Web-based image access empowers Austrian patients

From the White House to the Department of Health and Human Services, the U.S. government is encouraging the adoption of medical information technology. The primary goal is to reduce errors, and one way to accomplish that might be to give patients responsibility for their medical records. A radiologist in Graz, Austria, has done exactly that, with surprising results.

When Dr. Peter Kullnig offered patients at his imaging center access to their images, his intention was less to empower them than to gain control over an unwieldy administrative problem. Austrian standards of medical practice mandate that only healthcare practitioners involved in the care of patients should be allowed to see those patients' records. Rather than trying to keep track of which doctors should view them, Kullnig put his patients in charge, issuing them private logins to the imaging center's Web-based PACS.

With this approach, patients control access to their medical information. They can give the logins to their primary physicians and any others to whom they are referred, in private offices or hospitals. But soon after Kullnig distributed the logins, he noted that the patients themselves were looking at their records.

"We realized from the log files that up to three quarters of patients accessed their own images at least once," he said.

The patients appreciate the ability to see and control their medical records, as do the doctors who need access to the information, Kullnig said. Additionally, referring physicians can use the Web-based PACS to schedule patients for imaging exams at the Graz center.

Empowering patients has led to unexpected consequences. Their ability to choose which physicians can access their medical records has weakened relationships between patients and primary care physicians.

"Some referring physicians don't like it," Kullnig said. "They don't want to see their patients really make choices."

Some hospital administrators are also dissatisfied. They want staff doctors to read images from the hospital PACS, but the doctors prefer to use the imaging center's PACS.

The center's iPACS Web-based PACS, installed in January 2001 by RealTimeImage, is used widely because it is consistently available from any Web portal, while access to the hospital PACS is more restricted. The iPACS also contains more information about the patients, he said.

Kullnig has persisted in providing patients with control of their medical records, despite pressure to scale back, and he may soon have another reason to persevere.

The government-based insurance program in Austria plans to create online patient accounts containing comprehensive medical records, each accessible to individual patients. Smartcards containing medical in-formation, including radiological images and medical data such as lab findings, are being issued to patients. The next step, online availability, may soon follow.

"We have developed a system that will fit perfectly into the government plans for the patient record," he said.

Public access to the Internet in the U.S. has been credited with patients' increased awareness of medical choices and involvement in their care. If the U.S. government's initiative to bring medical records into the digital age takes a similar course, Kullnig's practice could serve as a model for how this might be done.