The following series of articles appeared recently.
Will PHRs rule the waves or roll out with the tide?
By Ken Terry
Rick Schooler, vice president and chief information officer of the Orlando (Fla.) Regional Health System, a seven-hospital network, has high hopes for electronic personal health records. In the future, he believes, portable, patient-controlled, Web-based PHRs will form the basis for regional and national health information networks and give providers access to comprehensive health data on each patient.
But he’s skeptical that they’ll catch on with the public anytime soon. For that to happen, he says, the government needs to create PHR standards for data transfers and privacy, vendors have to make the information understandable to consumers, payers have to pressure providers to transfer clinical data to PHRs, and employers and health plans have to give consumers incentives to use PHRs to manage their health. “There’s got to be a motivating factor to cause the individual to want to make use of the record,” Schooler says.
The entrance of Microsoft, Google and other well-financed players into the PHR space—as well as a Medicare pilot in South Carolina—undoubtedly will raise the visibility of the service. But while more than 200 different models are available on the Web today, only 1 percent to 4 percent of the population takes advantage of them, according to consumer research polls from the Markle Foundation and Harris Interactive.
One reason is privacy. Although 65 percent of respondents to a 2006 Markle Foundation survey said they “would like access to all of their own medical information” online, 80 percent worried about the privacy of electronic records and that their health care information might be misused or sold. When asked by Harris Interactive in 2006 to rank their top concerns regarding online health information, 68 percent of respondents put privacy as their top worry, followed closely by security at 66 percent.
While those polls look broadly at the topic of electronic records, the Markle Foundation, in a survey released in June, asked specifically about PHRs and found a high level of concern: 57 percent of people who said they were not interested in opening a PHR ranked privacy and confidentiality as their primary concerns.
It’s also unclear what type of PHR will gain public acceptance. Records that consist mainly of patient-entered data have gotten little uptake. Even when PHRs are prepopulated with claims data, as they are for 70 million consumers who have insurer- or employer-provided records, just 1 percent to 7 percent of people use them, according to industry observers.
The most substantial use of PHRs to date has occurred in big group practices like those of Cleveland Clinic, Group Health Cooperative and Kaiser Permanente. In those groups, patients have access to PHRs mirroring the electronic medical records of their physicians, as well as to secure messaging services that connect them with the practices.
To some observers, a method of linking doctors to patients online is a prerequisite for a PHR to gain any degree of consumer acceptance. “The PHR that doesn’t connect into your doctor is like an ATM without any money in it,” declares Ed Fotsch, M.D., president and CEO of Medem, which offers a PHR that includes secure online messaging.
Similarly, John Halamka, M.D., chief information officer of Beth Israel Deaconess Medical Center in Boston, which has offered its PatientSite PHR for eight years, views the doctor-patient link as indispensable. “From our perspective, you can’t separate the PHR and the messaging. If I’m going to share a lab result with you, and you have a question, you need to have the loop closed with me.”
Some experts disagree. “It’s a mistake for us to prejudge and formalize what the desirable features of these new applications will be,” says David Lansky, president and CEO of the Pacific Business Group on Health. “There may be huge numbers of people who get great benefit to their health [from a PHR] in ways that don’t involve connectivity to the health care system, and we should encourage that, not inhibit it.”
Much more here – with links to additional material:
This article and set of sidebars are a useful summary of the PHR state of play as of August 2008. Highly recommended reading.
David.
What a great quote by Ed Fotsch "PHR that doesn't connect with your doctor is like an ATM without any money'.
ReplyDeleteThe gimmicks of fax input or patient generated records have no value. It will be a very brave clinician indeed that will take on face value medical information on a fax from a source one cannot validate.
Creating a half cocked solution is often worse than no solution at all and my fear is that the googles etc. will never be interoperable and therefore could easily be more dangerous than helpful.
Do we really have to go two steps backward to get one step forward in the world of PHR's?
Your last commentator is so, so, right. I couldn't help but wonder and listen in amazement at the Microsoft presentation by Neil Jordan, Managing Director, WW Health Microsoft, at the HIC08 conference in Melbourne last Monday.
ReplyDeleteHe made it abundantly clear that Microsoft had no intention or desire to build a PHR. They only intended to provide links into their HealthVault product and assist 3rd party developers to connect to HealthVault and feed information in and out of HealthVault. !!!!!!!!!!!!!! Welcome to the new world of confusion which is about to be thrust upon us. Anyone who thinks Microsoft does not have plans to build a PHR and position itself at the absolute centre is in cuckoo land. Of course they do, and of course they will - and with so so many 3rd parties feeding stuff in and out to the Microsoft 'framework' ........ oh confusion and hype - we love you both, for you are the fodder upon which our industry thrives. As for interoperability - your previous commentors feas are well founded.
Rest in Peace.