THCB

A Rebuttal to PHR Luddites

Unlike some of my colleagues, I’m not losing ANY sleep over whether personal health record (PHR) systems ultimately will be adopted and used by patients.

In my mind, the issue isn’t WHETHER, but WHEN.

Yes, I know that adoption has lagged and that surveys suggest 7% or less of the U.S. population has used a PHR.

Stay with me on this one for a minute. You’d have to have two underlying beliefs to conclude that PHR systems won’t eventually emerge:

  • That health record data will persist in non-electronic formats, i.e., paper
  • That people won’t have interest in accessing or using their health record data

Please think about this a moment. If you truly believe PHRs will continue to remain a non-starter, then you MUST logically believe in one or both of these assumptions.

I for one believe both of the statements are false. Health care is destined to join the rest of the world economy in digitizing data. People will want electronic access to their digital health data. Period.

HOW will people want to access their health record data? That’s a different question — and a fair one.  It might not be with what we think of as a PHR today — but whatever you imagine as the technological answer becomes the PHR system of the future.

Again, I’m not losing sleep wondering WHETHER PHR systems will be adopted, but I do spend a lot of time thinking about the evolution from today’s technology to tomorrow’s technology.

WHEN will PHR systems be adopted?

…when they provide sufficient VALUE to patients.

Notice that I keep saying “PHR systems”, not just PHR? What’s the difference?

RWJF Project Health Design has a great paper describing the evolution of PHRs to PHR systems.

  • Think of a first generation PHR as simply a repository — a bucket — where people store health record information. There’s some value here, but it just scratches the surface.
  • Think of a second generation PHR system as an integrated platform and applications. Not only can you access your health record, but the applications provide useful ways to conduct transactions with care providers and to manage and improve your health. That’s value

…and fortunately we already have great examples of PHR systems that provide value. Kaiser’s PHR system has over 35% adoption among it’s members and Group Health Cooperative is at over 60%.

To see what I’m talking about, check out Kaiser’s PHR system — My health manager. It’s not just a bucket of information — it’s a platform with applications. You can exchange email with your physician, make appointments, see test results, review your plan benefits…that’s a “PHR system” that’s providing VALUE today.

As noted by science fiction writer William Gibson,

“The future is already here — it’s just not very evenly distributed.”

Vince Kuraitis, JD, MBA, is a health care consultant and primary author of the e-CareManagement blog, where this post first appeared.

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dave kirbyVince Kuraitisdean reinkeDavid Tao Recent comment authors
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dave kirby
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dave kirby

I agree with Vince’s points- with Kaiser’s case being a good example proof. I’ve seen presentations on this system’s adoption and noted that the really popular “killer” uses were – communicating with one’s physician (in hopes of doing so being in lieu of the trouble of an office visit), and lab report reviews. Kaiser found that this reduced office visits by about 25% ; this is savings from Kaiser’s point of view but income loss from the typical provider’s point of view. I hope that health reform will reset these perverse incentives but until then we’ll have to not count… Read more »

Vince Kuraitis
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Our friend and celebrity spokesperson e-Patient Dave wrote his own blog post elaborating his POV:

http://e-patients.net/archives/2011/04/not-just-a-bucket-of-information-%e2%80%94-a-platform-with-applications.html

dean reinke
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I am really looking forward to this, even just a bucket would be great. Going thru my 200 page paper record for my stroke is painful.

David Tao
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Thanks Vince, I’m with you on this. I agree that patients would want a PHR “system” not just a passive bucket of data. That system should make life easier for the patient, and part of that “ease” will be enhanced through transactions with providers and by interoperability between PHRs and other systems (e.g., providers’ EHRs) so that patients don’t have to redundantly maintain data such as results, procedures, and meds on their own, and so they can share their personally-entered data with providers with whom they choose to share it. I have two PHRs today, neither or which yet interoperates… Read more »