Tech

Why Can’t someone Give Me the Perfect Managed Personal Health Record (mPHR)?

flying cadeuciiI’m not as scared of dying as I am of growing old, Ben Harper, Glory and Consequence

Whether we admit it or not, most of us are afraid of growing old.  There is a sense of loss, of youth and vigor, coupled with the burden of managing your health in relative isolation.  Although as a country we would like to think that we are each responsible for our own care, most of us as individuals would prefer for someone to be there, helping us through our time of need.  Years ago when I was advising one of the Presidential hopefuls regarding a healthcare platform,  I suggested that the campaign should be propose that individual was responsible for their own health, but as a country we would partner to provide the tools for the individual to succeed.  Now, almost a decade later, we are not much closer to this goal.

Personal Health Records (PHR) were thought to be the answer.  These records differ from more traditional EMR in that they are owned by the patient and aggregate information from multiple sources to give a complete picture of the patient.  For example, they might include clinic visits from multiple providers, hospitalizations and updates on an exercise program.  Literally billions were spent on PHRs by the likes of Microsoft (HealthVault) and Google.  Both efforts were failures with thousands (in the single digits) rather than the expected millions of enrollees.  As noted by David Shaywitz, healthcare is a negative good, something viewed more with resentment than in anyway positive.  And that extends to things that keep us healthy.  To interact with your health means you are imperfect, you are mortality.

Rather than a PHR, I would like to propose a different tool, a managed PHR (mPHR).  This would be owned by the patient, but managed by a surrogate, a care coordinator (CC).  This person would be responsible to keep the person on track, taking their medications, keeping their appointments, explaining their illness (or at least research) their problem.  This may seem far fetched, by I believe CC will be a new job in 3-5 years.  And when this army of providers spreads across the land, they’ll look for a tool to do their work.  And it won’t be an EMR.  It will be a mPHR.

What would the perfect mPHR do?

Here is a list I’ve compiled

  • Upload data from disparate hospitals and clinics
  • It would store and view previous radiology exams
  • It would do med reconciliation and education
  • It would send reminders
  • It would manage exercise programs
  • It would allow differing levels of permissions and access…for the patient, the advocate and family
  • It would message those defined in the persons ecosystem if the PHR identifies a down trend.
  • It would report on utilization and changes in utilization
  • It would collect biometrics including wt, BP but also depression and pain indices with reporting and messaging
  • It would link/suggest support groups based on the problem list
  • It would leverage secure texting and email for messaging
  • It would be platform agnostic & cloud based

The critical thing here is actually not the functional requirements…these have already been fairly well defined…it is the ability to easily work with surrogates and family while maintaining some level of choice and control by the patient.

This is not an idle ask.  I am now working with a developer building senior communities with integrated care and care coordination.  I can buy an EMR, but not an effective PHR for these communities.  With any luck at all, we will be managing thousands of lives in these communities in the next few years.

To all you bright entrepreneurs out there, help me out.  Build the perfect mPHR.  If I am right, and there is a lot of evidence I am, you’ll transform how we care for one another, and make a lot of money doing it.  I won’t be your only customer.

Alan Pitt is a neuroradiologist and informatics physician, Barrow Institut

Livongo’s Post Ad Banner 728*90

Categories: Tech, THCB

Tagged as: , ,

14
Leave a Reply

10 Comment threads
4 Thread replies
0 Followers
 
Most reacted comment
Hottest comment thread
13 Comment authors
Kyle AndersonLindsey HolzbergerShweta SinghSocial MagazineLydia Sugarman Recent comment authors
newest oldest most voted
Kyle Anderson
Member

Dr. Alan Pitt, I can’t agree more. Working in an ER I noticed time and time again that patients were poor at communicating their health history, it was frustrating and led to unnecessary testing. When patients have an easy way to aggregate their health data, share their information with whomever they choose, and are allowed to grant others access to their profile we’ll see a shift in the efficacy of PHR’s. Ideally these systems will incorporate data from patient portals, EMR data, and all of the patient generated data sources.
The future is coming!

Lindsey Holzberger
Member

Am really surprised Chartspan hasn’t been mentioned on any posts on PHR solutions! They’re still fairly early in development, I suppose, but the app was the # 1 medical app for a while after it was launched. Cool solution that doesn’t require manual data entry.
http://www.chartspan.com/
http://www.prnewswire.com/news-releases/chartspan-becomes-the-most-downloaded-medical-app-in-america-300009397.html

Shweta Singh
Member
Shweta Singh

nice selection of professional healthcare blogs. but still i think there is one site i found a year later doing legendary work in healthcare IT field. they’re doing innovative work in the field of PHR (completely free – which i personally use to store my health records) along with amazing information on various health topics : http://mediklik.com/

Social Magazine
Guest

Thanks for sharing.
http://note.taable.com/feed/Reuters-Health-News/2B3 It is also good to read about the topic.

Lydia Sugarman
Guest

I loved reading this article and all the comments. We are presently in closed Beta with plans to launch the private Beta next month. Nearly everything being requested is either already built or already in our development timeline. With regards to a Care Co-ordinator or Care Concierge, the Better (https://www.getbetter.com/) is already doing a great job of filling that need. If you want to learn how well it works, just read Jason Calacanis’s blogpost, How I fell in love with—and invested $250k in—the BETTER App, here-http://calacanis.com/2014/12/ While Mr. Bushkin’s passion for his product, MedKaz is admirable, we feel there are… Read more »

Merle Bushkin
Guest

Good luck.

Deborah Verran (@VerranDeborah)
Guest

As a healthcare provider who regularly faces the problems with lack of interoperability alon with communication issues leading to barriers with accessing and/or relaying info on patients I believe a simpler solution is required. What is needed is for patients to be able to access an iterative summary of their own medical history and pass this on to caregivers. That is for there to be a problem list with dates of initial medical diagnoses, dates and types of procedures and finally a list of current medications along with drug allergies. It would be useful if an immunisation record was also… Read more »

Doc's widow
Guest
Doc's widow

In pre-computer days, I typed ‘Emergency Medical Records’ for my husband and myself, including everything mentioned by Deborah Verran. I knew in general what questions would be asked by physicians and hospitals, and in approximately what order. I kept his data current until his death, and will continue to keep mine current. Copies were in his wallet, my purse, on the fridge, with our children and on my computer and backup drive. So far, all emergency personnel, doctors and hospitals I’ve presented it to really like it because the printed information makes their data entry much easier. They, and I,… Read more »

William Palmer MD
Guest
William Palmer MD

You have to remember a few things about medical records: 1. There are many errors. Lab work often has a Coefficient of Variation of more than 10%. Radiologists might miss ground glass infiltrates. Histories are often biased. Blah, blah, ad infinitum. You know this. 2. It is good, therefore, for contemporary providers to rethink medical records, to be a little quizzical and confused, to review and repeat and re-diagnose, to ignore a lot, to take trends and mental averages. It is not the worst thing to have incomplete medical records. A series of Hgb’s of 8.7, 9.4, 9.2, 10.3, 8.9… Read more »

J. Kirschman, MD
Guest
J. Kirschman, MD

I would also suggest that Dr. Pitt forgot to add: 6. Who is going to pay for creation, implementation, maintenance, and upgrades for such an interconnected system or for the proposed care coordinator (CC)? There is not enough savings in “wellness” by implementing such a program to pay for the medical informatics or the support personnel for care coordination. I would also suggest that a care coordinator position could be replaced by a Care Concierge (through an Employer’s EAP) to help employees get the best value for their money when considering elective procedures. For the public, healthcare sherpas could be… Read more »

Merle Bushkin
Guest

I agree completely with your desire for patients to control their complete personal health record from all their providers but not with your concept of a professional care coordinator performing the functions you describe. Whether you are right remains to be seen but our MedKaz® personal health record provides the the starting point for the system you and I both envision. It aggregates a patient’s complete record, both paper and electronic, from all his providers, and our patented application to manage them, on a MedKaz Green Drive®. He carries it on a keychain, in a wallet or wears it and… Read more »

Doug
Guest
Doug

Because right now perfection is acting as the enemy of good. The disparate data sources for middle-aged and elderly population will make it too difficult to construct a record that physicians will rely on. My suggestion is to build the record around the use the system less and will be more willing to embrace it. Complement the care of middle aged and elderly data from these sources but do not make all your decisions around it. Jenna 15 years you will have a great personal health record system.

Whatsen Williams
Guest
Whatsen Williams

Flawed logic. Your concept assumes peoplw have nothing else to do than perseverate over the nuanced interval changes in their measurements. Anal compulsive, and a woderful product for the worried well. You should be asking for better preschool education and medication and food for the indigent and downtrodden. So solly to rain on your parade.

@BobbyGvegas
Guest

Hell must have in fact frozen over. You and I agree on something. Imagine that. See my review of Vik Khanna’s new book.

http://tinyurl.com/q3nzbf6