a standard registration form for enrollees.

To accommodate the addition of additional information to a PHR, these companies also offer a "concierge" service for a fee.

Akahame admits that the medical information in the PHR isn't protected under HIPAA, the Health Insurance Portability and Accountability Act. But, he says, "The vendors are required to have strict privacy policies. ... The records are encrypted and are (handled) similar to bank accounts."

That type of assurance isn't sufficient for the World Privacy Forum ( In an analysis released last year entitled "Personal Health Records: Why Many PHRs Threaten Privacy," the forum listed eight concerns.

In a telephone interview, Pam Dixon, executive director of the forum, highlights some of these issues, including the possibility that the information could be used for marketing purposes.

"There is a real possibility that the records will lose medical privilege, especially in a lawsuit. ... There may be situations where the person on Medicare won't know if the records are subpoenaed," she says.

Despite those privacy issues, and the disappointing response to the pilot program so far, Tritle holds out hope for PHRs.

"Once people understand what it is," he says about a PHR, "they really want it. But the program needs a comprehensive outreach to sign people up and ongoing support to add to their records to keep people using it."

Tritle believes individual physicians will eventually need to play an important role in promoting PHR use. "Doctors communicating with people in a health-care setting is the right time," Tritle says about promoting the program.

Given the lack of interest in the pilot project to date, Tritle has mixed emotions about the January 2009 launch. On the one hand, he says: "You have to walk before you can run. It had to start sometime in order to learn from it."

On the other hand, Tritle expresses some doubts about the planning which went into the project.

"If we'd had more time to plan the outreach before it started," he observes, "the program would have benefited."