TECH: Brief musings on the PHR

Some brief musings on the PHR…given that I gave a talk on it for HIMSS N. Cal yesterday

— Email is unreliable! Not a comment on the PHR but I sent the organizer my talk in both Powerpoint and PDF (one for the talk, one for the web so the secret stuff hidded in the PPT stays hidden). Most of the intellectual property is of course in the fancy “builds” I did in Powerpoint. When I started clicking into my presentation, it became apparent that only the PDF version had gotten tp him, and was the one loaded on the computer. I of course had a copy of the Powerpoint on my thumb drive and this could have been avoided. Motto—always check what’s on the computer you’re presenting from.

— Kaiser Permanente’s PHR is rolling out pretty well, and has decent usage so far. It’s relatively transparent in terms of the views it gives into the patient record (gives full lab results) and links well to Web 1.0 generation content/information therapy.

—One of the points Kate Christensen (from KP) made was that they felt PHRs should be portable. But thus far that means portable within the world of Kaiser. I asked  if a member using KP.org changing plans could move all their data to Palo Alto Medical Foundation (which uses the same basic Epic software and is therefore the easiest imaginable “move”). Kate said that a) no one had asked so far and they didn’t yet have a policy on that yet, b) the data structures were different so it was more complicated than I’d made it seem, and c) they had a technical team working on it, really! Take it as read that this is a major potential future stumbling block and  view all those slides about “portability” and “interoperability” with extremely jaundiced eyes.

—One word baby: Autopopulation

— I didn’t smell sulphur. In fact the entire HealthConnect EMR (clinician part) was basically unmentioned, other than by me saying I didn’t smell sulphur. I think that knocks the conspiracy theory on the head.

This article finally confirms that the just announced Intel/Walmart/BP et al initiative will be using PHR’s developed by JD Kleinke’s Omnimedix Institute. He was keen to point out when I last talked with him that his was a data auto-population and storage, non-profit, trusted 3rd party model, which others could build applications on top of. (i.e. competition for WebMD/Intuit).

— Cleveland Clinic has rolled out its Epic System including the PHR, faster and harder (if that makes sense) than Kaiser. They also have a way that allows referring physicians to get access to their patient’s records when they’re at the Clinic’s hospitals. This is a model for how providers not integrated with insurers or using a “monogamous we hope” (to quote Kate) medical group can roll out EMR and PHR. However, it was very hard work. Holly Miller, the doc in charge of eClevelandClinic, had to buy a lot of pizza. She’s leaving next year to take up the CMIO role at University of Cleveland. I joked that this meant that the Clinic’s docs had succeeded in running her out of their organization, but not yet out of town! Rather more likely, the Univ. Hosp likes her pizza buying/persuasion skills and realizes that the quickest way to catch up with its major cross-town competitor is to steal the talent! (Isn’t that what the Dallas cowboys and the 49ers used to do to each other in the 1990s?)

—Cleveland Clinic is also doing virtual visits into Mexico and Arizona, separating the reading from the diagnosis, and they’re pushing second opinions online as a service. Clearly they see their brand as a major weapon in getting national and international market share. They may be early, but if enough records go online, why does your second opinion need to come from the same city or country? And more importantly why does the patient have to be in the same physical room, when a tech can move the stethoscope or instrument around the patient, and the doc can see it all on screen, or an entire team of experts can be assembled virtually online?

—One reason why is that state laws restrict practice across state lines, and in some states (Holly think Ohio, but it was certainly true till recently in Georgia) even a prescription has to be handwritten and signed by the doctor. So 200 years of trade protection will not go quietly into the night.

—Matthew Guidin from Frost & Sullivan has done some real research on PHRs, which may make my back of the envelope stuff obsolete (or more valuable?). He seems to think that the health plans are talking a good game about interoperability, but have little intention of doing much. He also thinks that CCR (the AAFP-based standard for moving data between EMRs) is being sabotaged by the IHE crowd before its really gets off the ground.

—Everyone I met at the meeting that used to be a client is now a consultant! Who’s doing the hiring these days?

—Whenever a new incredible “innovation”  on their PHR was shown by KP or Cleveland Clinic Phil Chuang (my ex-i-Beacon colleague) and I kept whispering to each other “Didn’t we build a better version than this in 2000?” And we did. Which goes to show that timing, politics and marketing are everything. And technology is largely irrelevant.


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SBDGadflyTheLastPsychiatristtom scholomitiMatthew Holt Recent comment authors
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Adrian Blakey

Let me see if I can get the links right …
Johannes Ernst invented
Lightweight Identity.

Adrian Blakey

You don’t seem to be the only one with an opinion about the PHR. The week of December 4th must have been PHR week after the Markle Foundation published a nice white paper and Adam Bosworth of Google said that the PHR should be a URL to which health information can be attached. Actually, this is not a new idea. Johannes Ernst of NetMesh invented some technology called Lightweight Identity that is exactly this. It is a very powerful concept and leads to some startling conclusions which address the PHR requirements identified in the Markle report. It is also a… Read more »


I actually used the eCleveland Clinic second opinion back in March. The first step was getting my Urologist to sign the request. If he would not sign the request, no second opinion would be given. Once this was completed and I overnighted them a CD with 3-D Holographic images of my CT Scan, the following emails were sent to me. March 3, 2006 In regards to your eClevelandClinic consult request, ID XXXXX: Your medical records are complete and have been forwarded to the appropriate Cleveland Clinic specialist. Your Remote Consult will be ready within 5-7 business days. For Remote Second… Read more »


Thanks for sticking up for *genuine* portability! As for email – Kaiser delayed giving me the email portion of medical record for months (I participated in an email test run for Oakland), and at first they said that it wasn’t accessible. When I finally got my records, I was given the explanation that it had taken my primary physician that long to figure out the system. Portions, notably the email I most wanted, were missing – Kaiser is counting on faded memory so they can select which portions of your medical record to turn over. Also, when I tried to… Read more »

Matthew Holt

Switching costs, Tom, switching costs. But come time for the upgrade to Vista, well then who knows…
TLP (nice TLA there)–you may well be right. I like the idea of recordings and transcripts anyway–especially for health records and revisiting what the doctor said in that once every 3 months interaction. And of course lots of other uses. How far away from searchable video/audio are we?


I think it will be even more drastic than this. Certainly, radiology is easiest to identify as soon to change (or outsource, your choice.) But it seems to me obvious that very soon all patient interviews/examinations will be videotaped. First, the cost of storing all these recordings is going down to almost zero. consider that Google stores all emails, pictures, caches of ever webpage, ever search you’ve ever performed, all Adsense data (including who visited the page, from where, and where they went next (even without clicking on an Adsense ad). It is therefore (going to be) a very small… Read more »

tom scholomiti
tom scholomiti

Matt – Hope you’re at least using OpenOffice (the free office suite) to create your presentation. If not, go here: http://www.openoffice.org/

Matthew Holt

And what’s so English about Ron Artest…and Cantona was French anyway! Thanks for the nice remarks.

Adrian Blakey

Your comments were very insightful and left me feeling that the other speakers really did not “get it.” Maybe this was because your quirky English presentation style (Eric Cantona, indeed) went straight over their heads, but more likely because the conclusions support a threat to the establishment.
A consumer-driven market for health care, facilitated by third-party consumer information intermediaries (read Google, Yahoo, MySpace …) upends the provider medical guilds.
Web front-ends to a provider’s store of patient electronic medical records, dressed up as a PHR, is a lame response to the competetive threat posed by a real PHR.