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Is the Market Ready for PHRs?

April 28, 2011
by Jennifer Prestigiacomo
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Studies show both patients and providers are just not there yet
With the announcement this week of PHR provider MMRGlobal offering military members and their families a MyMedicalRecords Personal Health Record account at no cost for as long as they are on active duty (and veterans and their families a no cost one year access), I wonder what it will take to get true market penetration of PHRs.

Personal health record adoption has been slow to catch on. This point is reinforced by a recent study by IDC Health Insights that showed that the vast majority of the 1,200 respondents aren't using a PHR simply because they don’t know about them yet. There is a bit of promise in IDC’s results, as 28 percent of the respondents indicated that they would use a PHR system if their physician recommended doing so. However, some patients don’t see the value of a PHR since they don’t seek many healthcare services, while others don’t trust the security of PHRs.
 

 

Not only are patients not quite ready for PHRs, hospitals aren’t there either. A Healthcare Informatics poll showed a basic lack of preparedness of hospitals to implement PHRs. According to the survey, 44 percent of respondents said their organization was somewhat prepared to have its patients use PHRs, while 40 percent said they were not ready at all.

CMS has done a couple PHR pilots, one of which has yielded some interesting results. Launched in 2008, the goal of the My Personal Health Record (MyPHRSC) pilot in South Carolina was to provide fee-for-service (FFS) Medicare beneficiaries with free access to a Web-based PHR. An evaluation of MyPHRSC ultimately found limited standard measures for PHR usability and utility and no specific guidelines for PHR development. Barriers impeding provider PHR use included the potentially negative impact on office workflow, data inconsistencies, and the lack of reimbursement for provider participation.

The pilot also showed that consumer preferences for PHRs included: pre-populated, downloadable data; simplified log-ins; strong technical support; streamlined and combined administrative and clinical data; direct on-line communication between patient and provider such as prescription refills or email contact; and alerts and tracking mechanisms for monitoring preventative or chronic conditions.

Another pilot, the Medicare PHR Choice pilot, is open to Utah and Arizona residents with fee-for-service (FFS) Medicare. Unlike MyPHRSC, beneficiaries in Medicare PHR Choice are able to select one of the four participating PHR vendors (Google Health, HealthTrio, myMediConnect, and NoMoreClipboard). The Medicare PHR Choice pilot launched in 2009 and will conclude June 2011.

With Stage 3 meaningful use goals of patient access to self-management tools and EHRs having capability to exchange data with PHRs, what will be necessary to get patients and providers over the edge of adopting PHRs? Please share your thoughts with me below.


 

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Comments

Jennifer,

Great post! I have been following the PHR topic closely from three perspectives for different reasons.

1) PHR can close care gaps through communication:

The Networked-PHR is a different animal from the "untethered PHR." I didn't realize I was being manipulated by language until it was pointed out to me, I believe correctly, that the term "tethered PHR" is deliberately and inappropriately disparaging.

The Networked PHR is the glue between a patient and provider organizations that enables the better/faster/less expensive, trusting relationship to coordinate care. Multiple community-oriented provider systems (Geisinger, Partners, UC Davis, Kaiser, the VA and others) have shown that certain populations of patients get objectively better care as a result of having a Networked-PHR as part of the care system.  Networked-PHRs can and do close care gaps.

2) Many PHR's today stink:

Caring for a loved one, whose primarily clinical challenge includes high blood pressure management, has illustrated to me how poorly the popular PHRs I've looked at manage this common condition.

The PHRs I've looked at do a lack luster job of capturing and displaying multiple blood pressure recordings during the day, juxtaposed against the blood pressure medicines.

This is not rocket science and our paper solution has demonstrated that the capture and display challenge can be pretty easily met. Most of the solutions appear to have been designed by engineers with no training in understanding requirements, much less domain knowledge in healthcare. I would have hoped for much better considering the consumer-focus of the hosting parent companies involved. I cannot advocate using these PHRs; they are not ready for the market.

3) PHR can promoting wellness:

Lastly, think of the PHR as a tool to support health and wellness, rather than supporting clinical medicine practiced by the providers and patients in the above cases.

Like 99.9% of readers I suspect, I personally struggle with weight management influenced by diet and exercise. A few years back, a service was offered by Nike through the Apple iPod, to track running exercise history, and offer coaching to achieve goals. After a few months, I realized that this was as much of a wellness PHR as anything else. I had signed up for a PHR and hadn't realized it!

So, my personal health history at the level of my daily exercise (time, duration, speed, calories burned predicted by body weight) have been flowing to the Nike web site. "Encouragement" (see Lance Armstrong's Congratulations on a personal best) has been therapeutically applied in the form of audio messages to me at the end of my run.

Apparatus to electronically collect blood pressure and pulse for this ecosystem is now at the $100 price point. I don't have one of those bluetooth bathroom scales feeding daily weights yet, but I would welcome that.  The PHR and associated behaviors have a positive, addictive quality that for me is healthful.

Final thought:

The name PHR is an unfortunate legacy of the term EMR. It's not the "Record" aspect that serves the patient. It's the communication with providers, knowledge and community that creates the value.



I agree with your comments, Joe. Having worked for years on PHR development and adoption (an EHR-connected Patient Portal), I think these offer great value - in many but not all cases. It's key to focus on tasks, and gaps. What tasks does a patient have to accomplish, and is there something slowing them down or stopping them from completing the task?

The most common "value" areas are things like Medication Refills, or Lab Results Reporting, or viewing a Visit Summary to recall the takeaways after a doctor's visit. For a patient managing diabetes, all three can be VERY helpful. For a healthy 25 year old, taking no meds and rarely visiting a doctor, the value is not clear.

I recently reviewed an excellent report on "health literacy" - the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Nine of 10 Americans, even those with decent educational backgrounds, have difficulty understanding and making health decisions - especially complex ones. PHRs that connect individuals with their chart information, with trusted reference information, and very importantly - - with people who can provide guidance or be a good sounding board - - can be powerful.

We don't conclude that insulin is bad treatment, just because some patients refuse to take it or don't understand its value in certain forms of diabetes. It's important to promote PHR use when the value proposition is clear, and not to feel disappointed if they are not used vigorously by everyone.

I forgot to provide a link to the report on health literacy... here it is:

http://www.health.gov/communication/hlactionplan/

Jennifer Presti...