Comments for Personal Health Records: Lots of Interest, but Few Users

Personal Health Records: Lots of Interest, but Few Users

2009-01-15T20:38:16Z

According to Manhattan Research, a healthcare market research company, personal health records (PHR) are slowly becoming more popular in the U.S., but concerns about privacy and a lack of understanding, as well as doubts about the efficiency of PHRs are holding back widespread adoption. Only about 7 million adults in the U.S. actually use PHRs. Especially those without serious illnesses often don't see the need for using electronic health records.

]]> Microsoft's HealthVault (our review), Google Health, and WebMD all offer interesting and consumer friendly services, but they have not been able to gain significant traction in the marketplace, even though there is compelling evidence that electronic records can reduce the chance of medical errors significantly.

What is Holding People Back?

According to Erika S. Fishman, Manhattan Research's Director of Research, besides privacy concerns, one of the biggest hurdles to overcome for the adoption of PHR is a lack of motivation among Americans to use these records unless faced with live threatening illnesses.

Meredith Abreu Ress, Manhattan Research's VP of Research, also doesn't expect to see PHRs to take off this year. As she points out, its hard to see what would motivate patients to curate their own health records when most doctors still have "your entire medical history in a coffee-stained manila folder."

Obama: Electronic Health Records for All Americans

As Greg Sterling pointed out over a year ago, the success of PHRs will be "tied in to the political outcome of universal healthcare initiatives." President-elect Obama has made electronic health records a cornerstone of his administration's proposed health policy, but some groups are already voicing concerns about the privacy implications of creating electronic medical records for all American.

According to CNN, in American, only about 8% of hospitals and 17% of physicians keep electronic records of the kind that Obama envisions and that President Bush also proposed in 2006. The administration hopes to make all medical records available in electronic form by 2014.

CC-licensed Image of 'health card' courtesy of Flickr user juhansonin.

Comment from ParanoidSchizo on 2009-01-15

2009-01-15T21:57:16Z

What's gonna stop the NSA from spying into my health records now?

Comment from http://id.rogersplus.net/rogersdc on 2009-01-15

2009-01-15T23:53:10Z

Meredith Ress hit the nail: why would I spend a lot of time creating an online medical record when it won't be used? If there is no benefit to doctors to convert to an online record system, they won't do it. And, honestly, neither will I.

Even if one of my doctors uses online medical records, what if he uses one of the services that I didn't? I may choose Google, but maybe my doctor is a big Microsoft fan. Or, worse yet, what if my doctor chooses a system that only a few medical offices have purchased, and then my records are locked in to his office. If the records are not accessible regardless of which system my doctor or I choose, there is no benefit to either of us.

Comment from Diane Fowler on 2009-01-15

2009-01-16T01:06:12Z

I think people really need to better understand where their exposure is and where it isn't regarding electronic information. my mother would say: if the president elect's blackberry can be hacked, how do I know this less secure website is safe? My gut says there need to be more universal terms and repositories of information on digital safety and security before most folks will feel comfortable storing their most personal information electronically.

Comment from MIke on 2009-01-15

2009-01-16T03:41:46Z

PHRs as simple information repositories have indeed have limited updatake. However, the new generation of PHRs like Google health (GH) and Microsoft Health Vault (MHV) are taking a different approach - rather than asking the patient to type in their health information, these systems can pull the patients record from their hospitals - thats a good start.

Secondly, both GH and MHV allow third-party applications to interact with the patients PHR (with their consent) to provide better services. For example, immunization reminders to patients if they are due for the next vaccine dose. More advanced apps like TrialX make personalized clinical trials recommendations based on a the users PHR information.

More such apps will make the "static" information in the PHR more useful to the patient and hence drive adoption.
Obviously privacy remains a concern but with everything there are risks and benefits and technical security measures can mitigate the privacy concerns significantly.

Comment from Robert Rowley, MD on 2009-01-15

2009-01-16T05:49:32Z

By themselves, stand-alone PHRs are simply empty containers. There will be some enthusiasts who fill in their information in order to have it in one place, but its utility is limited. The real key to having PHRs that are useful are ones that are automatically populated by, and linked to a patient’s physician’s EMR.

EMR adoption by physicians has been low, largely limited by expense and disruption in ordinary workflows in physician offices. And, of the traditional EMRs in the market, mainly the large and most costly systems are the only ones that have patient portals – few have good linkages with stand-alone PHR endeavors.

New technologies are arising, however. Secure, web-based, hosted, easy-to-use EMRs (so-called “EMR 2.0” systems) are being developed and introduced into the market. Practice Fusion, for example, is a free EMR with an innovative business model that uses advertising in order to offer a free service to physicians. The hopes of widespread adoption of these kinds of systems will make patient portals valuable – a PHR populated by the physician’s EMR, which also offers a secure interface by which patients can interact with their physicians, arrange appointments, review when specific health screenings are due, and so forth. It is when this kind of linkage is made that a PHR becomes something truly of value, and its adoption will become dramatically more wide-spread.

Comment from John@Chilmark on 2009-01-16

2009-01-16T17:00:11Z

Hey folks, it is still very early in the game here for PHRs and adoption numbers are all over the map. Why, really quite simple, it all about value and no, it is not about privacy risk, that is a ruse put out there by those that would rather control your records, than having you directly control them yourself.

So adoption...
Kaiser-Permanente has a PHR, really a tethered consumer portal to their EMR from EPIC called MyChart. KP has done a fantastic job with putting a lot of value in that PHR and guess what, they are seeing adoption rates on the order of some 30+%. Let's look at employer EMC who is sponsoring WebMD's PHR for their employees. They have also done a superb job here, while insuring employee's privacy is maintain. PHR adoption at EMC is now at 50% - as with KP, EMC has packed a lot of value into that PHR that makes it truly useful to the employee.

Sure, with dismal adoption of EMR's among physicians we still have a long ways to go here folks, but go we will and consumers, not all, but many, will migrate out of necessity to taking a more proactive role in managing their health and PHRs will likewise become increasingly important.

Caveat to above: The immortals (btwn ages of 20-35) will be very late adopters, if at all.

Comment from Sue Reber on 2009-01-16

2009-01-16T17:05:41Z

Mr. Lardinois has done an admirable job uncovering the issues – privacy and connection to our medical records – that are delaying wide-spread adoption of PHRs. The Certification Commission for Healthcare Information Technology (CCHIT), a nonprofit organization with the mission of accelerating the adoption of robust, interoperable health IT, is doing something about that. The Certification Commission, its volunteer Advisory Task Force and technical Work Group, representing some of the organizations already mentioned, have begun work on developing a voluntary certification program for PHRs.

The Commission already tests and certifies electronic records used in doctors’ offices, hospitals, emergency rooms, and other settings. The Commission applies widely accepted standards to test electronic health systems and awards a “seal of compliance” to health information products that meet its criteria. This seal is a mark of quality, much as the seal of Underwriters Laboratories brings peace of mind when choosing electrical products.

We’re working to bring that same level of assurance to consumers who are considering use of a PHR product or service. We’ve heard that safeguarding privacy is the number one concern for consumers, but we’ll also be checking that PHRs keep your information secure, connect up with other sources of information, and do the things you need.

For more information about the Commission’s work with PHRs, go to http://phrdecisions.com, to get a consumer’s guide, download a podcast or find out how to comment on the Commission’s work.

Sue Reber, CCHIT

Comment from Hobart on 2009-01-17

2009-01-17T13:00:19Z

Advanced PMRs are the future. You the patient should own and control access to all your medical information. The healthcare providers and EMR software vendors have spent decades preventing an interoperable medical record because they want to control and own your medical data. There is money in datamining medical data. If patients own and control their medical data then they will make the money instead of those corporations who "steal" the data and try to keep it from you.

You will hear about "privacy concerns" from the corporations. But do you think they keep your medical data private? Hardly. They share it in any way they can to make more money. Go to your large medical provider and ask that your records only be seen by people who take care of you. They won't do it becausew they can't do it because the software can't do it.

Comment from Brad Murphy, CEO Valtech North America on 2009-01-17

2009-01-18T02:47:52Z

I have two major comments:

1st - EMR adoption resistance is NOT, and I repeat, is NOT primarily related to cost. At most, cost is 40% of the "issue". FREE EMR is definitely a "bonus" but cost is the minor objection.

2nd - Most importantly, the single biggest issue to overcome relative to EMR adoption is Physician patient interaction habits... Paper is AWESOME, if you are documenting uninstructed interactions with HUMANS! EMR today does little to help physicians overcome a very real barrier to adoption. How do we help them capture unstructured interactions that result in structured data capture by EMR systems. This is the holy grail of EMR. If we don't equip phycians with an equally compelling tool as PAPER, we're doomed to marginal adoption of EMR.

Comment from Brad Zdanivsky on 2009-01-18

2009-01-18T23:54:50Z

OK, people think security is the show stopper? Not true, but is what people instantly jump to and worry about.

Really this issue is granularity of information. How much and with whom do I want to share information with? As an example, I want to share my workout records with friend (joggers group), but I don't want my employer knowing I am HIV positive. So, how do we easily select these things and make it simple enough for say, my grandmother (because I need to keep tabs on her health and I live in a different city)?

These things must to be sorted out before people will see the benefits of getting rid of paper records. I see about 4 Docs and hate having to deal with records being CC'ed to each one or having to wait for one office to FAX it over.. it is just plain efficient and well.. dumb. Considering that we trust web (SSL) to pay our bills, why is this so hard to accept?

Oh.. I do think web voting is just too important to be done on private machines. Like open source and linux etc, this systems need to be 100% open to have any real credibility.

Brad
Verticalchallenge.org

Comment from H.K. on 2009-01-18

2009-01-19T04:33:49Z

Getting all the medical community to use these formats will not be easy. Accomplishing selective availability of the information is going to be difficult. Who needs to see what and how often? How do you manage your "account"? Despite what you or I might believe, the general public, the real users of this program, do need to be confident in the security associated with this.

Comment from John Shagoury on 2009-01-20

2009-01-20T19:42:05Z

Talking about patients adopting personal health records to some extent is a little “cart before the horse.” Before patients can implement electronic records as part of their health routine, the healthcare industry needs to get doctors to broadly utilize electronic health records to document their patient encounters – today only about 15-20 percent of doctors do this. While Obama’s goal to digitize medical records is a great one, it is important to ensure these EHR solutions are deployed in a way that makes them usable for doctors. So many doctors struggle with adoption because of the need to document via keyboard and the mouse, a process that can be time consuming and error ridden. One way to get doctors on board is to add speech recognition technology to the process. Physicians can create medical documents entirely by voice and not reduce patient records to point-and-click templates or brief typed-notes; care is actually improved – more detailed documentation drives better patient care (narrative is not lost and can be shared with other caregivers); eliminating typing allows clinicians to spend more time practicing medicine and up to 25 percent less time documenting care, when compared to using a non voice-enabled EHR; and with reduction in transcription cost, EMR investment is recovered more quickly. Speech recognition technology is one viable option to consider as more doctors address the adoption of EHR systems.

Comment from Brad Zdanivsky on 2009-01-20

2009-01-21T02:15:24Z

Good points about the Doctors, maybe the messy hand witting is a job security thing? No idea why automated data collection is not the leading the charge:

http://conversations.nokia.com/home/2009/01/nokia-n79-active-bears-polar-heart-monitoring-skills.html

Nokia is doing what we are all waiting to see from Apple + Nike. Maybe the gadgets need to win over consumers first. Wii + WiiFit does simple measurements and anyone can use it. Health Vault has many drivers for blood pressure and similar home test too. No, not Gold Standards, but with enough baseline, one will see trends in weight, activity and even mood (via HRV etc). This can be used to order lab testing early.

So, why isn't there a dumb terminal in my Doc's office? If my dentist can show me my cavities in real time, my Doc should have all my medical imaging, not a just a FAX'ed summary report.

One Doc said that they need to be there to give bad news and be sure they don't loose it. That the doctor is liable if the patent become unstable after receiving, say a terminal diagnosis. But for most cases, just put the "all clear" reports into my account. The situations that require a visit can be simply be restricted until explained to them. Only bother (booking, travel) when a human experience is necessary. (many questions about treatments etc)

Security and Privacy are never "solved", they are paid for and require constant diligence. A bank can square up an account after an attack/fraud, but once medical records are violated, that can't undone. If someone lost there job this way, they would have a case against the record keeping cooperation. (maybe hard to prove and would be an interesting case with digital evidence being used -- were are all those 'lost' white house emails?)

Regarding Google VS Health Vault.. I'm hearing that they won't scrap it out. Will be hooks to import and export from one to the other.

Comment from Kevin on 2009-02-10

2009-02-11T03:43:08Z

I have used a PHR (personal health record) for myself and my father for over 2 years now at www.medicalrecords247.com and have found it extremely useful. My DAD became ill and passed out he was rushed to the hospital via 911. The ER doctor had all the old records with in a few minutes to review, he was able to determine a drug interaction was likely a cause of the problem and did not admit my father for a costly and lengthy hospital stay. There in lies the power of electronic medical record. A friend who is a hospital adminstrator told me that the bill for a 3 day stay on a cardiac unit can be between $10,000-30,000 dollars. Wow !!!!