Pilot projects under way in the state of Washington to create personal health record (PHR) banks in three communities have found that many consumers don’t have a computer and Internet access, but almost all of them have mobile phones. By simplifying the interface and using text messages, the health record banks have enhanced the interoperability of their system and increased participation, according to Juan Alaniz, the Health Record Banking Project manager with the Washington State Health Care Authority in Olympia.
That development described by Alaniz is exactly what Paul H. Keckley, Ph.D., executive director of the Deloitte Center for Health Solutions, Washington, D.C., has been seeking to understand. His research center, which follows disruptive innovations in healthcare, recently published an issue brief, “The Mobile Personal Health Record,” which states: “The personal health record embedded in mobile communications devices is the ‘killer ap’ that may change the game for providers, consumers and payers.”
Healthcare Informatics recently interviewed Keckley about some of his findings. The key, he says, is that relatively inexpensive and widely used mobile communication devices could both send and receive patient data.
“It is a different view of information flow, not vertical but a two-way flow of information in which patients can capture information with biomonitoring devices and send it to clinical systems to be stored in registries,” he says. The mobile PHR could provide patient-specific information such as medication reminders and healthy eating tips.
The sweet spot for the introduction of this type of technology, he says, is someone with a condition that requires lifestyle modification, such as diabetes or hypertension. “This is moving from a paternal model to helping you make judgments for yourself,” Keckley adds, “so you can see your own health data in an actionable context. This maps to the medical home concept perfectly.”
The Deloitte report notes that mobile phone pilot projects have shown promise. For instance, a Cleveland Clinic project that allowed diabetic and hypertensive patients to transmit vitals to their PHRs reduced the number of required office visits. A Kaiser Permanente study in Colorado found that 58 percent of hypertension patients using mobile PHRs lowered their blood pressure to healthy levels within six months compared to 38 percent receiving conventional treatment.
Despite identifying the potential promise, Deloitte identified several barriers to widespread application:
• In order to tap relevant patient data, technical standards must be adopted for moving data between electronic health records (EHRs) and PHRs, and more physician offices have to make their records electronic.
• Consumer demand for the data must increase. Currently only 10 percent of American adults use a PHR, and 61 percent say they don’t think they need one because they don’t perceive any benefit.
• Consumer concerns about privacy and confidentiality may limit user uptake of PHRs.
• Providers may be concerned about the data integrity of PHRs. Deloitte says providers must make the legal medical record distinct from any patient-entered data.
Despite these barriers, tech startups, investors and telecom companies are making big bets on mobile healthcare, Keckley notes. “This may be a case where the market is ahead of the healthcare delivery system. The change may be driven by consumers, employers or insurers, not by providers,” he adds.
The push for mobile PHRs also may be generational. The Deloitte 2010 Survey of Health Care Consumers found that twice as many Gen X and Y consumers want to access and maintain their PHRs using a mobile device than do baby boomers and senior citizens.