Rebuilding The PHR

By Ken Congdon

By Ken Congdon, Editor In Chief, ken.congdon@jamesonpublishing.com
Follow Me On Twitter @KenOnHIT

Revolution Health and Google Health are two high-profile examples of the literally dozens of consumer-based electronic PHR (personal health record) providers to close their doors over the past few years. Many chalked these failures up to a patient community that just wasn’t ready to take responsibility for their own health information. However, a lot has changed in the healthcare industry since the demise of these notable PHR vendors (e.g. healthcare reform, Stage 2 Meaningful Use, etc.). Have these changes been significant enough to finally make the consumer-based PHR model viable? Maybe, but it’s clear that patients still won’t propel the widespread use of these tools on their own. Health providers will need to play a crucial role in determining the ultimate success of PHR adoption.

Meaningful Use Encourages Patient Engagement

In 2011 (when Google Health shut down), providers were just beginning to attest for Stage 1 Meaningful Use (MU) incentives, and the Stage 2 rules hadn’t even been announced yet. When the Stage 2 MU criteria were finalized in the summer of 2012, they placed a premium on patient engagement. In response, many EHR software vendors began to tether online patient portals to their EHR platforms. These developments have placed renewed focus on the importance of patients being able to access and manage their own electronic health data. While the patient portals and PHRs tethered to EHRs are a big step in the right direction, Jeff Donnell, president of NoMoreClipboard.com (an online PHR provider), believes that this model will be impractical in the long run.

“The problem with tethered PHRs is interoperability,” says Donnell. “What if I’m a patient that sees five different doctors that belong to different health systems? Am I supposed to walk around with five different tethered PHR accounts with five different buckets of data in them? I think the PHR model that will ultimately win out is one that provides patients with a tool where they can easily aggregate their health data from a wide variety of sources, and can share this information with whichever providers they need to.”

HIEs As A Conduit For The PHR

Another change that has occurred over the past few years involves the role of HIEs. Historically, HIEs were established strictly as a means to share patient information between health providers. However, a select few HIEs are now being leveraged to provide patients with aggregated health data to upload into a PHR. In addition, these HIEs allow patients to quickly and easily share the data contained in their PHR with a multitude of providers of their choosing.

NoMoreClipboard.com has been at the forefront of this development. The company has enabled this type of PHR functionality with five HIEs in the state of Indiana and is finalizing agreements with the Kansas Health Information Network (KHIN) and three other statewide HIEs to provide similar PHR integration capabilities.

Blue Button Provides Blueprint For Consumer PHR Success

In 2011, Blue Button, a program initiated by the VA in an effort to provide Veterans with quick and easy access to their health information via the MyHealtheVet portal, was in its infancy (the initiative launched in mid-2010). Since then, the Blue Button concept has taken off. Initially, Blue Button simply allowed a Veteran to download their health record in PDF or ASCII (American Standard Code for Information Interchange) text format to share with a clinician. Even with this limited functionality, Blue Button was used by more than half a million Veterans. The impressive adoption among the VA community prompted much of the healthcare industry to embrace the Blue Button concept and expand upon it. Today, many PHR providers, EHR vendors, and health plans have embedded Blue Button-type functionality into their platforms. Many of these tools go beyond PDF and ASCII configurations to provide patients and providers with truly interoperable CDC (Continuity of Care Document) or XML (Extensible Markup Language) EHR extract document.

PHRs Need To Balance Patient & Provider Value

One of the reasons Donnell believes Blue Button will be so instrumental in promoting PHR adoption and use is because it makes embracing the technology easy on the health provider.

“PHRs won’t succeed based on patient momentum alone,” he says. “Today’s PHRs need to provide the right balance of value to both the patient and the clinician. I’ve encountered many patients that have gone to a physician with a PHR, only to have that physician discard the PHR in favor of their own documentation practices. The reason?  The provided information didn’t integrate easily with existing provider workflows. Blue Button-type functionality allows a provider to simply press a button within their existing EHR to transmit or upload patient data. It’s a game-changer because it doesn’t impede clinical workflow.”

While the pieces of PHR technology seem to be in place, it clear a cultural shift still needs to occur to encourage widespread adoption and use of these tools. This shift will require significant education on both the patient and provider front. In an effort to educate these PHR stakeholders, NoMoreClipboard.com — in conjunction with Microsoft HealthVault and Indiana Health Information Technology — has started The imPatient Movement.

“The purpose of The imPatient Movement is simple,” says Donnell. “We simply want to foster dialogue between consumers and clinicians about the importance of sharing health data electronically. For example, our website provides several resources patients can use to initiate a conversation with their physicians about gaining access to their health data. Likewise, the site contains several first-hand accounts from providers currently exchanging data electronically with patients. These narratives are an effort to alleviate some of the fears many providers have about heading down the PHR path.”

Donnell understands that many providers are uncomfortable with the idea of sharing data securely with patients. As such, Donnell recommends a “crawl, walk, run” approach to providing patients with health data for their PHRs.

“There is no need for providers to share all health data with patients today,” he says. “In fact, this approach would likely be overwhelming for both the physicians and their patients. Instead, start slow. Begin by sharing the basics, such as medications, allergies, lab results, and problem lists. You can then layer in more and more data over time.”

If patients and providers can jointly encourage one another to embrace PHR use, the results can be monumental. For example, Leonard Kish brilliantly illustrated the benefits of patient engagement in his 2012 article, The Blockbuster Drug Of The Century: An Engaged Patient. However, Donnell has witnessed first-hand how some smaller benefits of PHR use have made an immediate positive impact.

“Many of the providers we work with are amazed at how quickly PHR technology encourages several of their historically noncompliant patients to suddenly begin following their treatment regimens,” he says. “In these instances, the PHR is the missing piece of the puzzle. PHR use has also made many patients aware of errors in their health records (e.g. incorrect medications, dosages, diagnoses, missing information, etc.). These types of errors and omissions in the medical record can cause all kinds of downstream problems, but with a PHR, patients can alert providers of these mistakes and get them corrected, preventing any resulting issues.”