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