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BMJ 2008; 336 doi: (Published 24 April 2008) Cite this as: BMJ 2008;336:914

Online health records on the horizon in the US

Patients in the US may soon be able to store and manage their own health records online. Microsoft, Google, and a consortium of large US employers have already developed online repositories where in theory people can upload and store their own health data and share it as they see fit. Pilot testing is still at an early stage, says one national correspondent, but the long term goal is for users to build up a secure and lifelong record that will help them manage healthy lifestyles as well as illnesses and improve the coordination of complex care.

These initiatives have the potential to improve health care and may even cut costs, he writes, but will they be secure? As yet, online repositories are not subject to the same US security regulations as other electronic records, which leaves personal health data open to misuse or commercial exploitation. Without new legislation, the privacy promises made by Google, Microsoft, and others will not be legally enforceable. A linked article (p 1732) details other challenges—hospitals, clinics, and laboratories have yet to agree to release data for online use by patients; paper is still popular and electronic data formats are not standardised; and it is hard to be certain of users’ identities online.

New isn’t always better

Doctors, patients, and policy makers are often seduced by new and fancy technologies for managing illness. So called “gizmo idolatry” is widespread, say two observers, and it is responsible for the rapid dissemination of practices that are unsupported by evidence. Swan Ganz or pulmonary artery catheters are a good example. Intensivists used them with great enthusiasm for decades, and are still using them despite good evidence that they do more harm than good. New technologies are always more expensive than the old, diligent, and usually unglamorous way of doing things. So health care …

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