Thank you for your continuing support of PAMFOnline. We've had a wonderful year. Many of you told us during our 2004 PAMFOnline user survey that the service has given you the tools to be a more active participant in your own health care. That makes our day!

This has also been an exciting year that has seen increased attention of the federal government to the use of information technology to support health care. Congress and the Administration are calling for widespread adoption of electronic health record (EHR) systems, like the one we are using, within the next 10 years so that all Americans can enjoy the quality, patient-safety, efficiency and convenience benefits of using EHRs.

Meanwhile, we are continuing to add features to the EHR system and expand the number of health care services available online. In this newsletter, we describe some of the new features currently available -- many of which you asked for in the 2004 user survey. We hope you will continue to take advantage of PAMFOnline and give us your feedback.

Sincerely,
Paul Tang, MD
Chief Medical Information Officer
Palo Alto Medical Foundation

One of the most frequent requests the Palo Alto Medical Foundation (PAMF) received in its Customer Satisfaction Survey was online appointment reminders. In response to this need, PAMF patients enrolled in PAMFOnline will now receive an e-mail message two days prior to their upcoming appointment. The notice will be sent to the e-mail address listed in your PAMFOnline account.

Also coming soon - Patients whose physicians recommended a follow-up appointment will also be sent an e-mail message seven days prior to the suggested time as a reminder to schedule an appointment.

PAMFOnline is also launching a new service called "Proxy Access," which allows spouses, adult children, legal guardians, conservators and other caregivers to access the PAMFOnline record of adults for whom they are overseeing health care. After both the patient and proxy representative complete an authorization form, this system will allow the proxy representative to electronically access the patient's medical record and better manage the patient's care. In addition, the proxy representative may communicate electronically with the patient's physician if the patient subscribes to PAMFOnline Messaging for a $60 annual fee.

The response to Proxy Access has been tremendous. Patients, proxy representatives and providers who have already used PAMFOnline have given the service high praise. Of Proxy Access users in our alpha test, 100 percent said they would recommend the program to others. In addition, 75 percent said the availability of the service would keep them coming to PAMF even if given the opportunity to receive health care elsewhere.

Most importantly, 75 percent said the program has improved patient care. Providers said Proxy Access makes it "easier to coordinate the care of the patient and that it has "increased quality of care and greatly increased the proxy representative's satisfaction." Meanwhile, proxy representatives find the service makes it easier to schedule appointments, receive test results and refill prescriptions. Others like Proxy Access because it allows them to take advantage of electronic health records, even if the patient is not versed in such technology. "I think it is a great program as my spouse does not use the computer and is not online," said one proxy representative. "This way I can assist him in taking care of a lot of his medical needs."

Proxy Access is designed to ease the responsibility of overseeing health care for another adult, such as an elderly parent or an adult child with disabilities. At any time of the day, from anywhere in the world, these caregivers can use PAMFOnline to access clinical guidelines; medication instructions and other information that can help them better manage the patient's medical needs.

Currently only PAMF patients over the age of 18 are eligible for Proxy Access. The designated proxy representative must also be over the age of 18 but does not have to be a PAMF patient. Based on the success of this program, we anticipate launching a pilot program for children under the age of 12 in early 2005.

Do you use the Google Desktop Search tool or use a shared computer to view PAMFOnline?

Google recently released a new tool that allows people to scan computers for information in the same way they use Google to search the Internet. To enable the search, there is a setting that will index and cache Web pages including secure web pages like PAMFOnline. In other words, the tool has a photographic memory of what is on your computer.

What does cache mean? Cache is the area of your computer's hard drive that "remembers" data/Web pages you have visited recently.

Who does it affect? Cache affects computers using Windows XP or Windows 2000 operating systems, and the Internet Explorer browser. It does not cache Web pages viewed with Netscape or Mozilla browsers, or affect MAC computers at this time.

How does this affect me? If this tool has been installed on a PC that you are using, it is possible for your private health information viewed through PAMFOnline to be cached on the computer's hard drive and retrieved later by someone else.

What can I do about it? If you uncheck the "Include Secure Pages (HTTPS)" option, the tool will no longer be able to retrieve secure PAMFOnline pages.

How do I uncheck the "secure pages" option?

• Launch the Google Desktop search tool.
• Click on the "Desktop Preference" link.
• Uncheck the "Include Secure Pages (HTTPS) in web history" box.
• Click the "Save Preference" button.
• Close the browser to ensure the setting has been saved.

The good news: Google Desktop Search is only able to retrieve Web pages that are viewed after it is installed. In other words, if you view PAMFOnline on a shared computer (e.g., Internet café, Library), someone cannot come along after you, install Google Desktop Search and pull up the pages you previously viewed.