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TECH: Just a little more about the PHR

You can skip this one if you’re bored but the Personal Health Record and associated stuff just won’t quite go away. I’ve not only got a tawdry past associated with the PHR/CHR, and have spent far too long thinking about it, but I’ve also fooled myself into creating a paper for a forthcoming academic presentation on the subject–which will be an archeology of the attempt by commercial vendors to get the PHR up and running.

Now USA Today has a piece on PHRs which goes onto talk about yet another new one (Mymedicalrecords.com) which is basically a "fax paper in vault" which looks exactly like half of the ones that came out in 1999, such as PersonalMD.com.  And BTW their technology was backwards even for then! So it look as to me as though USA Today has been a little bit snowed.

So let me give you my four categories of PHR

1) The PHR that is looking into a real EMR.  See the version that PAMF or Group Health of Puget Sound uses based on their Epic system.

2) The PHR that looks into the claims database of an insurer and changes the view of the CRM system the patient sees.  This is the one that I was selling back in the day, and that WebMD via its Wellmed purchase is now just offering to plans, and has had Empire launch (and Wellpoint announce it will be launching). The recent IBM announcement is in this vein, although I doubt any American trust their employer enough for that to be a success. (see yesterday’s 60 Minutes as to why)

3) A PHR that allows a patient to look into their doctor’s system if they have one, or not. RelayHealth has a version of this, and Medem’s iHealthrecord is able to look into Allscripts EMR (and theoretically a bunch of others too). This is the ultimate answer for most of America (or some version of it) but it’s dependent on using physicians as a distribution channel to patients and that’s a bit of nightmare.

4) A standalone device like Quicken, that may in some way be able to take in some portion or version of the EMR from providers. This is the route Capmed is going, and where RedMedic, MymedicalRecords, et al are heading.  I remain very, very skeptical about this — particularly their attempts to make consumers pay for it — but to be fair that’s what MedicAlert does and plenty of people are buying that bracelet.

Of course if you want to get everyone using one of these PHRs you’d be better off putting your whole state or national insurance system into it, as the Germans are doing.

Meanwhile, back in the UK, they are trying to get their related Choose and Book system up and running. This is a referral and appointment system between GPs and hospital specialists. (Note that in the UK there is very little patient self-referral). The answer seems to be that it is slowly beginning to work (in some places) and that it is increasing the role of the patient in choosing who they are referred to. (A choice which didn’t really exist before). Meanwhile, this article focuses on the early adopter the Whittington hospital, in North London, using Choose and Book. Of course The Whittington has always been ahead of the game introducing new and amazing things to the world. Yup, I was born there!

CODA: The USA Today piece horribly misquotes Mark Bard as saying that DrKoop.com had this PHR idea back in 2001 but never really got it going. DrKoop.com had this PHR idea before it was up and running in 1998, but couldn’t get it right and took the easier route of instead being a web health content portal. It never got the PHR thing into any level of production and having been an Internet star in 1999, it was on the famous March 2000 Barron’s list of companies that were losing too much money to survive (the article that helped start the dotcom crash). By 2001 it was basically going under. At least I hope Mark is being mis-quoted!

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Thanks for highlighting the 60 Minutes segment. That’s chock full of points I’ve been trying to make for the past two years.
I wrote the National Workrights Institute a couple of times, though, and they never replied to me. I’d say if there’s going to be any anti-Employer-Totalitarian movement in this country, it should start with just replying to people and letting them know they aren’t alone. Otherwise it feels like the whole country is just telling you to move on and that you don’t matter because you’re the only person who has been harmed.