For more than a decade, the financial services industry and retail merchants have been creating and perfecting an intricate weave of interoperable Web-based applications and data sources. Consumers can invest in markets worldwide, transfer assets from bank to bank, pay credit card and utility bills, and search for deals on their favorite products without ever leaving their living room.
But give healthcare consumers a home blood pressure monitor or glucometer and see if they can send their measurements to a primary care physician or specialist; or how far physicians get in integrating a patient's data from different offices in the same city, within the same medical group or IPA, sometimes the same building.
Should tech-savvy consumers broach the subject with their doctor, it's likely they'd hear some pretty stock responses — healthcare is complicated; EHRs are expensive and there's no ROI for the doc (just the insurance company); there are too many formats and terminologies to integrate smoothly. Sorry.
Nonsense, says one industry analyst.
“You know, if the industry had really wanted to solve this problem, we would have a long time ago,” says Lynne Dunbrack, program director for Framingham, Mass.-based IDC's Health Industry Insights.
Google, Mountain View, Calif., and Microsoft, Redmond, Wash., are promising to do just what the established healthcare IT community has failed to do — create portable and interoperable health records, available to consumers and caregivers alike, accessible anywhere via Web browser. Their technological architectures differ slightly, but the principle is the same, and expert consensus says it is absolutely revolutionary: The consumers control their own data. And, given the reluctance that entrenched vendors have shown to enable interoperability and accessibility, and the reluctance of clinicians and insurers to adopt the retail attitude of “the customer is always right,” it might fall to acute care CIOs to lead the charge.
Will Weider, CIO of Ministry Healthcare and Affinity Health Systems, Milwaukee, says he has not had good experiences in “multiple” attempts to foster a compelling PHR/patient portal with traditional healthcare IT vendors. He thinks the Google and Microsoft efforts are far better attuned to the needs of both healthcare professionals and patients than existing offerings. “I truly see what they're doing here as something that's going to change healthcare,” he adds.
Larry Stofko, CIO of St. Joseph's Health System, Orange, Calif., says the Google and Microsoft platforms are harbingers of a wider phenomenon. “If I step back just a little bit from this specific PHR, it's even broader, to social networking to instant messaging. It's the consumerization of the enterprise. That's going to be increasingly important in the next three to five years.”
Both technologies are just out of the starting gate, though HealthVault officially launched six months prior to Google Health (which launched publicly May 19 after pilot testing at Cleveland Clinic). While the two have yet to agree on a common API, there is consensus on using the Continuity of Care Record and Document (CCR/CCD) standards. Pioneering CIOs are optimistic there will be no insurmountable integration hurdles.
“On the transport side, it's SOAP, XML and HTTPS,” says John Halamka, M.D., CIO at Boston's Beth Israel Deaconess Medical Center, and Harvard Medical School, and chairman of the American National Standards Institute's Healthcare IT Standards Panel. “On the data side, the Continuity of Care Document is really a synthesis of HL7 and ASTM's CCR, and a really nice convergence. It really does everything folks need — structured data, problems, medications and labs and narrative data, history, physicals, summaries, etc. That, to me, is the tipping point,” he says. “That's done.”
Intangibles and a ‘sea change’
One of the more interesting aspects of the Google and Microsoft entries is the introduction of the intangible into the economic equation for hospitals. That is, while they will not be shouldering the cost of creating or storing these applications and databases, they will have to find some way to integrate them with their existing or proposed EHR/PHR plan. And, because direct marketing via these platforms is being strongly discouraged to protect patient privacy, it can be hard to discern a quantifiable ROI. But Halamka (who served on the Google Health advisory panel prior to the pilot's launch), Cleveland Clinic CIO C. Martin Harris, M.D., Stofko, and Weider all say there is enough upside to the Google and Microsoft platforms to bore ahead.
“The patients who use PHRs love them, and have basically said it is the one thing that has kept them a devoted patient of Beth Israel Deaconess,” Halamka says. “So, if I can attract and retain patients based on PHR integration, it's pretty important.”