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TechnologyDaily Mobile
The Push For Personal Health Records
by Aliya Sternstein
Technology companies are zealously introducing services that let consumers collect and store medical information from their doctors, support groups and other caregivers.
The presumed benefit of such "personal health records," or PHRs, is patient empowerment. The hope is that if patients have such information at the ready, they can help synchronize the currently fragmented and paper-based healthcare system, which in turn will help drive down medical errors and costs.
But some observers say the likely reality is that few consumers are going to use the products immediately because they do not add much value in today's healthcare delivery system. "There's a massive education component to this thing," said Scott Wallace, president and CEO of the National Alliance for Health Information Technology.
Consumers first must be convinced that the programs are private and secure. Also, they need to understand why PHRs are relevant: "If they already think that the provider has all of this information, why bother," Wallace added. Finally, doctors and other providers have to be convinced that the patient information is valid; they hesitate to trust data about patients that comes from patients.
The Makings Of An E-Health Market
Microsoft, Google and Intel believe their PHR ideas can deliver immediate value for consumers and the firms' bottom lines.
Earlier this month, Microsoft launched the HealthVault program to let consumers collect and make sense of information from patients' doctors, pharmacies, weight-loss groups and all manner of medical applications. The tool is free and the company plans to make money from partnerships and advertisers.
In June, Google announced it has an advisory council of healthcare providers, consumer and disease groups, physician organizations, research institutions, and experts from other fields to offer feedback on health-records product development.
And last month, Intel and Wal-Mart -- part of a coalition of large employers that is pulling health data together for their employees to use in PHRs -- said they have a new technology provider and new members. AT&T and sanofi-aventis are the latest firms to join the employer-driven project, dubbed Dossia. Likewise, Verizon is now offering PHRs to 38,000 employees.
Having multiple players in the field will fuel the shift toward patient-controlled healthcare spending and treatment, said David Kibbe, former director of the Center for Health IT at the American Academy of Family Physicians, where he now works as a senior adviser. At the outset, he said mostly people with chronic diseases or without employer-based health insurance will take advantage of the offerings.
Within five years, PHRs will supplement a national network of physician-owned electronic medical records, according to Center for Democracy and Technology President Leslie Harris.
"There is strong interest in PHRs by employers as a tool to encourage employees to take more responsibility for their healthcare and to participate in wellness programs," she said. "At the same time, people remain very concerned that their privacy can be protected in an interconnected healthcare system. And they have reason to be concerned."
Current privacy laws for non-medical records are thin. And some privacy advocates maintain that companies are creating PHRs in hopes of encouraging consumers to add personal information that can be searched, sold or used to discriminate. However, others say that software companies, with their information security expertise, are perhaps best-suited to be the intermediaries between healthcare providers and patients on the information superhighway.
More Evolution Than Revolution
A Google or a Microsoft can create a bridge to encourage the flow of information, said David Lansky, director of the Markle Foundation's personal health technology initiative. There is "this need for trust and this need for some standards on how information is shared."
The right technology combined with the right kind of healthcare system will encourage consumers to use PHRs, added David Merritt, a project director at the Center for Health Transformation. As the burden of healthcare costs shifts to the consumer, eventually PHRs are going to become necessary, he said.
"I think you can see the changes starting to occur with [health savings accounts]. Consumers taking on higher premiums, higher co-pays," Merritt said.
It remains unclear whether physicians will buy into PHRs, although some have begun to embrace them. Kibbe said he thinks family physicians have enough resources and know-how to interact with Microsoft's HealthVault.
"I'm hearing all the time from our members that they are willing to participate in health 2.0," he said. "We believe that patients that take some control, responsibility for their healthcare, are better patients to work with."
Other physicians are less enthusiastic. Scot Silverstein, a physician, consultant and former director of Drexel University's Institute for Healthcare Informatics, said one of the many "false assumptions" about PHRs is "that the lay public has the ability to interact with complex medical data in a meaningful manner [and] can help steward that information when people often don't do it well with old-fashioned pencil and paper."
The companies are looking for "an easy next big thing," and "may have been had" -- by people with great ideas, presentation skills and the ability to start fads but who lack depth in understanding social issues in informatics, Silverstein said. "AT&T's core competence is not medicine, nor biomedical informatics, as far as I recall."
A Mix Of Confidence And Caution
The technology firms are confident in their ambitions. Of the 38,000 employees eligible for Verizon Communications' PHRs, currently less than 2,500 are using them. But Audrietta Izlar, the company's senior benefits consultant, said, "I think demand will increase along with awareness."
"I liken it to the introduction of technology to the banking industry such as ATMs and online banking," Izlar said. "People need to grasp the concept and then realize how practical and secure it is."
The e-health firm WebMD does not disclose customer statistics publicly but claims it is the market leader in PHRs and will continue to be the leader. "WebMD is deeply engaged in providing greater connectivity to our end users, helping them to connect electronically with their care providers, while also making their lifelong PHR portable," the company said in a statement.
More than 5 million employees and family members will be eligible for the Dossia system when it starts to go live by the end of the year, according to Dossia President Colin Evans. "An employee could certainly put their own health data into another PHR system ... but [employees] will not get the benefits of this data being assembled for them and they would have to ask Google or Microsoft about their privacy policies and what their data is being used for," Evans said.
Some consumer advocates suggest a "buyer beware" approach for now with respect to PHRs.
"I just wonder if the company that tells you that they won't [sell your data] is still going to be the company -- in five years -- that tells you it won't sell your data. I don't know," said Deven McGraw, chief operating officer of the National Partnership for Women and Families. "Read every little spec of fine print" to see if the systems are as protective of privacy as expected.
As for whether she personally would use a PHR, McGraw said, "Ask me again in a year."
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