The concept of personal health records is nothing new. Over the past few years, a number of different market segments — from insurers to employers to niche vendors — have made it clear they want to provide a nice, safe home for consumers' personal health information. One reason everybody wants to own this home, of course, is because they see the lucrative possibilities. From offering advertising right on a PHR Web page to straight-out selling (identity stripped) health data for studies, where there are online clicks, there are possibilities. These once-hopeful PHR homes also saw the chance to more closely tie consumers or employees to them, figuring people would be less apt to stray from where their health histories reside.
But to the infinite frustration of these companies, PHRs have largely not caught on. Why? Because today people change jobs about as often as they change the tires on their cars. That means building a repository of personal health information into an application owned by an employer, insurer, or even a doctor isn't something most people are willing to do. Consumers know it's annoying enough turning down a job opportunity because there's only one more year until full vestment in the company 401(k), let alone having to stay put because the family's personal health history is deeply embedded in an employer or insurer PHR. (I know, they're supposed to be portable, but do you want to test that yourself?)
The game was destined to change when a PHR landlord emerged that was not tied to a specific doctor, hospital, employer, insurer, or unknown vendor, for that matter. And so it has. With the launch of Microsoft's HealthVault PHR platform, such a home has arrived, one with about as much brand recognition as you can get. You want proof of its pull? Check out the 40 companies that have decided it's in their best interests to play nice with Microsoft's new toy, including such familiar names as: Allscripts, Eclipsys, NextGen, Medseek, and Kryptiq.
And it won't end with Microsoft. In fact, even if Microsoft's mouse trap isn't destined for success due to system bugs or functionality weaknesses, the overarching model has been set. I'm sure the healthcare guys over at Google and Yahoo! received a stern talking to about getting a competitive offering to market, post haste.
I, for one, am going to try HealthVault to see how user friendly it is. I may even order a blood pressure cuff to see how information from a consumer-targeted biomedical device is downloaded into the application. In the world Microsoft envisions, this information could then be pushed out to, or pulled in by, my physician. But that's where Microsoft may have been dreaming of the world they want to see, rather than the world I inhabit.
Someday, sure, the majority of physicians or their administrators may be pulling and pushing, importing and exporting data between Web-based PHRs and ambulatory EMRs, while data from those same ambulatory EMRs is exchanged with acute-care EMRs from the hospitals in the community. But my doctor still writes notes on the inside of a manila folder that contains scraps of paper with my medical history. He and I sure don't exchange e-mails, and I don't even know if he's got Internet access in the office (I still think he's a good doctor, though.). As of today, I don't think HealthVision allows for an export into my physician's folder, but maybe they're working on that too (Yes, that was a joke).
Most agree that the Internet revolution is finally coming to healthcare, yes, years after it came to just about every other industry. And we also know that the Internet revolution has always meant consumer empowerment and control of industry dynamics. For healthcare, it will be no different.
Physicians, acute-care CIOs, and everyone who's ever been responsible for interacting with a patient be warned: sooner than you think, patients are going to come into your office or emergency room with nothing more than a card revealing their name, a Web site, a username and password. One day soon it will be your responsibility to gain access to that information, provide it to clinicians and use it as the basis of treatment, as the basis of an inpatient or outpatient medical record.
The PHR game has changed. Will you be ready to play?
Anthony Guerra, Editor-in-Chief
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