Personal Health Information:

The Last Frontier on the World Wide Web

James J. Cimino, M.D., Soumitra Sengupta, Ph.D., Eneida Mendonça, M.D., M.S.,

Department of Medical InformaticsColumbia University

Vimla L. Patel, Ph.D., Andre Kushniruk, Ph.D.Centre for Medical Education, McGill University

Things You Can Do On the Web

• Read a newspaper• Buy groceries• Banking• Trade stocks• Track your Fed Ex package• Get health information

Kinds of Health Information You Can Get

• Medline citations• Drug advertisements• Quack therapies• Viagra prescriptions

Kinds of Health Information You Can’t Get

• Your cholesterol level• Your mammogram report• A list of your current medications• Advice from your doctor

Personal Health Information on the Web

• Access to your electronic medical record• Ability to contribute to your medical record• Relevant, reliable, understandable advice• Fostering patient-clinician communication

Challenges

• Web access to electronic records• Security and confidentiality issues• Political issues• Ethical issues

Web Access to Electronic Records

• Data in electronic form?• Data accessible?• Data queries• Presentation• Writing to record

Security and Confidentiality Issues

• Identification• Authentication• Authorization• Privacy

Political Issues

• Clinician response• Medicolegal issues• Institutional Review Board

Ethicial Issues

• Discovery without supervision• Misunderstanding and worry• Misunderstanding and complacency• Patient-clinician communications

– better– shorter– worse– longer

PatCIS: An Experiment to Gain Experience

• Funded by the US National Library of Medince

• Architecture• Applications

PatCIS Screen shot

Data Entry

Review

Advice

Education

Comments

Help

Logout

Javascript

Vital Signs Blood Sugar

Data Entry

patcis.cgi

Web ServerWeb Browser

SessionRegistry

Re-enterPassword

UsageLog

Internet

Javascript

Link

1

2

3 4

5

67

8

910

CGI

CGI

11

PatCIS Architecture

• Integration• Security• Tracking• Evaluation• Feature blocking

PatCIS Domains

• Data entry• Data review• Education• Advice• “Infobuttons”

Data Entry

• screen shot

Data Review

• graph? More screen shots

Mammogram Advice

• screen shot

more screens

Current Experience

• Small number of users• No problems thus far• Favorable response• Evaluation under way

Potential Areas of Expansion

• Advance directives• Pap smear infobutton

Addressing the Challenges

• Web access to records• Security and confidentiality issues• Political issues• Ethical issues

Conclusions