A better way to share and store electronic health records

Box's foray into confusing world of digital health data could be the first step toward consumerizing this messy tech

Missy Krasner faces a big challenge in taking care of her aged mom, who sees eight doctors for different medical issues. Krasner discovered that these doctors have no way other than fax to share data with one other, so each has an incomplete picture of her mom's medical status. That creates risk of misdiagnosis, bad drug interactions, and so on. Most of her providers allow Krasner to download her mother's medical data, but they use different formats, none of which is human-friendly or integrated. As a result, she must interpret and manage dozens of data files.

Krasner is also a former policy adviser on health IT issues at the Office of the National Coordinator (ONC) at the federal Health and Human Services Dept. The ONC is the agency charged with implementing Obamacare, and it was responsible under the George W. Bush administration a decade earlier for setting the policies for the national electronic health records (EHR) mandate and the health information exchange (HIE) efforts that precipitated the current health tech scramble. Krasner was also a marketing executive at Google Health, the now-defunct personal health records (PHR) cloud-based vault.

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Krasner is more able than most people to navigate the system, understand the data, and know how to share it. Yet even for her, it is hard.

Could commercial cloud storage systems bridge some of the gaps? Krasner thinks so, and since fall 2012 she has been advising Box on the topic while also working as a health care startup scout for VC firm Morgenthaler Ventures.

The first steps in Box's effort were revealed this week when the company announced it achieved federal HIPAA and HITECH compliance certification (which competitors such as Dropbox have yet to earn) for storing health information while maintaining patient privacy, as well as getting smaller EHR providers to use Box for cross-provider data exchange, small-facility EHR sharing, and PHR use.

The data-sharing problem in today's systems
Today, a bunch of companies called health information exchanges (HIEs) are trying to connect different EHRs, but overall HIEs are struggling to succeed.

PHR systems, such as Microsoft Health Vault, let patients keep copies of their own medical records. Typically, a PHR is either tied to a specific EHR system or does not have a conduit from at least some of your health care providers.

Even if you're a patient at a so-called integrated provider like Kaiser Permanente, you're likely to use unaffiliated providers for dental and optometric needs, and your provider may even send you to a separate caregiver if you need specialty care. More commonly, you have a primary physician in a smallish medical group and specialty providers at other doctor firms. They may take the same insurance, but they're not likely to have the same EHR nor be able to share your records with each other.

In the absence of a dependable, workable HIE system, the providers still fax each other -- and even then some information never is shared. Likewise, if health care providers offer you a way to get copies of your medical records, they're in different formats and perhaps tied to specific PHR systems.

Due to these HIE and PHR limitations, your health data remains scattered, at least outside of your primary provider's systems.

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