Note: Practice Fusion announced today that it released Patient Fusion, a personal health record with real time links to the company’s electronic health record. Patient Fusion users will be able to see actual clinical data as it appears in the record being kept by their doctor.
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In 1895, German physicist Wilhelm Rontgen stumbled upon an image that had been created when X-rays passed through his wife’s hand and then exposed a photographic plate. The image revealed the bones and soft tissue of her hand in exquisite detail. No one had even dreamed this was possible.

Rontgen’s discovery was extremely significant, in part because it helped drive an unprecedented social transformation of medicine in which physicians rose from humble wage-earners in a cottage industry to prestigious professionals who sat atop gigantic health systems.

Physicians occupied the pinnacle because they could make sense out of those wondrous images. Laymen trusted them to explain their hidden meaning, as they did in later years when it came to the interpretation of lab tests, EKGs, and so forth.

But while Rontgen’s contribution remains clear and unquestioned to this day, the image of the omnipotent physician has faded like a daguerreotype.

There are many reasons for the fall. Nowadays for example, anyone who can jump on the Internet can access more medical information in seconds than a physician can digest in a lifetime.

But we’ll defer the patient-empowerment story for another day. Today we focus on something less glamorous but no less important. It is the fact that modern health care systems built to support physicians have accumulated so much complexity that they are bound to fail.

Take for example, a report from a few months back showing that 18% of EHR-generated alerts designed to inform physicians about radiology reports that specified serious or life threatening results were never opened by physicians. Nearly 8% of the stricken patients did not receive timely follow-up and their conditions worsened.

As another example, Cornell researchers recently reviewed laboratory test results from patients cared for at 23 primary care practices. Of all patients in all practices who had a “significant” abnormal result, 7% were never notified by their caregivers. In one practice, 26% of these patients were never notified.

Furthermore, the scientists found that implementation of an EHR had no impact on these results.

According to the scientists, the only thing that favorably impacted results was a good process for managing test results. They suggested that in such a process:
(1) All results are routed to a single, responsible physician who signs off on them.
(2) The practice informs all patients of all results (good or bad).
(3) The practice documents that the patient has been informed.
(4) Patients are told to call the practice after a specific time interval if they have not heard about their results.

If all practices adopted a process like this, notification errors would be reduced but there would still be room for improvement. Harried physicians often go days at a time without checking their patients’ lab results. There will still be communication errors, as when voice mails are overlooked or mistranslated. And step 4 in the above process is a poor fail-safe mechanism, since patients will forget to call, or be too afraid, or assume (despite warnings not to) that “no news is good news.”


Personal health records (PHRs) can improve this process, but only if the PHR is linked to the EHR being used by the physician. In this instance, the patient can instantly check his or her lab results. Secure messaging can be used to ask questions or communicate additional information.

The PHRs offered by Google and Microsoft fail totally in this respect. In fact, Kaiser Permanante offers the only PHR that is linked in real time to an EHR.

In Q1 2009 alone, Kaiser patients viewed more than 5 million test results on its PHR. They had access to the information at the same moment their physicians did. And the data they saw was as pristine and accurate as Rontgen’s view of his wife’s hand more than a century ago.

With today’s release of a free PHR that is linked in real time to a free EHR, the rest of us can finally get up to speed.

Glenn Laffel MD, PhD
Sr. Vice President, Clinical Affairs, Practice Fusion