TECH: PHRs, EMRs and pretty much useless surveys

Because there was a conference Tuesday on Personal Health Records sponsored by RWJ and Markle, there were two surveys out yesterday about consumers and their interest in/love for/need for/ likelihood to buy into electronic medical records. The Markle Foundation, by the way, is one of the (frankly too) many organizations trying to push EMRs and PHRs on the unsuspecting American public — other than the public is now starting to suspect a little bit. In fact my girlfriend showed me an article in the Southwest Airlines magazine about the national health information initiative which I suspect wouldn’t have happened five years ago.

Markle’s survey suggests that 71% of Americans are in favor of EMRs, although in their release and in this article there are suggestions that privacy, confidentiality, motherhood, baseball, cute puppies and apple pie will have to be provided before people will actually use them. David Lansky is not a dumb guy but the seven principles are little too obvious and somewhat ignore how information technology actually gets dispersed and used (forget higher moral callings, and think porn and Baywatch). It’s yet another necessary but nowhere near sufficient list that was clearly designed by a committee, and I’m not too sure that their worthy effort will help that much.

But at least they have some decent numbers in their survey, suggesting that 60% of Americans want a secure online PHR and only 19% wouldn’t use one under any circumstances. In fact more say they would use one (68%) to order prescriptions than would support the creation of PHRs in the first place.  I assume the extra 8% are on the fence but would use it if it was there — or maybe it’s just an example of Americans being unable to keep their survey answers logical from one question to the next.

Meanwhile Manhattan Research continues to put out absolutely minimal snippets of information in its press releases. (I know I used to work for Harris but by comparison their releases and newsletters are treasure troves). Today’s release is that 15% of Americans (adults I assume, as they claim that equals exactly 29.8m people and there are about 300m Americans) are "on board" with an unspecified level of "interest" or "demand" in a PHR. Beyond the fluff there’s not much more information in their release other than they think that there are "7.6 million consumers actively emailing with their physicians". Working backwards from their other numbers this that means about 4% of American adults are emailing their doctors. Whether that counts me I don’t know. I emailed my doc using the RelayHealth system, and 6 months later his office emailed me back telling me that my application to email him was rejected.

So given that 15% is a lot less than 60%, Manhattan’s numbers are way lower than Markle’s and also way lower than these numbers from Harris last year regarding interest in using personal health records (although Harris found that almost no one was using an electronic PHR). In addition Manhattan’s email numbers are not far from the numbers I was getting about patient-to-doctor email use back in 1999–even though use of email generally has grown dramatically since then. Now, I’m not so sure Manhattan’s wrong. I don’t know — although I’ve asked and hopefully they’ll tell me — what their exact questions are, and the difference in the results is probably in the phrasing. And anyway all the way through the 1990s their predecessor organization, CyberDialogue, consistently under-counted the number of adults on the Internet, at least compared to Harris and Pew. But the evidence of successful PHR companies (or rather the lack of them) suggests that this type of PHR or patient-provider communication is minimal.

But the point here is not which survey company has got it closer to the truth. The point is that the growth of the PHR has almost bugger-all to do with interest from the consumer. If you’d asked consumers about their interest in online banking, online poker or online porn back in 1993, their answers would have been equally irrelevant. Consumers got online because they got used to it at university and work, and then at home it became available cheap (thanks AOL) and most of all because of email. Once they understood email, and once Tim Berners-Lee (from CERN not Cerner, as HISTalk hilariously pointed out) invented the Web, then all those other applications took off because someone supplied them and aggressively marketed them (OK, perhaps the porn didn’t require that much marketing!).

The problem with PHRs and EMRs is that the people who could or ought to do the supplying (the people with the patients’ data from which to supply the information) either didn’t do it for a combination of business reasons and technological incompetence (health plans) or because they didn’t have the data in a usable format (hospitals and doctors). And no one had any interest in marketing it, other than the standalone eHelath companies who had no links to the local providers and services, or personalized data, that the patients wanted.

To be frank, we’re not a whole lot further on, although we may be getting somewhere finally on the health plan side if WebMD finally gets Empire and Wellpoint off the dime. But as with the ridiculous survey that Accenture put out a few months back, asking consumers what they want to do and would pay for is pretty useless. They’ll do it if it’s marketed well to them, if it fits into their life "workflow", and if it’s useful and/or entertaining. That’s why Google searches on health topics are off the charts and why no one emails their doctor (even if Syd at Medpundit apparently thinks its her patients’ fault)

But the key issue is that we’re still a long way from many doctors having the data in a usable format to supply to their patients. Unless of course we all move to Seattle and sign up for Group Health. Harris reported in a WSJ survey just last week that while 79% of the public approve of the idea of the EMR (again near Markle’s numbers) only about 16% of the public had actually seen a doctor ever use one in real life. And if you think that the system is magically going to immediately respond to the consumer’s newly discovered desire to get their own health information every place they need it when they want it, well go back and read MrHISTalk’s excellent article on whether one health care organization can actually share basic allergy information within its own IT systems. then extrapolate to whether they can then provide that information back to consumers in double quick time. Hint, the answer is "extremely unlikely".

CODA: By the way, Esther Dyson is one of the people who’s now glommed onto this PHR space, and ran a session at the conference as well as a (damn expensive) day of her own conference on the topic. While I really liked her the one time I met her, I reviewed an early draft of her recent paper on the eHealth space and let’s just say that I don’t think I’ll be writing any papers on Eastern European venture capital any time soon. Oh, and when I met her she was essentially telling a bunch of health plan CIOs that they had to get on the web or die a horrible economic death. That was in 1997. So Esther, be wary of being sucked into our little vortex. Things move very slowly here!

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