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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.

What is Direct?

Posted on June 10, 2014 I Written By

Julie Maas is Founder and CEO of EMR Direct, a HISP (Health Information Service Provider) whose mission is to simplify interoperability in healthcare through the use of Direct messaging EHR integration and other applications. EMR Direct works with a large developer community to enable Direct for MU2 and other workflows using a custom, rapid-integration API that's part of the phiMail Direct Messaging platform. Julie is passionate about improving quality of care and software user experience, and manages ongoing interoperability testing within DirectTrust. Find Julie on Twitter @JulieWMaas.

John’s Update: Check out the full series of Direct Project blog posts by Julie Maas:

The specialist down the street insists he wants to receive your primary care doctor’s referrals, but only if it’s digital: “Sure, I’ll take your paper file referral sent via fax. But the service will cost an extra $20, to pay the scribe to digitize the record so I can properly incorporate the medical history.”

Does it really sound that far off? Search your feelings, Luke…

Will getting medical treatment using paper records soon be like trying to find somewhere to play that old mix tape you only have on cassette?  Sound crazy?  Try taking an x-ray film to a modern radiology department, and see if they still have a functioning light box anywhere to look at it.  It’s all digital now.

There are, of course, other factors.

Because MU2.

Because nobody, and I mean no small company and no large company, wants to be referred to as a data silo anymore.

Direct Exchange is a way of sending and receiving encrypted healthcare data, and certified EHRs must be able to speak it, beginning this year.  Adoption of Direct is increasing rapidly, and its secure transfer enables patient engagement as well as interoperability between systems that were previously dubbed silos.  Here is a brief overview of where Direct is currently required in the context of MU2 (please refer to certification and attestation requirements directly, for full details):

Certified ambulatory and acute EHRs need to use Direct for Transitions of Care (170.314(b)(1) and (b)(2)). They have to be able to Create a valid CCDA and Transmit it using Direct, and they have to be able to use Direct to Receive, Display, and Incorporate a CCDA. In the proposed MU 2015, the Direct piece may be de-coupled from the CCDA piece and modularized for certification purposes, but the end to end requirement would remain the same.

EHRs or their patient portal partner additionally need to demonstrate during certification that patients can View, Download, and Transmit via Direct their CCDA or a human readable version of it.  Yes, you heard correctly, I said patients.  As in patient engagement.

So, how does a healthcare provider get Direct?

1. Get a Direct account through your Direct-enabled EHR vendor

One way HIT vendors offer Direct is through a partnership with one or more HISPs (OpenEMR, QRS, Greenway, and others).  Others run their own HISPs (Cerner, athenahealth, and others).

2. Get a Direct account through an XD* HISP that’s connected to your EHR

HIT vendors alternatively enable access to Direct through an XD* plug-and-play (mostly) connector.  These “HISP-agnostic” EHRs allow healthcare organizations a choice between multiple XD*-capable HISPs when meeting MU2 measures (MEDITECH, Epic, Quadramed, and other EHRs have implemented Direct this way).  EMR Direct, MaxMD, Inpriva, and a few other HISPs offer XD* HISP services; not every HISP offers XD* service at this time.  Of course, there is a trade-off between this flexibility and the extra legwork required of the practice or hospital in setting up Direct.

3. Get a web-based or email client-based Direct account not tethered to an EHR or Personal Health Record (PHR)


Direct doesn’t have to be integrated into an EHR to transfer information digitally. Non-tethered accounts cannot attest to the sending side of (b)(2) nor the receiving side of (b)(1) on their own, but they can be Direct senders and receivers nonetheless, participating in Transitions of Care or data transfer for other purposes.  They may also be used to exchange health data with patients, billing companies, pharmacies, or other healthcare entities who are Direct-enabled. In fact, some very compelling use cases involve systems who may not have their own EHR, but want to receive digital transitions of care—one such example is skilled nursing facilities.

By the way, patients are also an integral part of the Direct ecosystem.  Several PHRs are already Direct-enabled, and more are on the way.

So, go digital and get your Direct address, and begin interoperating in the modern age!

Patients Benefit From Access To EHR Data

Posted on April 8, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

While doctors may not be completely comfortable with granting patients access to their EHR data, new evidence suggests that doing so produces significant benefits.  A new study published in the Journal of Medical Internet Research has concluded that granting patients such access “overwhelmingly” yields positive results, according to a report in FierceEMR.

To track the benefits of patient data access, researchers studied the My HealtheVet EHR pilot program, which gave access to the initial PHR established by VA. The pilot recruited 7,464 patients at nine VA facilities between 2000 and 2010.  An enrolled patient completing in-person identity proofing could access clinic notes, hospital discharge notes, problem lists, vital signs, medications, allergies, appointments, and laboratory and imaging test results. They could also as enter personal health data, access educational content and authorize others to access the PHR for them.

To evaluate the impact of the pilot, researchers from within and outside of the VA conducted focus group interviews at the Portland, Ore.-based VA Medical Center, which had 72 percent of pilot enrollees.

In discussing the program with patients, researchers found that they did have some negative experiences, such as reading uncomplimentary or offensive language in notes, concerns with inconsistencies in content and some technical problems with the EHR, FierceEMR reports. On the other hand, having access to their data improved patients’ communication with clinicians, coordination of care and follow-through on key items such as abnormal test results, the study found.

That being said, there are some repercussions to offering this access, researchers found. Though having access to notes and test results seems to empower patients, increase their  knowledge and improve self-care, it does have an impact on how physicians practice. “While shared records may or may not impact overall clinic workload, it is likely to change providers’ work, necessitating new types of skills to communicate and partner with patients,” the authors said.

Connected Healthcare Consumption Starts with Equal Access

Posted on August 2, 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.

It’s that time of year again – back to school. My oldest daughter’s first day went smoothly. She came home talking of magic Play-Doh, songs about alligators in elevators, and imbibing “pink” milk, which I’m surprised is even an option in the lunch line. I guess there’s just no getting around these temptations, or 1st grade peer pressure. That being said, I think I’ll pack her lunch tomorrow.

The novelty of my daughter eating a hot lunch at school for the first time reminds me that healthy eating habits can and should start at a young age. And I think the same can be said of healthy technology habits. I think it’s no secret that extremely young children are pretty good at using a variety of Apple devices, and so I wonder how we can combine these two efforts to help children learn how to make good healthcare choices that will continue to benefit them throughout their lives. Perhaps in the near future we could see these kids regularly accessing a personal health record, securely emailing their doctor or routinely using telemedicine services – and having it be no big deal.

But I’m getting ahead of myself a bit here. I should add that my daughter is at a new school, one that seems to have more technology resources than her last. How then we do we ensure that the difference in resources doesn’t prevent a divide from opening up, enabling one group of kids to do more with more, while their counterparts have to do less with less?

I’ve come across several news items recently that tie into this very question. According to Open Colleges, which produced the awesome infographic below, 91 percent of teachers in the U.S. have access to computers in their classrooms, 81 percent believe tablets enrich classroom learning, and one in five students have used a mobile app to organize coursework. On top of that, the company’s research found that teachers that integrated digital games into lessons increased average test scores by 91.5 percent compared to non-digital games. I highly advise checking out the infographic at its intended size for more interesting tidbits.

While these statistics are all well and good, how can students in underprivileged communities continue to keep up with technology at home? I came across a blurb in one of my daughter’s school e-newsletters about Internet Essentials, a Comcast program that offers qualifying families (typically those who students who qualify for free or reduced school lunches) Internet service for $10 a month. The program also offers qualifying customers $150 computers, and Internet training. The screenshot below gives you an idea of additional resources provided.

To me, it’s this kind of basic access to reliable Internet, training and resources that will ultimately help this country transition its healthcare system. I think the more educated we are about how technology can help us lead healthier lives, the more accountable we’ll make the entire system – from ourselves as patients to our providers, insurance carriers and ultimately our government.

My daughter might say that day will come when alligators DO ride elevators, but I prefer to remain optimistic and hope that it will at least occur in her lifetime.

EMRs Coming to a School Near You

Posted on July 5, 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.

As I mentioned in a previous post, my family and I are experiencing one of our busiest summers ever. With our decision to become landlords comes a simultaneous decision to move to a new area, for the usual reasons. We’ve found ourselves in love with a house in an entirely different county, and thus a new school system.

Now I don’t know about you, but summers seem to be getting shorter and shorter when it comes to the school calendar. Weeks between Memorial Day and Labor Day seemed to stretch on endlessly. But now we’re lucky to get a full eight weeks of summertime fun. Needless to say, we’ve got just about four weeks to get into our new home before the school year starts.

I’ll be registering our oldest daughter soon after the 4th of July break, and on my list of questions will be “Is there a school nurse on campus at all times?” After reading a recent article at, I may just have to add, “Does the school participate in exchange of electronic medical records with local healthcare facilities?”

The article relates that Pennsylvania’s Bethlehem area school district’s board has approved “joining a regional partnership that would make the electronic medical records of Bethlehem and Allentown School District readily available to emergency room doctors and nurses alike.”

The Children’s Care Alliance is a partnership between the school districts and four hospital/healthcare systems. You can read the article linked to above for most of the details.

I’d also be interested to learn how they are going to go about choosing an EMR vendor. Will it be a strictly pediatric solution? It would be interesting to see an EMR created from scratch for the sole purpose of serving students in public school populations. Barring any HIPAA-related concerns, the opportunity for population health management research at this level would be enormous.

Being in the marketing business, I’d also be interested to know how they are going to get students and their parents to opt in to the program, and what sort of choices students will be left with if they opt out. Will they partner with local pediatricians to create support on that end? It seems like a great teaching tool with which to start creating a younger, more engaged patient base. Wouldn’t it be cool to have the school nurse come in to health class one day to explain the benefits of an EMR, and how students can access it or a corresponding, school-sponsored personal health record from the computer at their desk, or their iPads at home?

I do wonder, though, just how easily this alliance could be created in other communities. The price tag of $2.3 million seems high.

Perhaps I’ll ask that very question when I head to the school registration offices next week.

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.

Increase in Patient Self Pay Increases Collection Risks

Posted on May 4, 2012 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.

There is a major trend that is happening in healthcare that is going to impact the economics of healthcare in a major way. This trend is the increase in Patient Self pay. There are a number of factors which are causing more patients to pay for their medical expense including lost jobs and employers dropping health insurance coverage. I’ve heard a number of people predicting the move to a patient focused payment model with high-deductible insurance plans. In fact, this New York Times article says “The share of employees enrolled in high-deductible plans surged to 13 percent in 2011 from 3 percent in 2006, according to Mercer Consulting.”

Personally I think this is a great thing for healthcare since I’ve long been a proponent that any healthcare reform needs to put the consumer (patient if you prefer), not the insurer or the government at the center of the healthcare financial system. However, this change also poses a risk for practices and hospitals since the risk inherent in collecting self-pay balances rises in parallel with this increase in patient self pay.

How then are EHR vendors and revenue cycle management companies dealing with this shift to patient self pay?

This certainly won’t be a comprehensive list of ways that revenue cycle management can help with patient collections, but it will show a few ways technology can help now and in the future.

EHR software can integrate a Patient Pay Estimator to provide patients a close approximation of their final bill which helps a practice collect payment before they leave. The software physicians use to estimate the patient total for an office visit are going to have to get better and more accurate. I don’t have the numbers in front of me now, but I’ve seen multiple studies that illustrate well how the key to good patient collections is to get the money while they’re present. Once the patient leaves your office your ability to collect from that patient drops dramatically.

I know I’ve been to a lot of doctors where I get to the front desk and they don’t know what to charge me. Far too often they just say, don’t worry about it, we’ll send you a bill in the mail. If they just had the right information available to them, they could collect the money on the spot and not have to worry about collecting it from me later. An EHR can really facilitate this process if it has a good patient liability estimator built into the EHR.

In the cash or check world, it was much harder to set up budget plans or recurring payment. Now there are more and more systems out there where you can store a person’s payment information and set up the recurring payment to happen automatically. This will likely be a key trend going forward.

I’ve even seen some of the larger EHR vendors who have programs that offer financial assistance. In fact, the really large EHR vendors have whole financing divisions that can assist patients who have financial issues related to their healthcare. I wonder how deeply these financing options can be integrated into EHR software, but I could see it as a big advantage to have it as an integrated part of the payment workflow. I’m always amazed at how quickly you can be approved for a credit card or financing a car. I expect this type of financing will be pushed down throughout the various layers of healthcare. Will it become a differentiating factor in a large EHR vendor versus a small EHR vendor?

Another interesting idea to stem the patient payment problem is to accept prepayments. Meaningful Use is bringing the patient portal and PHR software back to the forefront of many EHR implementations. If you have patients filling out the paperwork for their office visit, why not collect the co-pay at the same time? Pre-payment could become a really great way to avoid revenue cycle management issues on the back end.

I’d love to hear other people’s thoughts related to patient payment and revenue cycle management trends. What can be done to help avoid the patient self pay collections issues?

Ruined Healthcare IT Words

Posted on April 10, 2012 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 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 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.

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!