PHRs: Where Are We Headed?

Howard J. Anderson, Executive Editor
Health Data Management Magazine, April 30, 2008

Personal health records are in the spotlight at center stage now that two technology giants—Microsoft and Google—have both launched high-profile projects to support PHRs. The debate on what long-term role — if any — PHRs will play in improving the quality of health care while cutting costs is intensifying.

Some observers suggest all the hype about PHRs is extremely premature, given that the vast majority of doctors’ offices don’t yet have their own patients’ records automated. PHR proponents, however, say consumers are demanding better access to data, and even a partial PHR is better than nothing.

Privacy advocates are declaring “not so fast” as they point out that Microsoft, Google and a growing list of other technology vendors are not “covered entities” under HIPAA and thus cannot be held accountable for complying with this federal law’s data privacy and security rules. They are cautioning consumers to take an extremely close look before they leap into PHRs from these vendors.

A broad array of players, even including some technology vendors, are advocating expansion of HIPAA or passage of new federal regulations to ensure that PHRs are secure and the data they contain remains private.

Meanwhile, the end point—the “ultimate PHR,” if you will—is far from clear. Many observers have concluded that we’ll likely wind up with several PHR models from which consumers can pick and choose.

For now, some PHR projects are leveraging communitywide health information exchanges or a health record bank (see sidebar). Others are tethered to data from a single integrated delivery system. And some are initiated by employers (see sidebar, below).

“If we’re really consumer-oriented, we have to acknowledge that it’s up to the individual how to frame a PHR to meet their needs by offering a variety of options,” says Linda Kloss, CEO at the American Health Information Management Association, Chicago. The trade group has created a Web site, myphr.com, that educates consumers on their options.

For now, it’s difficult to assess whether PHRs ultimately will prove to be a passing fad or a ubiquitous technology.

A Definition?

Representatives from every health care sector continue to debate how a PHR should be defined. But there’s a growing consensus that, ideally, personal health records should somehow gather data from multiple sources, including, for example, the electronic health records of physicians and hospitals, the medication records of pharmacies, the test results from labs, the claims data from payers, and the patient’s own notes, such as information about their blood sugar levels or weight changes.

Realizing this ideal, interoperable, all-encompassing vision of a PHR will be a huge challenge. For now, most PHRs remain in the very earliest stages, with hundreds of models for how they should be assembled.

Google, Microsoft and a few other technology firms envision providing a national platform that consumers can use to store PHR data, often also using technologies from PHR vendors.

Meanwhile, some consumers are simply filling out electronic forms on their own and carrying them around on USB flash drives or storing them on their computers at home.

And some enterprising physicians are helping their patients select a PHR option that best fits their needs.

“We don’t know enough at this point to know which PHR model will prove best,” says Margret Amatayakul, president at Margret\A Consulting LLC, a Schaumburg, Ill.-based firm specializing in electronic records. “A lot more physician offices need their own EHRs before they start having a PHR that they’re supposed to rely on for information.”

As the consultant works with group practices adopting EHRs, she’s finding that “they generally envision PHRs as the last thing they’ll implement.”

Nevertheless, Amatayakul says a PHR that’s linked to providers’ EHRs could be e xtremely valuable in cutting costs related to redundant tests and reducing workloads in taking patient histories.

PHRs will prove especially valuable to the chronically ill who see multiple providers and need to keep track of records from all of them, says Kate Borten, president at the Marblehead (Mass.) Group, a consulting firm that focuses on privacy and security issues. Otherwise, it’s far too soon to tell whether PHRs will have broader appeal, she argues. “I’m not sure why most people would want to have a PHR.”

Likewise, Robert Cothren, director of the clinical information systems practice at Northrup Grumman Corp., Los Angeles, says the value of PHRs to most consumers has yet to be well-demonstrated. “Until EHRs are more widespread and physicians are more integrated with other providers and are sharing electronic information, PHRs don’t have a great deal of value,” he argues. The consultant for the systems integration firm says the industry has yet to carefully articulate the business case for PHRs.

A Revolution In The Making?

In contrast, PHR advocates say an all-encompassing, longitudinal record of treatment, complete with patient’s notes, could help revolutionize the culture of health care.

“The cultural change is that clinicians and their patients must have a partnership relative to the patient’s health care and wellness,” says Holly Miller, M.D., chief medical information officer at University Hospitals in Cleveland. “It’s changing the focus in the United States toward preventive medicine.”

The physician argues that PHRs can play an important role in helping stem what she calls an “epidemic of preventable diseases” related to lifestyle choices, such as overeating and smoking.

Complete PHRs could help doctors make sure that patients receive appropriate educational materials and are reminded of the need for follow-up visits and tests, she says." Miller strongly argues that waiting until all doctors use EHRs in their practices before moving toward PHRs is impractical. “Essentially we are living in a market where consumers have become interested in personal health records and will drive the development and use of PHRs.”

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