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Taking a New Look at the Lamented Personal Health Record: Flow Health’s Debut

Posted on June 8, 2015 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site ( and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

After the disappointing lack of adoption suffered by Google Health and Microsoft HealthVault, many observers declared personal health records (PHRs) a non-starter, while others predicted that any progress toward personal control over health data would require a radically new approach.

Several new stabs at a PHR are emerging, of which Flow Health shows several promising traits. The company tries to take advantage of–and boost the benefits of–advances in IT standards and payment models. This article is based on a conversation I had with their general counsel, David Harlow, who is widely recognized as the leading legal expert in health IT and health privacy and who consults with companies in those spaces through the Harlow Group.

Because records are collected by doctors, not patients, the chief hurdle any PHR has to overcome is to persuade the health care providers to relinquish sole control over the records they squirrel away in their local EHR silos. Harlow believes the shift to shared risk and coordinated care is creating the incentive for doctors to share. The Center for Medicare & Medicaid Services is promising to greatly increase the role of pay-for-value, and a number of private insurers have promised to do so as well. In short, Flow Health can make headway if the tangible benefit of learning about a patient’s recent hospital discharge or treating chronic conditions while the patient remains at home start to override the doctor’s perception that she can benefit by keeping the patient’s data away from competitors.

The next challenge is technically obtaining the records. This is facilitated first by the widespread move to electronic records (a legacy of Meaningful Use Stage 1) and the partial standardization of these records in the C-CDA. Flow Health recognizes both the C-CDA and Blue Button, as well as using the Direct protocol to obtain records. Harlow says that FHIR will be supported when the standard settles down.

But none of that is enough to offer Flow Health what the doctors and patients really want, which is a unified health record containing all the information given by different providers. Therefore, like other companies trying to broaden access to patient data, Flow Health must deal with the problem that Dr. Eric Topol recently termed the Tower of EMR Babel. They study each format produced by different popular EHRs (each one using the C-CDA in slightly incompatible ways) and convert the data into a harmonized format. This allows Flow Health to then reconcile records when a diagnosis, a medication list, or some other aspect of the patient’s health is represented differently in different records.

What’s next for Flow Health? Harlow said they are preparing an API to let third parties add powerful functionality, such as care coordination and patient access from any app of their choice. Flow Health is already working closely with payers and providers to address workflow challenges, thus accelerating the aggregation of patient health record data for access and use by clinicians and patients.

A relative of mine could have used something like Flow Health recently when her eye doctor referred her to the prestigious Lahey Clinic in the Boston area. First of all, the test that led to the referral had to be repeated at the Lahey Clinic, because the eye doctor did not forward test results. Nor did anyone provide a medication list, so the Lahey Clinic printed out a five-year old medication list that happened to hang around from a visit long ago and asked her to manually update it. There was also confusion about what her insurer would cover, but that’s a different matter. All this took place in 2015, in the country’s leading region for medical care.

It seems inevitable that–as Flow Health hopes–patients will come to demand access to their medical records. A slew of interesting experiments will proliferate, like Flow Health and the rather different vision of Medyear to treat health information like a social network feed. Patient-generated data, such as the output from fitness devices and home sensors, will put yet more pressure on health care providers to take the patient seriously as a source of information. And I’ll continue to follow developments.

4 Health IT and EHR Blogs

Posted on August 12, 2014 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As I’ve been putting together these blog posts about other Health IT and EHR bloggers, I’ve been astounded how many former bloggers have stopped blogging. I guess I was write to post one of my first blogger features as “EHR Blogger Attrition.” I imagine many previous bloggers are still sharing content, but have likely moved to other social media which is much easier to sustain. A tweet can be generated much more quickly than a blog post.

With that in mind, I feel grateful that I’m still able to blog and that enough people come and read my blog posts that I can provide for my family with my blogging. While some might define my blogging as micro blogging, I think there’s more value in a blog post than a tweet. You don’t have to dig into subjects in a tweet. People don’t go looking through your old tweets like they do blog posts.

Those musings aside, here are some other Health IT and EHR bloggers you might find interesting:
Health Blawg – David Harlow has a fascinating blog covering many of the various healthcare regulations that encumber our lives. Many lawyers are afraid to blog, but David has overcome that fear and created regular healthcare content that’s well worth following.

The Health Care Blog – While this blog isn’t exclusively health IT, a large portion o the topics are Health IT related. This blog never ceases to amaze me at the number of people they have contributing quality content to their site. It doesn’t have one voice, and that’s what makes the site so great. You might read a post about healthcare analytics and then one on value based contracts. Plus, it has one of the most active communities for comments. In fact, I often find myself more interested in the comments than the post itself.

Phil Baumann – While Phil is an RN by training, he’s more of a healthcare communicator and marketer than anything. Phil’s been doing this long enough that he doesn’t pull any punches. He just says it the way it is and isn’t afraid of saying things others aren’t comfortable saying. That makes for a good blog.

Galen Healthcare Solutions – I always like to feature at least one health IT company that’s creating great blog content. Galen Healthcare Solutions is definitely one of the best out there and they’ve been doing it consistently for a long time. Looks like their first blog post was in July 2008. I’m not sure who’s behind their consistency, but they deserve a lot of credit for the work they’ve done. It’s a great blog.

FDA’s Social Media Guidance Insights

Posted on July 23, 2014 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I had a chance to watch parts of a Google+ hangout discussing the latest FDA social media guidance with David Harlow from Health Blawg. I’ve had a chance to work on a number of things with David and he’s a really smart guy that’s on top of a lot of the regulations that affect healthcare. I guess that’s a feature of being a healthcare lawyer. For those who missed it, you can check out the full video interview with David below:

For those who prefer the cliff notes version, David published some bullet points on his blog that do a great job summarizing the main points and key takeaways:

  • The draft guidance makes use of Twitter and platforms like Google Ads extremely unattractive, because the vast majority of the “real estate” must be given over to brand and generic names, indications for use, benefits, risks, and a link to fuller information about risks.
  • The FDA addressed itself to short-form communication without considering the way in which it is used most effectively – not as a canvas for ads, but as a forum for conversation.
  • Unbranded tweetchats, Facebook pages, and the like were OK before the draft guidance was issued, and they still are.
  • The correction of misinformation guidance lowers the regulatory bar for corrections (vs. marketing messages that must meet higher standards and may be subject to pre-review).
  • The misinformation guidance does not require a drug or device manufacturer to address all misinformation online about its products. Corrections must be focused responses to what others put out there on line, and should link to fuller information where appropriate, but corrections should not include or link to promotional material.
  • The misinformation guidance delineates an area of opportunity for drug and device manufacturers.

You can read more on his blog post including someone getting in trouble for liking a patient’s status. Think about that for a minute. Is it any wonder that pharma’s been really careful with social media?