Keyose Blog - Personal Health Records

As repoted in ksl.com Thousands of people are being cautioned to keep their eyes on their credit reports tonight. A laptop with names, Social Security numbers and personal health information was stolen from University Health Care in Salt Lake City.

In Keyose we know there is no 100% secure system. As a Doctor I understand that when talking about personal health information breaches a “one between a billion chance” is simply unacceptable.

For that reason, Keyose was designed to be a anonymous personal health record. A anonymous-non identifiable database in a stolen laptop would not be a privacy problem at all.

During the last days some big Health Plans in USA are releasing PHRs services. Vince Kuraitis analyses the reasons behind the failure on the adoption by the users of these services:

• Lack of Trust
• Lack of Access to Clinical Data
• Lack of Permission
• Lack of Convenience in Consumer Workflow

I read an interesting post from Gunther Eysenbach (a widely recognized academic on medical informatics) where he reminds his concerns about privacy and the presence of google ads in a online Personal Health Record.

“I see one particular privacy threat which I haven’t seen discussed anywhere. The privacy threat is created whenever a personal health record (or any other sort of dynamic, private information) is combined with Google Ads, because Google Ads are created by third parties, and Google Ads are keyword/context triggered. Any combination of Google Ads with any sort of personal health information spells a privacy disaster.
Why? Imagine I am a bad guy who wants to compile a database of people with the condition “Amyotrophic Lateral Sclerosis”. It is now a matter of five minutes to set up an ad at Google AdWords which is triggered by the keyword “Amyotrophic Lateral Sclerosis”. Google AdWords also lets me define a target site, so I could define health.google.com or any other online PHR site such as myPHRsite.com as the sole target site where the ad (context-triggered) should appear. Now, whenever a user on that site would review his personal health record with integrated Google Ads, my ad would be triggered only if the word “Amyotrophic Lateral Sclerosis” shows up in my record. The consumer of course does not know this and if the ad is something innocuous such as “Click here to receive a free gift basket” he might click on the ad and - bingo - all I (as the bad guy) have to do is to link to a questionnaire pretending to send a gift to the consumer, asking for his/her personal information - name, address etc. Thus, I have a list of people who have the keyword “Amyotrophic Lateral Sclerosis” showing up in their Personal Health Record.
Yes, it is that simple. ”

The first priority of Keyose is privacy and we agree with Eysenbach about the threath. In that sense we have decided to never include Adwords or Adsense advertising in Keyose service. We will never put our personal, our patients or our relatives health information in a service that provided AdSense in their website. You can trust us!

I am a medical doctor. I see patients every day. Including the Emergency Room where I work.

Because of that, I deeply understand, not only theoretically but as part of my daily experience that patient-physician relationship is the key for the quality of health-care.

A patient must trust his doctor. If there is no confidence, we lost a lot (patients and docs).

Saying that, privacy of data becomes a real importante issue. A patient that talks about his sexual activities, extramatrimonial affairs, fears, weakness, mental health… should be sure that the doctor will not reveal that information to third parties.

During thousands years physician have follow this hippocrates oath sencente: What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about.

So at the moment I designed the keyose service, I have a very clear idea: privacy must be the priority number one!

Storing thousands of personal health records electronically has a big risk. What if someone unauthorized (a cracker for instance) access to the database? No matter how much money or effort you invest in the security of a system. There is no 100% secure system in the world. And the health information of thousand of people is very attractive to so many people (government, insurers, bank, private companies, criminals devoted to extortion…).

There are many companies entering the business of eHealth. Google Health, Microsoft HealthVault are just the two most known examples. As a medical doctor I am really concerned about the privacy of data. 90% of UK physicians and German doctors think like me.

Keyose was designed in such a way that no personal information is stored. We do not need your name, email or identity. And more importantly: We do not want it.

I would never put my personal, my patients or my relatives health information in a online database that contains the identity of the patients. You can trust me!

Dr. Julio Bonis

It is estimated that up to 15% of medical diagnosis are not correct. The root of those misdiagnosis is sometimes the lack of access to relevant information about the patient. Keeping a Personal Health Record in Keyose could improve the medical decision making process.

Moreover , Dr. Groopman advises that there are three important questions that patients should ask their physicians after they receive a diagnosis:

1. What else could it be?
2. Could two things be going on at once?
3. Have you found anything–any laboratory test, or X-ray, or physical finding–that isn’t in sync with your presumption…that contradicts what seems to be the diagnosis.

A really interesting interview to Dr. Groopman about medical misdiagnosis is available via Youtube in part 1 and part 2.

We have heard of a new and interesting use of Keyose. We are proud of having some really active and innovative users that found new ways of using the Keyose service.

That is the case we report today. A rural primary care doctor from USA is using Keyose to obtain second opinions about some of their patients. With the previous authorization of their patients she writes the medical history and the results of test in the Keyose platform. Afterwards she send the keyose login and public password to the specialist so they can see and discuss the medical record at the same time.

There are several new tools that provides doctors with the opportunity of consulting other physicians to obtain second opinions. Esanum is a good example (with divisions in Spain, Germany and other countries). Keyose could be a perfect complement to those “second opinion searching” internet services.

The number of people travelling internationally is increasing every year. According to statistics of the World Tourism Organization, international tourist arrivals in the year 2005 exceeded 800 million. In 2005, the majority (402 million) of international tourist arrivals were for the purposes of leisure, recreation and holiday (50%).

International travel can pose various risks to health, depending on the characteristics of both the traveller and the travel. Travellers may encounter sudden and significant changes in altitude, humidity, microbes and temperature, which can result in ill-health. In addition, serious health risks may arise in areas where accommodation is of poor quality, hygiene and sanitation are inadequate, medical services are not well developed and clean water is unavailable.

All people planning travel should know about the potential hazards of the countries they are travelling to and learn how to minimize their risk of acquiring these diseases. Forward planning, appropriate preventive measures and careful precautions can substantially reduce the risks of adverse health consequences.

Although the medical profession and the travel industry can provide a great deal of help and advice, it is the traveller’s responsibility to ask for information, to understand the risks involved, and to take the necessary precautions for the journey.

Key factors in determining the risks to which travellers may be exposed are:

• destination
• duration and season of travel
• purpose of travel
• standards of accommodation and food hygiene
• behaviour of the traveller
• underlying health of the traveller

Destinations where accommodation, hygiene and sanitation, medical care and water quality are of a high standard pose relatively few serious risks for the health of travellers, unless there is pre-existing illness. This also applies to business travellers and tourists visiting most major cities and tourist centres and staying in goodquality accommodation. In contrast, destinations where accommodation is of poor quality, hygiene and sanitation are inadequate, medical services do not exist, and clean water is unavailable may pose serious risks for the health of travellers. This applies, for example, to personnel from emergency relief and development agencies or tourists who venture into remote areas. In these settings, stringent precautions must be taken to avoid illness.

The epidemiology of infectious diseases in the destination country is of importance to travellers. Travellers and travel medicine practitioners should be aware of the occurrence of any disease outbreaks in their international destinations. New risks to international travellers may arise that are not detailed in this book. Unforeseen natural or manmade disasters may occur. Outbreaks of known or newly emerging infectious diseases are often unpredictable.

The duration of the visit and the behaviour and lifestyle of the traveller are important in determining the likelihood of exposure to infectious agents and will influence decisions on the need for certain vaccinations or antimalarial medication.

The duration of the visit may also determine whether the traveller may be subjected to marked changes in temperature and humidity during the visit, or to prolonged exposure to atmospheric pollution.

The purpose of the visit is critical in relation to the associated health risks. A business trip to a city, where the visit is spent in a hotel and/or conference centre of high standard, or a tourist trip to a well-organized resort involves fewer risks than a visit to a remote rural area, whether for work or pleasure. However, behaviour also plays an important role; for example, going outdoors in the evenings in a malaria-endemic area without taking precautions may result in the traveller becoming infected with malaria. Exposure to insects, rodents or other animals, infectious agents and contaminated food and water, combined with the absence of appropriate medical facilities, makes travel in many remote regions particularly hazardous.

Travellers intending to visit a destination in a developing country should consult a travel medicine clinic or medical practitioner before the journey. This consultation should take place at least 4–8 weeks before the journey, and preferably earlier if long-term travel or overseas work is envisaged. However, last-minute travellers can also benefit from a medical consultation, even as late as the day before travel.

The consultation will determine the need for any vaccinations and/or antimalarial medication, as well as any other medical items that the traveller may require. A basic medical kit will be prescribed or provided, supplemented as appropriate to meet individual needs.

Dental and —for women— gynaecological check-ups are advisable before travel to developing countries or prolonged travel to remote areas. This is particularly important for people with chronic or recurrent dental or gynaecological/obstetric problems.

Assessment of health risks associated with travel Medical advisers base their recommendations, including those for vaccinations and other medication, on an assessment of risk for the individual traveller, which takes into account the likelihood of catching a disease and how serious this might be for the traveller concerned. Key elements of this risk assessment are the destination, duration and purpose of the travel as well as the standards of accommodation and the health status of the traveller.

For each disease being considered, an assessment is also made of:

• availability of prophylaxis, possible side-effects and suitability for the traveller concerned;
• any associated public health risks (e.g. the risk of infecting others).

Collecting the information required to make a risk assessment involves detailed questioning of the traveller. A checklist or protocol is useful to ensure that all relevant information is obtained and recorded. The traveller should be provided with a personal record of the vaccinations given (patient-retained record) as vaccinations are often administered at different centres. A model checklist, reproducible for individual travellers, is provided.

Medical kit and toilet items

Sufficient medical supplies should be carried to meet all foreseeable needs for the duration of the trip.

A medical kit should be carried for all destinations where there may be significant health risks, particularly those in developing countries, and/or where the local availability of specific medications is not certain.

Contents of a basic medical kit
First-aid items:

• Keyose card and a printed copy of your Keyose personal record
• adhesive tape
• antiseptic wound cleanser
• bandages
• emollient eye drops
• insect repellent
• insect bite treatment
• nasal decongestant
• oral rehydration salts
• scissors and safety pins
• simple analgesic (e.g. paracetamol)
• sterile dressing
• clinical thermometer

Additional items according to destination and individual needs:

• antidiarrhoeal medication
• antifungal powder
• antimalarial medication
• condoms
• medication for any pre-existing medical condition
• sedatives
• sterile syringes and needles
• water disinfectant
• other items to meet foreseeable needs, according to the destination and duration of the visit

Any traveller with a chronic illness should carry all necessary medication for the entire duration of the journey. All medications, especially prescription medications, should be stored in carry-on luggage, in their original containers with clear labels. With heightened airline security, sharp objects will have to remain in checked luggage. Recently, airport security measures have introduced a restriction on liquids in carry-on luggage; it is therefore necessary to check with current airport security measures. A duplicate supply carried in the checked luggage is a safety precaution against loss or theft.

The traveller should carry the name and contact details of their physician on their person with other travel documents, together with a printed copy of his Keyose record with informacion about the medical condition and treatment, and details of medication (generic drug names included) and prescribed doses. A physician’s letter certifying the necessity for any drugs or other medical items (e.g. syringes) carried by the traveller that may be questioned by customs offi cials should also be carried.

Travellers should be advised to have a medical examination on their return if they:

• suffer from a chronic disease, such as cardiovascular disease, diabetes mellitus, chronic respiratory disease
• experience illness in the weeks following their return home, particularly if fever, persistent diarrhoea, vomiting, jaundice, urinary disorders, skin disease or genital infection occurs
• consider that they have been exposed to a serious infectious disease while travelling
• have spent more than 3 months in a developing country

Travellers should provide medical personnel with information on recent travel, including destination, and purpose and duration of visit. Frequent travellers should give details of all journeys that have taken place in the preceding weeks and months.

Note. Fever after returning from a malaria-endemic area is a medical emergency and travellers should seek medical attention immediately.

Adapted from a original document of the World Health Organization.

As described recently in the medical journal Family Physician adverse drug events are common in older patients, particularly in those taking at least five medications, but such events are predictable and often preventable.

About one in three older persons taking at least five medications will experience an adverse drug event each year, and about two thirds of these patients will require medical attention. Approximately 95 percent of these reactions are predictable, and about 28 percent are preventable.

Keeping a well organized and updated record of the current medications of a patient is a key element to minimize those events. Keyose is an unvaluable tool when dealing with that task.

With Keyose you can update the list of treatments quickly (close to real time). You and your doctors will be able to access to that information from everywhere.

Therefore, the Medications section in your Keyose health record is very important, specially when you take more than 4 drugs.

It is recommended to review and update the list of your medications each 6 months, and everytime you change or introduce some new treatment or a new disease is diagnosed.

A medical researcher, Hamly, described in 1995 a set of simple questions you should ask to your doctor each time you review the medication list with him:

1. Is the indication for which the medication was originally prescribed still present?
2. Are there duplications in drug therapy (i.e., same class)? Are simplifications possible?
3. Does the regimen include drugs prescribed for an adverse reaction? If so, can the original drug be withdrawn?
4. Is the present dosage likely to be subtherapeutic or toxic because of my age and renal status?
5. Are any significant drug-drug or drug-illness interactions present?

The Keyose’s team hopes that our tool serves to minimize drug adeverse effects for you and your family.

Two in five (42%) adults keep personal or family health records, that is “one place where you keep all your medical records with the results of all your medical tests and details about prescriptions, vaccinations, treatments, known allergies and other health care information.” Almost every one (84%) of those who do not keep health records think it would be a good idea to do so.

At the moment, only a small minority (13%) of those with health records keep them electronically but many people – 40% of all those who do not have electronic medical records – think it at least somewhat likely that they will do so.
These are a few of the results of a nationwide survey by Harris Interactive of 2,242 adults who were surveyed online between July 12 and 18, 2004.
Other interesting findings include:
• Women (45%) are slightly more likely than men (38%) to keep personal or family medical records.
• Older people are more likely than younger people to keep personal or family medical records. Fully 58% of people over 65 do so.
• Among the many “good reasons” for keeping personal or family medical records are:
- The ability to provide doctors with useful information (78%).
- The ability to look back and recall what care was received (78%).
- The ability to have access to the record in case of emergency (77%).
- To help ensure the proper use of prescription drugs (54%).

The biggest concerns people have about keeping medical records are possible threats to one’s privacy (68%), and security (66%). Many, but far fewer, people are concerned about possible errors (37%), that critical information won’t be accessible in an emergency (37%), or that they won’t be able to keep their records up to date (33%).

For that reason, privacy and security have been the main concern of Keyose’s team from the beginning of the project.

Having a Personal Health Record of your children in Keyose is a great idea. As Larissa Hirsch states in this website when a child is ill or injured and requires emergency care, doctors, nurses, and paramedics will have many questions about his or her medical history. And even the most organized parent might not be able to remember the details of a child’s health history in a stressful situation. That’s why it’s important to keep a comprehensive record of your child’s health information nearby. In many cases, this information can help a medical professional make quicker diagnoses and decisions during an emergency, when each second counts.

The site contains several tips about how to write a useful Personal Health Record for your children. And Keyose is a perfect tool to do it easily.

If you decide to have the Personal Health Records of your children in Keyose probably you will have several keyose cards, and as those cards are anonimous, sometimes you will find difficult to know which card belongs to each child.

We recommend you to personalize the card (putting just the name of your child for example), by clicking in the are of allergies before printing it. Remember that the information you write in the card will not be stored in Keyose databases, so privacity is guaranteed.