The Winds of Change

The Winds of Change

Never before has the healthcare industry itself been part of such sweeping changes in the delivery of healthcare and related services since the birth of the Center for Medicare & Medicaid Services and Health Maintenance Organizations. While Personal Healthcare Records (PHR) have been in the background for sometime, the idea of consumers managing their health care and service information is gaining acceptance in the medical community and appealing to the consumer.

 To dispel any misunderstanding between a PHR an EMR (Electronic Medical Record), one significant difference is ownership.  An EMR is a software application used by clinicians to digitally document and store patient’s medical information and data. This record is solely controlled, managed and kept current by the clinician. Whereas a PHR can become an annotated record of one’s medical condition, medication and treatment plan as well as claims history. It is a record owned and managed by the consumer’s home-computing environment.

 In principle, the PHR sounds like a great concept, but they are problematic on many fronts.

Adoption

Doctors Mandl and Kohane, physicians and researchers at Harvard Medical School's Children's Hospital Boston, are enthusiastic about the potential benefits of online PHRs, but suggested that stricter patient information privacy standards be required, including an extension of HIPAA medical privacy rules to govern online data-sharing by providers, certification standards and patient education programs.[1]

Cultural Barriers

Non-English speaking communities however could be hampered in PHR adoption. This country is a melting pot of diverse cultures, customs, languages and even suspicions, which would make PHR’s even more demanding to implement and gain consumer-wide acceptance. 

For example, the Hispanic community is the largest minority group in the United States. By 2050, Hispanics will be the fastest growing population in the 65 and over age group, reaching 15 million people. Elderly Hispanics face many obstacles to health care, including language and cultural barriers that if not confronted, could make worse the growing health issues among this population.[2]

The Elderly & Younger Generation

The generational demographics paint a sobering picture, in that for the “boomers”, PHR adoption will be higher than the 65 and older population because of the extent of their computer literacy.  A Forrester Research report indicated that people who range from 55 to 64 years old are 44% more likely to use a computer than those who range from 65 to 74.  Further, people who range from 55 to 64 years old today currently use computers in the workplace at a higher rate than people in their 60s and 70s did at earlier ages.[3]

Today’s youth being “techno-natives” as oppose to older “techno-immigrants” should be perfectly comfortable managing their health along with other day-to-day activities on the computer.

Computer Networking Environment

Web-base platforms will avoid the messiness of software uploads of PHR programs. The services however will likely come with a subscription plan and some kind of fee continuum. Any vendor offering a PHR solution must provide for interoperability and health information exchange as part of a cost-effective implementation. Without it, the PHR application will become a silo creating a computer interface crater of communications.

On the Frontier

As previously mentioned, the PHR concept is making its way to the consumer, and in some cases has been implemented by medical centers and clinicians. The Center for Medicare & Medicaid Services recently introduced PHR demonstration projects which are currently underway in Arizona and Utah. “It will provide information and tools that will empower consumers to manage their health better,” according to former HHS Secretary Mike Leavitt. 

In contrast, an organization like the Health Record Banking Alliance was formed for the promotion of community repositories of electronic health records. “Health record banking is fundamentally simple. Each person keeps an up-to-date copy of their lifetime health record in an “account” with a health record bank.” All access to the information in the account is controlled by the account-holder (the consumer), who makes the information available to health care providers whenever necessary” according to William A. Yasnoff, MD.

Scottsdale Healthcare (SHC) recently launched its version of Personal Health Records using Relay Health to hold the PHR. The web-based application provides for computer connectivity for the physician to access and annotate the patient’s health record. The patient owns the record however, and has access to and maintains the record. SHC sees its 2009 PHR launch as a journey for furthering patient-physician relationship and continuity of care. [4]

Dr. Susan Wilder, a very successful family physician and proponent of advanced information technology notes, “the fragmentation of health care delivery necessitates patient-centric information storage and access. However, patients are inundated by hundreds of PHR options which are overwhelming. Which one do you choose? We need a simplified strategy for both patients and providers.”

Conclusion

A PHR may offer real value to the consumer, but many issues and questions need to be addressed first. Notwithstanding all the security and privacy the vendors offer, a central repository of personal and confidential health information still might be a high hurdle not only for consumers but clinicians as well.

[1] PHR Advocates Push for More Privacy, Security Measures, iHealthBeat, April 2008.

[2] National Effort to Improve Health of Hispanic Elderly Begins in Eight Cities, Senior Journal, August 2007.

[3] A Research Report Commissioned by Microsoft Corporation and Conducted by Forrester Research, Inc., 2003

[4] Cramer, James R., Vice President, CIO, Scottsdale Healthcare, AZ., March 2009.