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Lance Armstrong's Congratulations - Runners and BIkers, you have a PHR!

February 10, 2009
by Joe Bormel
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Lance Armstrong's Congratulations

If an iPod can be a PHR, ...

Today, for the first time, at the end of my morning work-out, I was greeted with "Congratulations! This is Lance Armstrong, and that was your longest workout yet.!"

I've been using the Nike-iPod product, $29, to keep track of my runs since October. It's remarkable in that it's a free coaching service for adults, that unobtrusively plugs into your existing life (and it's workflow, through your existing iPod and existing Nike shoes.) It's opt-in, and it's focused on performance improvement. Tethering is optional. And the user interface? Well, it's an iPod.

I was startled by Mr. Armstrong's voice. It was unexpected; I should have showered first.

I have been using the Nike+iPod dongle for the last 4 months as an odometer only. An odometer that records session times, distances, calories burned and average speed. And, oh yeah, it will upload it to the Internet if your interested. And provide free coaching, goal-setting, and probably social networking if you want. ... Hey,

this is a personal health record, at least of sorts.

Today, I chanced to let it talk to me by plugging in my head phones. There was Lance Armstrong, waiting for me.

Can I now tell people that I have and use a PHR? Can it keep track of my cholesterol? Now I'm interested in a PHR for myself. HR will be so happy!

Here is a screen shots from the web interface, just to give you a little flavor; I've spared you my performance data.

With all the talk about all American's having an EHR by 2014, and incentives to hospitals and clinicians, I find the PHR promise newly intriguing. There's a revenue model that currently doesn't include advertisements or subscriptions. Can someone please comment with the link to connect Nike+ iPod PHR with one of the more encompassing PHRs, so I can through in my weight, cholesterol, meds and flaxseed meal?



I am certain that any day a seventeen year old application writer will publish a shareware PHR for IPOD.

Dr. Joe,
The perspective of an EMR to improve health appears to have been lost in the proposed stimulus package. In my opinion, the more EMRs help people (like me) to manage their own health (PHR), or perhaps to help manage the health of others, via a hospital or doc tethered EMR, should be getting far more attention.

Joe, as you wrote in your HCIT 101/Part 1 post, to which I have still to post my own comment, but will, the sub-text for policy makers is to improve the affordability of care with broader coverage. So if PHRs help to manage such things as weight, diet, exercise, etc., we in healthcare should be leading the charge locally to achieve global results. Of course, if I get a shiny new iPOD in the deal, even if I have to pay for it, I think I can live with this type of HCIT, under certain conditions.

The fact is, at this point in time, do I really want to trust Apple, MS, Google, etc., with any of my personal info, knowing first their lack of ability to be good stewards of personal information, but more importantly, the ability of such companies to arbitrarily change their privacy policies to generate additional income by selling it? At the present time, my answer is no.

It may be nice to have Lance Armstrong address my latest physical prowess, given a choice, I'd rather have Kate Winslet to do so, but in either case, I'd rather not share anything at the moment. Care to change my mind? Thanks,


As I've disclosed previously, I'm not impartial. That said, I'm also better informed than most. As a member of the HIMSS' EHR association (EHRA), and through participation in the EHRA government workgroup, I've seen the issues and options for about a year. I think the analysis in the Brailer era Government Blueprint really nailed the issues and options (e.g. pay-for-use, pay-for-reporting, pay-for-performance, as well as the 4 necessarily use cases which did cover hospitals, individual providers, consumer health and biosurveillance.)

The stimulus package is clearly addressing incentive issues that the government is already well positioned to address. And, it's doing so is consistent with the experiments the CMS has been doing to gain experience.

There are aspects of the stimulus package that are "hard to tell" what impact they'll have.

Certification is one: People working on 'Certification' of products have been learning that the process is very challenging. Reading and understanding the specifications requires esoteric skills. For an objective, written description of that problem, read Gartner's Wes Rishel's research (commercial product) "HL7 V3 Messages Need a Critical Midcourse Correction" from June 2006. In it, he says "The [RIM] model is understood in depth by only a few hundred clinical informaticians in the world." That modeling is central to most of CCHIT. With all due respect to AMIA's 10x10 training programs, the certification process is hard, and with the required software lifecycle management, the work and staffing to address certification will continue to be a challenge. The stimulus package has modest support for training informaticians, last time I looked.

Another is the point raised in the blogs by Jim Feldbaum: The healthcare delivery system is rife with questionable spending on ineffective or non-cost effective care. If we accelerate EHR adoption, will that portion of healthcare spending stay the same, get better or worse. And will those cost impacts be measurable with that "T" word, trillion. I'll take this on in an upcoming blog post, to be titled "the Vowels of Care and the Impact of HCIT spending."

As you're alluding to, the stimulus package doesn't seem to have a meaningful arm aimed at consumer behavior. Such behavior of 'all citizen's adopting an EHR by 2014.' Built into the way the stimulus package is structured, that results in the EMR ownership that I reviewed in my 'Better Care Through HCIT - part one' posting, by physicians and hospitals. Sure, we all know that the patient has ownership rights to the content of the record it's just not frictionless to get that content. As my doctor reminded me last week, much of my record, the VA records, and others are in free text today.

Given the complexity of the governments well articulated goals (again, see the Blueprint document, the AHRQ site and CMS sites), the stimulus package is a very good step in the right direction.

As Apple has demonstrated, the iPod has it's own consumer-centric ecosystem that seems to be growing in the right direction, without a stimulus package or other government support program. I'm sure Jim is correct: there will be a great FREE PHR app, if there isn't one today. There are already iPhone apps for personal weight, fitness and diet. (And, of course, there are already a bunch aimed for clinicians.) The next iPhone/iPod-Touch I buy (ie the current ones do) have Nike+ exercise monitoring support built in. That's become mainstream.

IBM, Intel and others have shown bluetooth-based, disease management HCIT which can reasonably be predicted to be mainstream in 5 to 10 years. Today's $200 bluetooth bathroom scale will soon be less than the average doctor visit.

The government, for it's part, is increasing its healthcare coverage through existing programs --- through them, it's driving EMR adoption for providers. Seems like a rational plan to me.

Does that seem reasonable to you, Anthony?

Thanks for your comment.

As I promised above, there's now a blog post covering "the Vowels of Care and the Impact of HCIT spending."

It's titled "Better Care Through HCIT 101: Part Two, What Problem Does the EMR Address?"

I think this posting, "You Have a PHR" becomes more important. How much role and responsibility does the individual have in their own health?

If policy makers felt than most Americans could and would improve their weight and exercise status, would there be a specific and loud (ie well marketed) campaign for PHRs?

Privately, many policy leaders have shared that lifestyle is a political third rail issue. You touch it, you die.

This will obviously change, in it's own season. Personally, I'm ready for spring!

I looked briefly for a connectoid, to get the Nike+ exercise history into one of the PHRs out there.

Nothing yet on Google Search.

Jim, to your point, I'm blown away by the breadth of iPhone apps have appeared and how highly functional they are. On valentines day (2 days ago), I used's iPhone app to find and book a romantic dinner at the last minute. Made me a hero.

Joe. Based on the iPod observations, do you think the stimulus package is going in the right direction? Or is it too hard to tell?

seems reasonable. my test case will be to see when MY doctor gets an EMR, then I'll know things are changing :)

Joe Bormel

Healthcare IT Consutant

Joe Bormel