Microsoft’s HealthVault: a bad idea in its current form


There is some talk among physicians about using this service to “consolidate” health records for people. This is a phenomenally BAD idea, and I suspect these docs haven’t thought it through. The reason for this is because giving patients write access to their “official” healthcare records gives them license to remove or alter things that they don’t like, or want to tweak. Yes, I know this isn’t an official electronic repository for healthcare records right now, but as soon as a doctor treats it as such, how Microsoft bills the service becomes irrelevant.
When and if Microsoft is able to hide information and tier access to health records, I’ll withdraw my criticism of using this service in any official way:
It is better for a layperson to run their changes through someone with specialized knowledge than to attempt to amend their own records. Yes, there are smart people out there who know quite a lot about their medical issues and problems, but they are the minority. Better to have the pharmacist alter information about drug allergies; better to let your doctor alter the details of your colonoscopy findings.
Along the same lines, your pharmacist shouldn’t be able to edit the information about your colonoscopy findings, and the doctor’s secretary shouldn’t be able to note that you are “allergic” to Flagyl because it upset your stomach. Those are the differences between potential medical emergencies (allergies) and superficial issues (upset stomach).
The average layperson is unable (and often unwilling) to distinguish between the two. Ultimately, there is no reason they should have to, either.
Not ten minutes ago, my grandmother asked me to spell “Pergosent” so she can let her doctor know that she is allergic to it. She means Percocet, of course, but even knowing Percocet is imperfect. I asked her if she could take Tylenol (”Yes”) and wrote down “oxycodone” instead. That’s more accurate. But this is the type of (mis-)information that providers are going to receive if patients have the ability to modify their healthcare records.
This is why write access to any sort of unified healthcare record system (official or otherwise) should be tiered and protected. Patients should have write access only to leave notes to a provider who may then go in an alter the official record. Hiding data from patients is a good idea because it allows a doc, for instance, to leave thoughts about suspected psychiatric issues hidden from the patient while they are browsing their record. I have had instances of people becoming upset because they read something that they didn’t like in their record.
This information should be able to be flagged as hidden for anyone below a certain level of access, because a doctor shouldn’t worry about offending a patient. And in this particular case, the person DID have psych issues, as it turns out. But she was offended nonetheless.
This isn’t healthcare elitism. It’s just good medicine. If doctors use HealthVault in its current incarnation as an official and reliable repository for healthcare records, people are going to get hurt.
Yeah, the technology angle is fun, but from a patient safety and accuracy point of view, using HealthVault as a semi-official repository of medical records has many flaws. It’s also an invitation to be sued to kingdom come for any doctor that actually does this and something bad happens. There are other potential problems, too, like patients saying that they take 1mg of lorazepam twice daily when they really take 0.5mg at bedtime.
These are the reasons the official record should always be write protected. I’m sure my readers can come up with many other examples, too.
In the final analysis, I think services like this are absolutely fantastic. It’s about time the healthcare industry started thinking this way, but there are still some gaping holes that need to be addressed. Kudos to Microsoft for going out on a limb anyway. It’s about time someone did.