Recent news that Kaiser Permanente has made its patients’ electronic health records available via mobile devices comes as no surprise. Kaiser often seems to be at the forefront of interoperability and coordinated care, in large part due to its integrated nature and sheer volume of patients. As the company’s press release mentions, it maintains the “largest electronic medical records system in the world.” Now, 9 million of its patients can view their EHRs via a mobile site or Android app, with an iPhone app expected to launch in the near future.

On a macro level, I think this is a great step towards further empowering patients to take control of their health. By giving 9 million folks instant access to their own health information, I’d like to think that this will in turn prompt their friends and relations to ask, “Why doesn’t my doctor do that? What benefits am I missing out on?” And perhaps these same folks will then have a conversation with their provider about adopting this type of mobile access.

I’d be interested to see six months to a year from now, statistics comparing use of the mobile app/site to use of the tools found on the traditional website. Will Kaiser see a tremendous increase in the amount of emails between doctors and patients via its mobile apps? Are its doctors prepared for the potential onslaught of correspondence? I wonder if a few have balked at the possibility of being overrun by emails from particularly communicative patients.

Will they be able to tie these usage statistics to a jump in quality outcomes? Will mobile access ultimately become a criteria measured within accountable care models or patient-centered medical homes? Will mobile health truly equal better health?

On a micro level, I would certainly appreciate the effectiveness of access like this, which includes the ability to view lab results, diagnostic information, order prescription refills and the aforementioned email access to doctors. I can’t tell you how many times I’ve been on the phone with a pediatric advice nurse and drawn a blank when asked what my child’s current weight might be. It would be nice to be able to quickly pull that data up on my cell phone, especially while we’re on the go or out of town. I could eventually see patient charting apps being layered on top of this, so that in the event of a high, overnight fever, I could log temperatures via the mobile app and review them with our pediatrician – possibly alerted every time a new temp or symptom is entered – the next morning.

The possibilities seem endless. I think the big goal for Kaiser now is to get folks engaged and using these new access points.

So, Google Health’s slow collapse — akin to a tire with a slow but obvious leak — has finally come to an end. This week, Google officially ended the project, one of the pioneering efforts in the Personal Health Records space. While GH will stumble along through January 1, 2012, the jig is finally up.

Why did a high-visibility project backed by one of the world’s premier Internet companies fail so miserably? Well, according to former Google employee Adam Bosworth, who first launched GH, the effort failed because “it’s not social,” TechCrunch reports.  Another pundit, more convincingly, argued that unless PHRs are tied to reimbursement somehow, they’ll be “irrelevant” for most providers.

So, why should we care about the failure of a project that, I’d argue, was pretty much pie in the sky from day one? And more importantly, is the failure of GH relevant to people who care about the future of EMRs?

Well, for one thing, Google Health does offer some pretty interesting insights into what doesn’t work in the world of patient-centered clinical data. As I see it, they include the following:

*  Clinical data projects that aren’t interoperable are eventually going to wither away.

I think it’s telling that Google is, at the last possible moment, rolling out the ability for patients to transfer health data to other services supporting the Direct Project protocol.  Also notable is that Google is offering patients the option of downloading data that meets the Continuity of Care Record format. (That’s ASTM E2369 – 05e1 to any standards geeks out there.)

Does that imply that EMRs that don’t share data are going to be outmoded or a waste of time?  Certainly not, as EMRs can potentially solve many in-house problems that providers face, and serve a far more expansive purpose. That being said, the failure of siloed PHRs should be a warning.

* Without a live, fluid source of data, PHRs don’t matter.

In this cynic’s mind, the idea that patients would suddenly begin to post data to PHRs on their own was, to put it simply, pretty dumb.  Why would they?  Consumers seldom think about their health data unless they’re at a doctor’s office, if at all, and they don’t exactly know what do do with the data once they’ve compiled it.

Since day one of the PHR craze, I’ve been wondering who thought they’d change patient behavior en masse by dangling a technology carrot. What were they thinking? I’m not just slamming Google, I’m targeting pretty much any PHR that isn’t linked to an EMR or other clinical data source directly. (I’m talking about you, HealthVault, and probably Dossia too.)

* PHRs must be run by a trusted intermediary, and marketed vigorously to patients, before patients will take heed.

I think it’s no coincidence that while Google’s PHR, and possibly Microsoft’s, haven’t won over many consumers, patients are beginning to pay a bit more attention to PHRs provided by providers and health insurers.  (OK, I don’t have hard data on this, just a strong gut feeling — can any of you provide stats that support or contradict this assumption?)

A case in point: While they’ve arguably spent way, way too much to get there, Kaiser Permanente has built what may be the largest PHR user-base in the world — 3 million users as of spring 2010 — linked to KP’s big Epic installation.  True, Kaiser had to spend millions in advertising and other forms of outreach to get patients on board, but what’s telling is that patients seem to have stayed once they arrived.

So, I’m just wondering when the managers behind HealthVault will throw in the towel. Hey, MS, just turn out the light when you leave, OK?

So,  Google is going through some internal upheaval as co-founder Larry Page prepares to take over the reigns as CEO.  According to an piece appearing in today’s Wall Street Journal, Page is aggressively reviewing existing projects and is likely to take an axe to those that don’t seem to be working. Does it surprise any of you that one of the programs facing cutbacks may be Google Health and its faltering PHR?

As HIT expert Shahid Shah notes, Google has created some decent PHR technology — but despite having a vast reach and rich resources, hasn’t figured out how to grow its user community.  Even with its massive bank account, I’m not surprised to see that it hasn’t turned healthcare into a major income source. Google just isn’t that great at going outside of its box.

Then, consider that Microsoft doesn’t seem to be pushing Health Vault very hard these days, and you’ve got to wonder whether the whole “massive tech company builds PHR” thing can possibly work.   Yes, I realize I might get flamed by Microsoft execs saying this, but let’s get real here.  Microsoft isn’t great at connecting to markets it doesn’t monopolize either.

Oh the other hand, evidence is mounting that PHRs may be popular when driven by a provider and its own EMR.  Perhaps the highest-profile example of this may be Kaiser Permanente’s EMR/PHR ecosystem.  Its “My Health Manager” PHR system is closely integrated with its Epic EMR installation and now has millions of users.

Why is Kaiser succeeding at generating PHR interest where Google has failed? It’s largely because rather than offering a mixed bag of apps and options, as tech vendors have been doing, My Health Manager allows patients to securely exchange messages with physicians, refill prescriptions, review test results and schedule medical appointments.  Patients aren’t being asked to become updater and curator of their medical information, but rather, to use it. This just makes sense.

As I see it, the whole notion of a PHR as a freestanding app is basically circling the drain.  Realistically, patients have little incentive to interact with their health data unless it has some immediate impact on their lives.  An EMR/PHR combination, on the other hand, has tremendous potential, as it connects patients to both their providers and their health data effectively.  If I were Microsoft or Google, I’d just throw in the towel at this point.

Few would argue that Epic is one of the two or three most visible enterprise EMR vendors on the market today. There’s little doubt that these days, Epic is shortlisted when hospitals plan an EMR rollout, alongside of giants like GE and Cerner.

It’s hard to imagine that Epic isn’t in a sweet financial position, practically stuffing warehouses full of the revenue they’re generating in this pivotal period of HIT history. (For a sense of the scale involved, bear in mind that Kaiser Permanente’s reportedly $4 billion to $6 billion EMR rollout was an Epic installation.)

That being said, we really don’t know. Why? Well, while Cerner and GE and McKesson are public companies, Epic remains privately held. Looked at another way, health systems that sink half a billion dollars over five years to implement Epic know far less about its financial situation than they would about Cerner’s.

So, maybe I’m wandering out on a limb here, but if I were a big health system, wouldn’t it be a little bit concerning not to know some details on how robust the company’s financial picture is? Does it really make sense, despite its strong reputation and impressive customer list, to spend a staggering sum on Epic without some third-party analysis of its prospects?

After all, when you spend the kind of money health systems are spending, that vendor becomes an incredibly important partner. But if the vendor’s not open to Wall Street scrutiny , it might get away with fibbing about its ability to deliver.

Mind you, I’m not saying that health systems that go with Epic — or any other privately-held vendor — are behaving irresponsibly. It’s just that in this climate, more information can’t hurt.

P.S.: I began thinking about this when I saw a question (posted on Quora.com) asking what Epic would be worth if it went public. Could the poster know something we don’t?

I’m still working through some of the various wrap ups from HIMSS that I’ve found. Matthew Holt is always an interesting blogger. Turns out that he’s even more interesting in person. Here’s a few of his thoughts that I think are worth sharing:

Busiest booth?: I think Cisco wins. Maybe it was HealthPresence, maybe the magician—but it was always packed. What I think it means is that mainstream Internet tools are now coming into health care (with some little tweeks). But as MrHISTalk says, putting all the big guys in the A hall was a mite unfair on the C side—although I got to both a little.

Most intruiging announcement?: Epocrates will release a hand-held and web-base EMR app for the iPhone and other handhelds. Why is that interesting? Because they already have 275,000 docs actively using their tool on a handheld, most on iPhones. If their tool’s any good you have to assume they have a great marketing advantage. If this succeeds there’s no way they remain independent in 18 months.
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Most interesting niche company you’ve never heard of whose CEO you randomly met at a party?: LiveProcess is a SaaS-based emergency preparedness tool. (I think CEO Nathaniel Weiss said) it has 500 hospitals paying $10K a year each with no customization.

Other interesting niche company?: CPM does CRM outbound marketing for hospitals and as nearly doubled in size during the downturn (video of them to come).
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Most interesting philosophical chat?: Andy Weisenthal of Kaiser Permanente discussing how specialists are going to change entirely what they do now that everything in KP is online. One Hawaii endocrenologist is on a jihad to prevent diabetics ending up on dialysis—he’s completely reorganized how primary care docs treat their patients. It’s almost like his goal is to put himself out of a job. Andy said about Healthconnect’s finalization of the $6bn (?) implementation—”It’s not the end, it’s the start”.

It’s also worth linking to Matthew Holt’s interview with Epocrates about the Epocrates EHR. Although, I also just remembered I could embed it below: