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Innovative Collaboration on Medication Management and Community Resources

Posted on April 23, 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 (http://oreilly.com/) 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.

Although experts agree that the future of health is coordinated care, it is sorely lacking in the US health care system now. This article focuses on the single, relatively simple issue of medication management. Patients are prescribed barrels of pills, but there is little coordination other than looking for contra-indications and drug interactions–and these often suffer from the caretaker’s not knowing the patient’s full complement of drugs.

Sandra Raup, president of Datuit, points out that all kinds of subtleties get lost when patients are simply told how often to take a medication. For instance, if medications are spaced out throughout the day instead of being being taken all at once when we remember to take them (as so many people do), they may be absorbed more effectively and tolerated by the body. Patients–especially those with lower incomes and less education, who are more likely to be on multiple medications in the first place–need all sorts of support.

Here we come to an interesting twist: coordinated care does not have to be initiated by doctors. Given the doctor shortage and the forces keeping clinicians from adopting new models of treatment, other professionals can take on the long-term goals of improving patient health.

In a pilot ramping up in a residence for low-income seniors and the disabled in Maryland, Connected Health Resources is working with Alfa Specialty pharmacy using its Community Health Gateway to help patients straighten out their medications and keep to their schedules. This works because the pharmacy is in a somewhat unusual position: they have supported this community for some time and have built relationships with patients informally. The Gateway pilot has created a service, using Datuit’s SafeIX public API, that can potentially fulfill these needs with less work on the pharmacist’s part. The service is designed for easy navigation by the patients and their family caregivers, making it attractive to the patients and the pharmacists.

Connected Health Resources logo

The SafeIX Platform is designed using modern programming technologies to integrate data from multiple sources (including EHRs and HIEs) into a patient record for both patients and healthcare providers to use, based on their rights to access and share it. In the Gateway implementation, the pharmacist uses the SafeIX Platform to receive CDA documents from the HIE and to auto-assist medical data reconciliation between the various documents.

This information, along with the pharmacist recommendations, are organized into a daily medication calendar using an application from Polyglot Systems Incorporated, a company that offers medication regimen summaries in 18 languages. Low health literacy and the estimated 50 million people who do not speak English at home result in many patients not understanding their medication instructions. The plain language and multilingual, easy-to-use daily calendar can make the difference between understanding and total confusion.

Datuit’s SafeIX Platform uses interoperability standards (including, in test mode, the next-generation FHIR standard) to create a patient record that can show patients everything seen by multiple clinicians and allow a patient’s self-selected care team to view and add to a shared care plan. Datuit is encouraging app developers to build mobile apps for SafeIX that would prompt patients to take medications and record whether they did so, but that’s outside the scope of the pilot. There are plenty of challenges just fulfilling the tasks they have already taken on.

First, Connected Health Resources has to break down the clinical data silos that make it difficult for patients to collect their information. According to co-founder Shannah Koss, Maryland has a relatively advanced Health Information Exchange (HIE) called CRISP. However, it is defined as a provider-to-provider exchange, so it was only after a long-term relationship and negotiation that Connected Health Resources could collect medical data on behalf of the patients. This is the first time CRISP has allowed data to be retrieved for a patient-facing organization that is not a provider.

When enrolling, the patient gives the Gateway permission to get data through CRISP. Family and friends can be invited by patients to be part of their health community and enroll in the Gateway. The invitation includes a unique code that allows the Gateway to securely share records and help with health and social services navigation. If the patient wants help or is incapable of managing the medication list, a caregiver can do so.

CRISP transmits data primarily from hospitals. To round out a more comprehensive listing of medications from clinics and other healthcare providers, CRISP has enabled the ability to query Surescripts, which provides prescription fill data from chain pharmacies and pharmaceutical benefit management companies.

Pilot participants authorize the Gateway and the Alfa pharmacists to access their medication information and maintain, share, and augment the information in the secure SafeIX Platform. The CRISP data gives more complete medication records for the pilot participants. CRISP also provides an event notification system that let’s the pharmacist know whether a patient has been admitted to a hospital or visited the emergency department. These types of transition are precisely when medications get changed, but the clinicians at those crucial junctures often don’t know all of a patient’s current medications.

Finally, over-the-counter (OTC) medications can play an important role in a patient’s care. This has to be added to the daily calendar. The Alfa Pharmacist is helping round out the complete medication picture by working with the patient and family to identify OTC medications, supplements, and the medications that are actually being taken through the medication therapy management (MTM) program. The Gateway provides the means for everyone to better understand and manage the medicines for the best outcomes.

Further, the Gateway Community Resource Finder has enabled information about important resources such as transportation, meal delivery, social services, and home nursing. The MTM pharmacist knows that patients without food or transportation to their physicians cannot adequately manage their health or medications. The underlying SafeIX Platform also allows the Gateway to offer secure messaging that looks like email and lets the pharmacist, patient, friends, and family exchange messages about the patient’s care.

Traditional EHRs don’t accommodate treatment plans of the specificity designed by the pharmacy for patients in the pilot. This is where Datuit is pushing the EHR to new horizons: its SafeIX Platform helps multiple clinicians (including long term care providers), patients, and family caregivers contribute data. For example, patients can enter their own healthcare problems, such as fear of falling. The patients, families, and clinicians can then add interventions to address them.

Like other new organizations I’ve spoken too in health care, Connected Health Resources has grand plans beyond the current pilot. They are taking it slow, because Koss believes personal health records (PHRs) have tried to do too much at once and have overwhelmed their users with too many possibilities. But she would like Connected Health Resources to grow in response to what patients and families say they need. The Gateway tools already include the ability to generate multi-lingual discharge instruction from Polyglot. The initial pilot purposefully focuses on the more narrow scope of medications along with the health and social services support. The next step will be to engage hospitals to provide the plain language multi-lingual discharge instructions.

Chronic care ultimately goes beyond medications to things supported by a patient-centered medical home (PCMH), community health workers, and the many community-based service providers. The Gateway in partnership with the Datuit SafeIX Platform are poised to allow all participants identified by the patient and families to contribute to and be part of their health community.

Cracking Open the Shell on the Personal Health Record

Posted on November 5, 2014 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 (http://oreilly.com/) 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.

The concept of maintaining your own health data enjoyed a brief flurry of activity a few years ago with Google Health (now defunct) and Microsoft HealthVault (still active but not popular). It has gotten a second chance with Apple HealthKit, Google Fit, and other corporate offerings explicitly tied in with the convenience of mobile devices. Microsoft itself has galvanized HealthVault with a Microsoft Health initiative similar to Apple’s HealthKit. Recently I’ve been talking to health care reformers about the business and political prospects for personal health records (PHRs).

Patient access to data was enshrined as a right back when HIPAA was passed and is still championed by the US government through Meaningful Use (whose Stage 3 may well focus on it) and other initiatives, and has been endorsed by the industry as well. But this requirement won’t be satisfied by the limited patient portals that hospitals and clinics are hanging out on the Web. Their limitations include:

  • Many provide only viewing data, not downloading or transmitting it (all of these are mandated by Meaningful Use).
  • Data maintained by providers can’t easily be combined into a holistic, comprehensive view, which is what providers need to provide good care.
  • Data on portals is usually a thin sliver of all the data in the record: perhaps prescriptions, appointments, and a few other bare facts without the rich notes maintained by clinicians.
  • You can’t correct errors in your own data through a portal.
  • Clinicians rarely accept data that you want to put in the record, whether personal observations or output from fitness devices and other technical enhancements.

All these problems could be solved by flexible and well-designed personal health records. But how does the health care field navigate the wrenching transition to giving people full control over their own data?

Dr. Adrian Gropper has investigated PHRs for years and even considered building a simple device to store and serve individual’s health data. Now he says, “I can’t recall any physician in my medical society that has ever said they wished their patient had a PHR. Nor do I, after many years on the Society for Participatory Medicine list, ever recall a patient praising the role of their PHR in their care. Today’s PHRs are clinically irrelevant.”

This is not a condemnation of PHRs, but of the environment in which vendors try to deploy them. Many health reformers feel that several aspects of this care environment must evolve for PHRs to be accepted:

  • PHR data must become appealing to doctors. This means that device manufacturers (and perhaps patients themselves) must demonstrate that the data is accurate. Doctors have to recognize value in receiving at least summaries and alerts. Many benefits can also accrue from collecting vital statistics, behavioral data, and other aspects of patients’ daily lives.
  • The doctor’s EHR must seamlessly provide data to the patient, and (we hope) seamlessly accept data from the patient–data that the doctor acts on. Currently, most manufacturers store the data on their own sites and offer access through APIs. Another programming step is required to get the data into the PHR or the doctor’s EHR.
  • Clinicians have to agree on how to mark and collect the provenance of data. “Provenance” deals with assertions such as, “this data was generated by a Fitbit on October 10, 2014” or “this diagnosis was challenged by the patient and changed on August 13, 2010.”
  • Add-on services must make the data interesting and usable to both patients and physicians. For instance, such apps can alert the patient, clinician, or family members when something seems wrong, let them visualize data taken from the PHR and EHR over time, get useful advice by comparing their data to insights from research, and track progress toward the goals they choose.

“A critical force in increasing consumer engagement in digital health is the development of compelling, easy to use tools that make it simple to collect, understand and use health information to reach the goals consumers define for themselves, whether that’s managing a chronic condition, saving money, or fitting into their ‘skinny jeans’,” writes Lygeia Ricciardi, former director of the Office of Consumer e-Health at the ONC. “In an age of ‘one click purchasing,’ it must become incredibly easy for patients to access and share their own health information digitally–if it’s too complex or time consuming, most people probably won’t do it.”

In addition to sheer inertia, a number of disincentives keep PHRs from congealing.

  • Many doctors are afraid of letting patients see clinical notes, either because the patient will ask too many questions or will be upset by the content.
  • Hospitals and clinics want control over records so that patients will return to them for future treatment.
  • Marketing firms live off of rich data lodes on our health data.
  • Other organizations with dubious goals, commercial and governmental, want to track us so they can deny us insurance or control our lives in other ways.

Wait–what about the patients themselves? Why haven’t they risen up over the past several years to demand control over their data? Well, maintaining your health data is intimidating. The data is highly detailed and full of arcane medical concepts and terminology. Most patients don’t care until they really need to–and then they’re too sick and disabled to form an effective movement for patient control.

Still, several leaders in health care believe that a viable business model can be built on PHRs. The spark of hope comes from the success of apps that make people pay for privacy, notably SnapChat and Whatsapp. Although some sloppy privacy practicies render these services imperfect, their widespread use demonstrates that people care about protecting their personal data.

Private storage can be offered both in the cloud and by personal devices, using standardized services such as Direct and Blue Button. These will start out as high-end services for people who are affluent and have particular concerns about storing their own data and choosing how it is shared. It will then become commoditized and come down in price.

What about people who can’t afford even the modest prices for cloud storage? They can turn patient data into a civil rights issue. There’s a potent argument that everyone has the right to determine who can get access to their health data, and a right to have data generated during their daily lives taken into account by doctors.

We don’t need one big central service–that’s insecure and subject to breaches. Multiple services and distributed storage reduce security risks.

We’ll see change when a substantial group of people start to refuse to fill out those convoluted forms handed to them as them enter a clinic, saying instead, “Get it from my web site before you treat me.” Before that protest begins, there’s a lot of work in store for technologists and businesses to offer patients a usable record system open to the wide range of data now available for health.

HealthTap Offerings Track the Evolution of Health Care

Posted on August 15, 2014 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 (http://oreilly.com/) 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.

Health care evolves more quickly in the minds of the most visionary reformers than in real health care practices. But we are definitely entering on a new age:

  • Patients (or consumers, or whatever you want to call them–no good term has yet been developed for all of us regular people who want better lives) will make more of their own decisions and participate in health care.
  • Behavior change will be driven by immediate interventions into everyday life, and health care advice will be available instantly on demand instead of waiting for an annual visit to the doctor. Health care will be an integrated into life activities, not a distinct activity performed by a professional on a passive recipient.
  • Patient information will no longer be fragmented among the various health care providers with whom the patient comes in contact, but will be centralized with the patients themselves, integrated and able to support intelligent decision-making.
  • Mobile devices will be intimately entwined with daily behavior, able to provide instant feedback and nudges toward healthy alternatives.

I have seen this evolution in action over several years at HealthTap, a fascinating company that ties together more than 10 million patients a month and more than 62,000 doctors. I interviewed the charismatic founder, Ron Gutman, back in 2011 before they had even opened their virtual doors. At that time, I felt intrigued but considered them just a kind of social network tying together doctors and patients.

Gutman’s goals for health care were far greater than this, however, and he has resolutely added ratings, analytics, and other features to his service over the years. Most recently, HealthTap has moved from what I consider a social network to a health maintenance tool with continuous intervention into daily life–a tool that puts public health and patient empowerment at the top of its priorities. And it may go even farther–moving from seeking help on illness to promoting health, which Gutman describes simply and winningly as “feeling good.”

The center of the offering is a personal health record. Plenty of other organizations offer this, most famously Apple’s HealthKit. HealthTap’s personal health record is unique in supporting the service’s search feature, where patients can search for advice and get results tailored specifically to their age, medical conditions, etc.–not just the generic results one gets from a search engine. It also ties into HealthTap’s new services, including real time virtual consults with doctors.

09-TAKE-ACTION-Customized-Checklists-HealthTap
Sample update from HealthTap

Gutman is by no means interested in maintaining a walled garden for his users; he is looking for ways to integrate with other offerings such as HealthKit and with the electronic health records used by health providers. He says, “The only entity that will win the game is the one that adds the most value to the user.”

Other new features tied in to the HealthTap services include:

  • A recommendation system for apps that can improve health and well-being. The apps are rated by the doctors within the HealthTap system, must be in Apple App Store or Google Play, and must be approved by the FDA (unless they are part of the large, new category of apps that the FDA has chosen not to regulate).
  • Off-the-shelf checklists to help patients manage medication, keep track of healthy behaviors, etc. As part of HealthTap Prime, a concierge service ($99 per year for the first person and $10 for each additional family member), the user can get personalized checklists from doctors, as well.
  • With the concierge service, subscribers also have the opportunity to directly contact a doctor any time, 24/7, on all popular mobile platforms, using live video, voice, and text.
  • The “Get Help” module in the HealthTap app provides useful checklists through all mobile devices, and even Android wearables. Patients can get reminders, useful links to relevant content, and other content pushed to their devices, at a pace they choose.

Some of these features–such as the recommended apps and personalized checklists–go beyond advice and constitute a type of treatment that is subject to legal liability. HealthTap has covered all its bases insuring doctors have insurance against mistakes.

The numbers show that HealthTap is a big community; comments received from Gutman about patients who say they’ve saved their lives show that it is an effective one. I think the choices they’ve made are insightful and illustrate the changes all health care institutions will have to make in order to stay relevant in the twenty-first century.

New Year’s Resolution: Take the #BlueButton Pledge

Posted on January 3, 2014 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

I rarely make New Year’s resolutions, but 2014 finds me ready and willing to finally take the Blue Button pledge. Perhaps my impetus stems from the healthcare I received in 2013 (more than I would have liked), and the fact that I have logged onto to at least two different patient portals (not including my kids’) that of course can’t communicate with one another.

bluebuttonpledge

I’m even more anxious to give Blue Button a go after reading that the ONC has recently announced it is working towards incorporating the following Blue Button features:

  • the Blue Button Connector: a tool that will help patients find out which providers, health plans, and others offer Blue Button
  • OpenNotes, giving patients access to their providers’ notes
  • images such as EKGs
  • lab, medication and patient-generated data
  • vaccination records
  • Explanation of Benefits forms from payers and
  • a tool that will match eligible patients to clinical trials.

bluebuttonthankyou

As a patient, I decided to take the non-data holders’ Blue Button Pledge, whereby I “pledge to engage and empower individuals to be partners in their health through information technology.” I’ll do this by actively trying to bring all of my health data into one digital repository, and blogging about it along the way. Hopefully, I can paint a picture of how having this information at my fingertips benefits my care in some way. I already foresee it helping me to become more engaged.

I’ll also make it a point to bring up the Blue Button initiative with all of my providers. I’ll be interested to see who has heard of it, who thinks it’s a good idea, and who is so overworked they don’t have much time for it. Look to future posts for the nitty gritty of what it takes to actually gather disparate health data and put it in one place.

Have you taken the Blue Button pledge? How has it impacted your care, or that of your patients? Let me know in the comments below.

Giving Up on Digital Patient Engagement

Posted on May 10, 2012 I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

I’ve been a big fan of the “engaged patient” for about as long as I’ve known what the term meant, but until earlier this week, I hadn’t given much thought to the burden Meaningful Use requirements potentially place on providers to create these types of folks.

As I’m sure most readers know, comments on proposed Meaningful Use Stage 2 requirements were due to CMS this past Monday. Many organizations not only turned in comments, but released summaries of those comments to various media outlets as well.

Lynn Scheps, Vice President of Government Affairs at SRSsoft, has done a nice job of drawing out a few major themes from comments submitted over the 60-day period. In her most recent Meaningful Use Monday blog, she points out that:

“While increased patient engagement is recognized as an important goal, providers are expressing concern about having their incentives be dependent on actions by patients—actions over which they have no real control. For example, one proposed measure would require that 10% of patients access their information on the physician’s portal, and another that 10% of patients send a secure e-mail message to their physician.”

Now, as I’ve written (or tweeted) about before, I’ve tried to get into using a personal health record, and just found it to be too much trouble, too time consuming. If I, a fairly digitally savvy healthcare consumer (and thankfully a fairly healthy one), can’t keep up with a PHR, how likely is it that patients who don’t even have an email address will immediately jump onto their physician’s portal or send e-mail messages to their physician.

And it should probably be pointed out that those who make up the bulk of healthcare costs in America – the chronically ill and/or obese – most likely consist of patients in underserved communities, people who don’t have consistent access to the Internet. It’s a systemic problem that I could write at length about, but I’ll save that for another blog altogether.

On the flip side, the Robert Wood Johnson Foundation, in its Stage 2 comments to CMS, called for the criteria around patient engagement to be either maintained or enhanced. Its views on doubling the 10-percent threshold of patients viewing, downloading or transmitting their health information seems fairly indicative of their stance on the criteria as a whole:

“This change would provide an incentive to health professionals to adopt patient-facing platforms that have the potential to increase patient engagement and self-care.”

Needless to say, it will be interesting to see what route CMS takes when it issues a final rule sometime in August. I do hope that it errs on the side of conservative optimism, and keeps its proposed patient engagement criteria, rather than decreasing or banishing them altogether. Hopefully this can help healthcare overcome its bad habit of protracted procrastination and, with the tiniest of baby steps, help physicians get over the hump of getting themselves, and their patients, on the digital bandwagon.

Ruined Healthcare IT Words

Posted on April 10, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com 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 InfluentialNetworks.com and Physia.com. 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 know that I spend far too much time talking, writing, tweeting, posting, commenting, obsessing over everything EMR and Healthcare IT related, but doing so has had some interesting consequences when it comes to certain words or abbreviations. Let me give you some examples of Healthcare IT words or abbreviations that have been tainted one way or another.

Meaningful – I honestly can’t even use this word any more. Meaningful Use has ruined the word meaningful for me. I definitely can’t use the word meaningful in healthcare anymore without cringing. It’s like a permanent built in pun for meaningful now. Plus, meaningful just isn’t meaningful anymore because it’s been used so much. Meaningful will be forever tainted in my vocabulary.

PHR – I expect we’re going to see the general death of the word PHR. Too many failed EHR softwares have ruined this word. I’m sure we’ll still have many of the functions and features that PHR software offers and many PHR software will be around, but we’re going to see a new branding of what they do. Yesterday I heard one called Patient Relationship Management (PRM I guess) which could be a good replacement for the tainted PHR term.

mHealth – This word is a bit like PHR in that we’re still going to see plenty of mobile health, but I think the term mHealth is going to go away. Eventually mobile will just be an extension of healthcare IT and healthcare in general. We’ll still see some residual naming, but most won’t differentiate.

I’m sure there are a lot more. What other healthcare words or abbreviations have lost life for you?

Health Plan and Employer PHR

Posted on April 6, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com 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 InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

After the fall of Google Health, many had written off PHR (Personal Health Record) software as dead and gone. I can’t say that I had much hope for PHR software myself. Although, some of the recent moves by PHR vendor NoMoreClipboard have me pausing to reconsider what value a PHR could provide. My gut tells me they might want to distance themselves from the toxic term, PHR, but they’re definitely being creative with the platform they created.

Right before HIMSS I covered how the PHR could help to facilitate an ACO and Patient Centered Medical Home. Both ACO and PCMH are much more popular terms these days and quite frankly many are still trying to figure out how to make them a reality. I could see a PHR helping to make this happen.

Just yesterday, NoMoreClipboard announced a partnership with Healthx which makes PHR software available to Payers and Employers. I know that many in the investment world are arguing against trying to get money from payers and employers for wellness programs as a startup company. Although, NoMoreClipboard is not a startup company and I have little doubt that integrating their PHR with the Healthx portal was not easily accomplished. I’ll be interested to hear how many of the 12 million people who use Healthx end up using the PHR as well.

Add in the meaningful use stage 2 requirements that PHR can fulfill and maybe just maybe the PHR are back in style. Although, they’re not the PHR that most thought it would be. Instead, it’s taking on new forms that give it an interesting new life.

PHRs – A Difficult Pill to Digest?

Posted on October 31, 2011 I Written By

Priya Ramachandran is a Maryland based freelance writer. In a former life, she wrote software code and managed Sarbanes Oxley related audits for IT departments. She now enjoys writing about healthcare, science and technology.

A report from Manhattan Research earlier this month had some interesting statistics on consumer access to electronic medical records. According to the report, 56 million Americans accessed the patient records available from their medical providers’ EMRs, and another 41 million said they were interested in viewing their medical records online. Manhattan Research gets this information from surveying 8745 adults online and by phone in Q3 2011. Assuming the statistical basis for extrapolating this survey of 8745 people to the entire US population is sound (Nielsen does something similar to arrive at its daily media numbers), that’s a good 97 million people who are interested enough to have already accessed their records or are interested enough to, if given a chance.

But you know what’s the surprising tidbit? 140 million Americans have not used and are not interested in viewing their own medical records online! Predictably enough the report attributes this massive reluctance to an older or less tech-savvy population. I’m not sure how this will play out with the less tech-savvy population. With the older generation, this might just translate to access and maintenance of personal PHRs falling on authorized proxies – caregivers or adult children. Maybe this will span an entirely new profession – personal health advisers of sorts – whose sole job is to view your online medical records, explain them in plainspeak and research and offer up options. Certainly something to think about!

What Should We Make of Google Health’s Failure?

Posted on June 26, 2011 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

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?

Patient Centered Care Options

Posted on June 1, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com 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 InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Interesting list of options for patient centered care. I talk a bit about this in this healthcare IT and Active Patient care video. I wonder what other patient centered care options are missing from this list.