A Technology in Search of a Market

PHRs are much like the tides, news about them ebbs and flows. Right now, with the relatively recent demise of Google HealthDossia’s attempts at rebirth, and the significant inquiries we are receiving regarding meaningful use requirements to host a PHR (patient portal). But in and amongst all this Chilmark has heard on more than one occasion the following statement: “The problem with PHRs is that they are a technology in search of a market.”

This statement is simply wrong for the following reasons:

1) As we have said countless times before in previous posts, very few people are interested in a digital filing cabinet for their health records. Unfortunately, many PHRs in the market today are just that, digital filing cabinets. In this case it is not an issue of a technology in search of a market, it is just a bad product that really has no market.

2) Technology adoption does not occur for its own sake, it occurs when there is perceived value by the user that leads to adoption. PHRs, PHPs (personal health platforms), patient portals, etc., is certainly a technology, that when well-designed, and implemented can deliver significant value and subsequently see high adoption rates. Just look to Kaiser-Permanente’s instance of MyChart, where patient adoption is well over 40%. Up in the Pacific Northwest, the Group Health Collaborative (GHC) is seeing PHR adoption that is well over 50%. That’s a market!

While there is indeed a PHR market, the market is immature and likely to remain so for the foreseeable future. The market is unlikely to be found in stand-alone PHRs or PHPs where it is incumbent upon the end user to populate the system and establish the critical links with the broader healthcare system (borg) to drive those high-value transactions. Rather. the near-term market for PHRs will be with those systems that are tethered to a healthcare provider, be it an individual practice, a hospital or large IDN such as Kaiser or GHC that have the critical linkages for transactional processes such as appointment scheduling, Rx refill requests, email consults. etc.

Unfortunately, for those with complex conditions, who have a multitude of doctors and/or specialists, these patients will be burdened with having a multitude of PHRs (patient portals) to visit to view their records and when desired, invoke a transactional process. The dream of one complete longitudinal patient record will remain such, just a dream especially for those who are in greatest need of one such record, our sickest, most needy patients.

And one last point…
Why are organizations such as KP and GHC seeing such high rates of adoption while many other organizations do not? Quite simple really, these organizations have built these patient portals (PHR) and the tools they provide into the clinician workflow and actually have clinicians encourage patients to use the PHR. Most organizations we have spoken to have failed to grasp this critical point, and maybe they really do not care, they’re just checking off the meaningful use box of requirements that must be met.

John Moore is an IT Analyst at Chilmark Research, where this post was first published.

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5 replies »

  1. In a nutshell people want a PHR if it is automatic and they don’t have to do anything….as is the case when it is provided by an insurer or managed care provider such as Kaiser Permanente.

    Laziness is a basic human characteristic. This is the same reason it is so hard to motivate people to make better choices about their health. Its like working against gravity.

    I “could” pack a lunch on that long drive, or I “could” just slide into Burger King and save time and money. No one wants to add 64 oz Mountain Dew to their PHR or personal tracking system…they only want to report the good stuff.

  2. Looking back in time and thinking about how Internet has changed the structure of industries, the common denominator is this simple fact: the Web simplified the jobs people were doing using other methods. A PHR that is disconnected from the provider workflow is trying to solve a problem in a way that actually makes the job more difficult for everyone involved.

    Broadly speaking, Americans are frustrated by the difficulty they have communicating, scheduling, and working with healthcare delivery organizations. One reason the IDNs you mentioned have been successful where non-integrated HDOs have failed is their recognition of this problem, and their ability to act on a belief that increasing patient access to administrative, financial, and clinical workflows will increase efficiency and increase quality.

    Now that these connections have been established, their ROI measured and reported, more HDOs will follow in spite of the failure of PHRs such as Google’s.

  3. John, a personal health record (PHR) isn’t a portal and a portal isn’t a PHR. One is a medical record; the other an access point — perhaps to a PHR but not a requirement. Trying to equate them as you do thoroughly confuses the discussion and leads to wrong conclusions and actions.

    It’s wonderful that millions of Kaiser’s members access the Kaiser portal to schedule appointments, renew prescriptions and exchange e-mails with their doctors. But these interactions do nothing to inform care providers about a patient’s medical history, condition, care requirements, meds, etc. They do nothing to help providers avoid medical errors or unnecessary tests. And they do nothing to help providers improve and coordinate a patient’s care. Those are just some of the things a properly designed PHR should do — and that a portal can’t do.

    I agree that today’s PHRs don’t meet the needs of either doctors or patients but that doesn’t mean there is no need or market opportunity. It merely means that the wrong products are being offered. If you doubt this conclusion, just talk to patients and providers.

    I also agree with you on another point. If providers aren’t involved with and don’t support a PHR, it will fail.

    I believe there are four other requirements for acceptance, as well. One, is that it must be easy to use by both providers and patients. Second, it must integrated in the care process, not merely an “adjunct” to it. Third, it must meet the needs and requirements of patients, one of which is to not store their records on web servers accessible via the Internet. Fourth, it must be affordable and financially self-sustaining.

  4. Good points. MU will help catalyze any ongoing evolution of interoperability standards; ideally, a direct project-like arrangement of a healthcare internet involving trusted providers and uniquely identified patients will arise, provided both interoperability and security standards are robust enough to be ubiquitous and actually useful. Until then, the Kaisers of the world will apparently be the equivalent of AOL as a mid-way point in the evolution of the internet (as I believe Kibbe wrote in a prior post to this blog). I am excited to see what becomes of the VAs blue button deal; that holds some promise.