TECH: Fotsch talks sense on PHRs (let’s hope someone’s listening)

There’s a whole lot of rubbish talked by various MDs quoted in an article in Modern Physician called PHR liability, data overload making docs a little queasy. Essentially they’re all saying that they’re gong to be overrun by patients with printouts of their PHRs and because they’ll miss something on page 97 they’ll get sued. And one MD in particular Joseph Heyman (with whom THCB has had its run-ins before) is quoted as saying

there is a risk of ‘garbage in, garbage out,’ and if the record is populated by the patient, there are errors of understanding that can be inputted by the patient.”

It’s just the same as saying that if you give patients email access they’ll abuse it. Lots of doctors talked about that in the past. Several studies have shown it’s not true. You have to truck through a lot of rubbish in the article to get to someone who knows what he’s talking about. Luckily dog-owning Medem CEO Ed Fotsch does, and it’s worth reading:

Edward Fotsch, M.D., CEO of PHR-provider Medem, says that was something he rarely experienced during his years as an emergency medicine physician, ending in the early ’90s. “I saw 10,000 ER patients, and I can remember on one hand the number of patients who had any documented information when they came in,” he says. Fotsch says much of the confusion surrounding PHRs stems from a misunderstanding of what they are.“A disk with a mishmash of information is not a PHR, because I could call my dog a ‘Ferrari’ if I wanted to, but that doesn’t make him one,” Fotsch says. “A personal health record is, by definition, an online collection of structured data.” <SNIP>While agreeing that standards are needed, the AAFP’s Waldren disagrees that PHRs need to be Web-based. Although he thinks that Web-based models will eventually dominate the field, Waldren says there are desktop PHRs available “that are networkable.” But Fotsch wonders if the models mentioned by Waldren allow secured online communication between physicians and patients. Without that, Fotsch says a PHR is like an automated teller machine with no money in it that only allows you to check your balance. Fotsch says a PHR should resemble a continuity-of-care record or continuity-of-care document—two vetted and accepted formats for transmitting basic patient-care data. The PHRs should have defined fields where particular types of data should be entered and displayed, and they also should feature a secure e-mail connection between patient and physician. “There’s a structure around a personal health record,” Fotsch says. “So, if you say you accept a personal health record, you know what you’re accepting.”

So a structured useful PHR should be a good thing for doctors. And surprise surprise that’s what patients want to. So can we have a little less kvetching about this wave that‘s coming and a little more helping patients get these things?

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  1. Here are a few thoughts on the article and the comments here:
    1. Using the analogy of an ATM and a PHR is flawed for several reasons. It is much more straightforward from both a technical and legal perspective to send, receive, and view financial data compared to health care data.
    2. Heyman does have a legitimate point about the quality of data going into a PHR, especially from administrative sources such as claims repositories. I agree with his point about patient-entered data to a lesser extent although I do wonder the veracity/willingness of patients to use PHRs for sensitive (e.g. AIDS) or potentially embarrassing medical conditions (e.g., mental health).
    3. There are both pros and cons to having a highly structured PHR with well-defined data fields and elements. The biggest pros of a highly standardized PHR include increasing the utility and potential adoption of PHR solutions by patient/customers. The biggest con is that a highly, standardized PHR solution would potentially limit innovation and prevent a potentially breakthrough PHR type.
    The only way a highly structured PHR will emerge though in the next few years if it the CCHIT begins a certification program for PHR vendors.

  2. ATMs vs. PHRs
    1. Tellers make relatively low wages vs. Physicians highest paid in the US.
    2. Tellers have to balance their drawer every day and are personally responsible for any mistakes no matter what vs. physicians will put a stent in or fuse a spine even when there is no reason and get paid.
    3. Tellers have zero political power vs. the AMA and physicians personally lobbying their patients.
    4. Tellers can look up your balance and your last 5 transactions with a few keystrokes vs. most physicians who are still using paper charts.
    5. Tellers who decided that they weren’t interested in learning the new system would be fired vs. physicians who would be seen as charming luddites.

  3. Man, that example of the ATM draws into focus just how far we have yet to go. It’s been over a quarter century since my first transaction with an ATM, and it wasn’t too long afterwards that it became a global technology, allowing me to put my card in a machine in Bangladesh and count on the transaction to be as reliable as one in my home town.
    I was too young to remember, but can someone tell me: when the ATM technology was proliferating, were all the stakeholders fighting to keep their ox from being gored the way the medical field is doing today over PHRs?

  4. When reading articles like this it always makes me uneasy about the job that physicians are doing for the patients. Are they doing what they think is right, or are they doing just enough to not get sued? I think in many cases it is the later.
    So what really is the problem here? Is it that physicians are intimidated by new technology? I think that obviously is not the case. Every day physicians come into contact with some of the most sophisticated technologies in the world. Mastering database software is no problem to many of them.
    Instead, I look at the ease of being sued by their patients as being the reason many physicians are reluctant to adapt to new technologies. However in order for any of these consumer directed health care plans to work, patients are going to need to use information technologies to inform themselves and their physicians. And physicians are correct, more information for the patients will lead to more documents that can be used in court. Policymakers need to free physicians from practicing in a manner to not be sued and encourage them to use the tools available to improve the health of their patients by limiting liability for mistakes.