Will patients use electronic personal health records? Responses from a real-life experience.

The Department of Health and Human Services identifies the electronic personal health record (EPHR) as a fundamental "dimension" of a future national health information infrastructure. Currently thirty-some EPHRs are available on the market. Though the potential advantages for clinical care, patient education, and administrative streamlining are highly touted, they remain speculative, and the core question remains: Will consumers actually use EPHRs? Upon retirement in July 1999, the author provided 330 patients a commercial EPHR containing clinical office records from the practice's EMR. One year later, he conducted a mail-in survey that posed a series of relevant yes-and-no questions regarding usage and invited narrative comment and anonymous responses. This article tabulates the results and synopsizes patients' opinions. It provides considerable enlightenment regarding patients, who, among other responses, intended to begin or continue keeping records, used the EPHR on medical visits, would rather not store health information on the Internet, wished to use e-mail with the doctor's office, believed doctors do not keep full records, and strongly believed individuals should keep their own records.

The neurological deficit associated with sudden occlusion of abdominal aorta due to blunt trauma.

A review of the literature revealed five well-documented cases of abdominal aortic injury due to blunt, nonpenetrating trauma. An additional case report is offered. In all cases the level of aortic injury was at or distal to the origin of the inferior mesenteric artery. In five of these reports, including the present case, sudden traumatic occlusion of the distal abdominal aorta occurred and led to associated neurological deficit. The authors submit, based on clinical manifestations, selective angiography of spinal cord vasculature, and the operative experience of others, that these neurological deficits resulted from acute peripheral nerve ischemia and not from spinal cord ischemia as had been assumed in the past. The final neurological deficit due to acute peripheral nerve ischemia may masquerade as that seen with a "transverse" spinal cord lesion. However, the prognosis for recovery of neurological function differs markedly between the two conditions. All surviving patients experienced rapid resolution of their neurological deficits in the immediate postoperative period. Infrarenal aortic occlusion will not produce spinal cord infarction.