Tuesday, July 13, 2010

Let’s Get Real With This Silly Patient Controlled EHR Story.

I came upon this great opinion piece the other day.

http://www.fierceemr.com/story/tale-two-phr-models/2010-07-08

Portals see high usage, while untethered PHRs may compromise safety

July 8, 2010 — 1:29pm ET | By Neil Versel

Editor’s Corner

Whenever I get a pitch about personal health records, I immediately ask if the publicist has any evidence that people are using the product in question. I rarely get a response because I know that in most cases, there is no such evidence. The lone exception is a PHR that's "tethered" to a large health system's EMR.

Some such evidence surfaced this week, when the University of Texas M.D. Anderson Cancer Center in Houston reported that 57 percent of patients and a surprisingly strong 40 percent of outside referring physicians are using the center's year-old web portal. And using it often. According to Healthcare IT News, patients have been logging into the portal an average of 3.3 times a week--that's once every other day--and referring physicians are accessing M.D. Anderson patient records 2.8 times weekly.

Not surprisingly, M.D. Anderson's primary EMR vendor is Epic Systems. The company's myChart PHR--called myMDAnderson at the Houston institution--is an integral part of the Epic Care EMR for so many of Epic's customers. The Cleveland Clinic, Kaiser Permanente, NorthShore University HealthSystem in Illinois, the University of Texas Medical Branch and Dean Health Care are among those that have had success with myChart. Partners HealthCare System in Boston, which built its own EMR, also has seen wide acceptance of patient portal.

Why does this model work? Because the EMR automatically populates each patient's PHR, saving people from having to enter all of their own data. Think of personal financial software before online banking became widespread. Who was going to sit down and type the entire contents of a handwritten check register into a Quicken screen? Virtually nobody. But when users gained the ability to download bank statements directly into the software, sales took off.

That's why I am not surprised by the findings in a newly published paper in the Journal of the American Medical Informatics Association. The author, Dr. Donald Simborg, co-founder and board member of Health Level Seven International and a founding member of the American College of Medical Informatics, argues that "untethered" PHRs create "a form of unhealthy consumer populism" by disrupting physician workflow.

Read all the gruesome details here:

http://www.fierceemr.com/story/tale-two-phr-models/2010-07-08

Here is the link to the paper being discussed along with the abstract.

http://jamia.bmj.com/content/17/4/370.abstract

JAMIA 2010;17:370-372 doi:10.1136/jamia.2010.003392

  • Viewpoint paper
Consumer empowerment versus consumer populism in healthcare IT

  1. Donald W Simborg
  1. Correspondence to Dr Donald W Simborg, 407 Old Downieville Hwy, Nevada City, CA 95959, USA; dsimborg@sbcglobal.net
  • Received 19 January 2010
  • Accepted 30 April 2010

Abstract

Institutions, providers, and informaticians now encourage healthcare consumers to take greater control of their own healthcare needs through improved health and wellness activities, internet-based education and support groups, and personal health records. The author believes that “untethering” all of these activities from provider-based record systems has introduced a form of unhealthy consumer populism. Conversely, integrating these activities in a coordinated manner can sustain both consumer empowerment and consumer well-being.

----- End Abstract.

The one line summary is pretty simple – unless you have links between professional data sources and a patient held record they won’t be used and if they are they are likely to be potentially dangerous.

The only way the crazy plans from the Department of Health and NEHTA can work is if GPs, specialists, lab information providers and the like contribute information to the patient held record.

If you think this is going to happen without very substantial incentives and assistance being put in place – for which at present, as far as we know, there is no budget, you are dreaming!

This is the second shoe to fall in my view. First we know the evidence for the value and effectiveness of PHRs vs EMRs is absent and second we now know the apparent plans from DoHA will do nothing to remedy this issue.

Of course we have also yet to hear just how the issue of the ‘digital divide’ is to be addressed – i.e. how is a PHR going to help those without regular internet access? (This is a good fraction of the target audience as I understand it.)

All this needs to go back to a fundamental and open-minded review. Right now what we know suggests some pretty bad mistakes are being planned.

Maybe after the election!

David.

3 comments:

Lodewijk Bos said...

David, I couldn't agree more, as I have said it so often before.
http://blog.icmcc.org/2010/03/26/go-google-go/
http://blog.icmcc.org/2009/12/17/observations-17-december-2009-patient-data-again/
http://blog.icmcc.org/2009/03/23/observations-23-march-2009-whats-in-a-name/

Anonymous said...

The mistake everyone is making is in coining new terms. There are existing terms that adequately describe the types of systems of interest:
- EMR - a comprehensive medical record held by a single organisation
- SEHR - a longitudinal medical/health record collected from as many organisations as possible
- PHR - a health record owned and maintained by a patient

First NEHTA coined the term IEHR which is the same as SEHR.

Then the HHRC coined the term PCEHR, which they didn't define. What this should be is a way to enhance patient choice about who sees the records in their SEHR. What all the documentation and media coverage sees is a PHR.

As this article says, a PHR is useless without an SEHR. Australia has very little sharing of records. Surely this needs to come before we even start looking at PHRs.

Dr David More MB, PhD, FACHI said...

"As this article says, a PHR is useless without an SEHR. Australia has very little sharing of records. Surely this needs to come before we even start looking at PHRs."

I am not sure I agree with the SEHR (Shared Electronic Health Record) definition but using your terms - right on!

David.