YOU MAY FEEL confident enough to pay your bills and do your taxes online, but what about posting and maintaining your entire medical history?

That's a question many consumers will face as a growing number of employers, health insurers and other companies begin offering personal health records, or PHRs. These electronic records serve as a repository for an individual's medical history. For a cost of up to $200 (although many are free), PHRs will keep track of the doctors you've visited and the medications you've taken, as well as your allergies, cholesterol level, immunizations and even your family's medical history. You, and anyone else you grant permission to, can access all of the information via the web.

According to the World Privacy Forum, a San Diego-based nonprofit public interest research group, there are roughly 200 PHR products currently on the market. More than two million members are actively using Kaiser Permanente's PHR, called My health manager. IBM and Verizon, now offer their employees PHRs from health information site WebMD. And companies like Microsoft and Google both have plans in the works to offer their own PHRs to consumers.

For consumers who are considering putting their medical information in the digital domain, PHRs offer both benefits and drawbacks. Here's what you need to consider.

Benefits

"Who can remember the last time they had a tetanus shot or their teeth cleaned?" asks Deven McGraw, director of the Health Privacy Project at the Center for Democracy and Technology in Washington, D.C.

Instead of relying on your memory, a PHR will have all of that information in one place, offering ready access to all of your medical records for such things as taxes and flexible spending accounts, explains Gary Marchionini, a professor at the University of North Carolina's School of Information and Library Science. Another perk: Patients can easily transfer their medical records electronically to a new doctor instead of having to fill out a request to move the information. For those with chronic conditions like diabetes, daily at-home blood glucose test results can be recorded in a PHR and sent to a doctor's office, thus ensuring that the condition is properly monitored, says McGraw.

But the most touted benefit of PHRs is their potential to cut medical costs by reducing unnecessary and redundant tests. If your primary care physician recently took your blood to determine your cholesterol level and it was recorded in the PHR, then your cardiologist won't have to repeat the test to get that information and you won't get charged again.

Risks

While PHRs can offer plenty of worthwhile benefits, privacy advocates warn of the inherent risks that come with trusting your medical history to a third party.

That's because some PHRs are covered under HIPAA (Health Insurance Portability and Accountability Act) privacy protections, while many others are not. Under HIPAA, health plans, doctors, hospitals, clinics and nursing homes, are legally bound to protect patients' medical records. This law restricts who has access to health information and ensures doctor-patient confidentiality, among other things. Almost any PHR offered by a health plan or hospital will fall under these protections. To make sure, look for the phrase "HIPAA-covered" in your provider's security policies.

On the other hand, PHRs like Microsoft's planned HealthVault or WebMD's Health Manager fall outside HIPAA's protective umbrella. "I think consumers would be stunned as to the depths to which their records are not protected once outside the HIPAA system," says Pam Dixon, executive director of World Privacy Forum.

A PHR provider that's not covered by HIPAA has no fiduciary relationship with the patient as a doctor or hospital does, explains Robert Gellman, a privacy consultant in Washington, D.C. Once a patient gives their consent, the PHR provider can hand over your email address or drug prescriptions to a third party if it so desires. "It's really easy to wheedle consent out of consumers. Most people don't read those policy notices," Gellman says.

How to Choose a PHR

Before you start shopping for a PHR, figure out exactly what you want from it. "Articulate a reason why a PHR will do something you need. If you've got a chronic disease, if you want to record your blood pressure or blood sugar every day, it can be beneficial to have your information there," Gellman says.

A good place to start is the web site of the American Health Information Management Association, a nonprofit professional group that offers consumers advice on choosing a PHR. Here are some other things to watch out for:

Do some research. Once you figured out what you'll need, investigate the provider's policies and what their particular PHR offers. For example, if you're a mother of four and the PHR doesn't allow you to track multiple people's health records, it might not be useful.

Read the fine print. Don't assume your medical records are protected. The PHR's privacy policy should clearly disclose if the provider is covered under HIPAA or not. Look for the phrase "HIPAA-covered" or "HIPAA-covered entity" for confirmation that the PHR follows HIPAA regulations. If they use "HIPAA compliant," it doesn't necessarily mean your records are covered under the law. "You almost have to be a health-care attorney to parse out these policies," says Dixon.

For plans not subject to HIPAA regulation, the privacy policy should indicate if the PHR plans to provide your information to third parties, such as marketers, employers or insurers, says Gellman.

Watch for checked boxes. Pay attention to consent forms. A PHR vendor may ask for consent to share your data with third parties and you may not even realize you agreed to it. Keep an eye out for inconspicuous boxes that are prechecked or hidden at the bottom of a page. Read all privacy policies carefully to find out how consent works at the PHR, and make sure you can withdraw consent or completely remove your record from the PHR later on if you decide to.

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