There has been a significant increase in standards activities relating to the Personal Health Record (PHR), the private industry and more recently the government. MedicAlert is actively working with the Object Management Group (OMG), Health Level Seven (HL7) and ASTM International's Committee E31 on Healthcare Informatics to help harmonize and refine the emerging standards efforts.

In a step toward establishing a national electronic health information system, the Department of Health and Human Services (HSS) has agreed with the College of American Pathologists to license and distribute a standardized medical vocabulary based on the college's medical terminology known as SNOMED - the Systematized Nomenclature of Medicine (www.snomed.org). Additionally, the Institute of Medicine (IOM) will use the HL 7 Electronic Health Record functional Outline (www.hl7.org) as its model. HHS and HL7 officials expect the model to be completed in 2004.

In a related activity, ASTM International (www.astm.org), the Healthcare Information and Management Systems Society (HIMSS - www.himss.org), and the Massachusetts Medical Society (www.massmed.org) have joined forces to establish a standard for the Continuity of Care Record (CCR), which will enable healthcare providers to base future care on relevant and timely patient information.

MedicAlert® has developed a Personal Health Record (PHR) for tracking our members' medical information. The system, known as MED, is a sophisticated coding and classification system that stores medical information across a number of different tables in the database. The entry of medical information is verb-driven, which MED refers to as context codes. This verb-driven structure, along with an implementation based on the HL7 EHR Functional Outline, forms the basis for a comprehensive Personal Health Record for the MedicAlert members.

Because of this structure, medical information is retrieved as MED links these context codes to the detail codes and descriptions of medical information (medication, allergy, condition, medical device, etc.). This allows our Emergency Response Center to provide comprehensive and versatile information to responders in an emergency situation. We are able to track medical information in a variety of contexts, many of which save time and effort in the responder's evaluation and assessment process. The MedicAlert medical information profile incorporates information based on many of the major classification systems in use today -ICD-9, SNOMED, CPT, the National Drug Code (NDC) system and private-label databases such as the drug monographs available from First Databank.

The impact of privacy legislation on EHR efforts has been a long time coming, but in the past year or so the industry has had to face increasing accountability, despite efforts to delay and dilute the regulations. The Health Insurance Portability and Accountability Act (HIPAA), the growing efforts to address medical errors and the momentum of the new Department of Homeland Security, have been key factors in a number of federal government moves that have far-reaching consequences for the EHR.

Going forward, MedicAlert will expand and improve the codes, categories and processing of medical information with the goal of refining this technology into a highly optimized medical information engine for the MED application, and one that could be the basis of many solutions, and standards, in areas beyond our current MED application.

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