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The Lifetime Personal Health Record: A Disruptive Innovation

by Scott MacStravic

There has been a major effort underway to develop a model for a personal health record (PHR) that would follow individuals and families throughout their lives.  One example is the effort by the Dossia Consortium of mammoth U.S. employers, such as Applied Materials, BP America, Intel, Pitney Bowes and Wal-Mart contracting with Omnimedex in Portland, OR, though this has recently run into some snags. [R. Moody “Portland Nonprofit Caught Up in Health Deal Gone Bad” Portland (OR) Business Journal July 13, 2007 (portland.bizjournals.com)]

The idea is for individuals to have a personal record of their “health history” that would follow them and provide the basis for continuity of care throughout their lives.  Since people will inevitably have multiple, perhaps many, even dozens of changes in employers, insurers and providers throughout their lifespan, a single, lifetime record should follow them and incorporate their health and care experiences for their lifetime.

The interest of employers in sponsoring such a development is mainly economic.  By creating such a record, and enabling providers to access it whenever they treat individuals, diagnoses can be made faster and more accurately.  Repetition of patient interviews about past history, allergies, treatments, medical contra-indications, etc. can be minimized.  Quality, as well as efficiency and customization of care to individual idiosyncrasies, including genetic differences, should be improved.

But perhaps the greatest economic advantage of such records will emerge from their use in proactive health management (PHM) aimed at preventing the incidence and prevalence of “unhealth” in the first place.  With a lifetime record of, combined with the earliest possible initiation of PHM interventions, the greatest lifetime impact will be achieved, since health promotion, risk behavior and condition prevention, and the earliest possible interventions in managing existing chronic conditions tend to deliver the greatest lifetime benefit to individuals, and the greatest lifetime savings to payors.

Employers stand to gain the most from PHM interventions, since healthier employees and dependents mean lower sickcare costs as well as higher productivity and performance of their workforces.  Employers could promote lifetime PHRs as part of lifetime PHM.  Since it is in their best interests to have the healthiest possible prospects applying for jobs, employers could invest in promoting PHM through improved prenatal care, well baby care, child development, and school health before individuals reach working age.

By the same token, governments could benefit by promoting the same early interventions and lifetime records in order to promote having the healthiest possible beneficiaries when they become eligible for Medicaid or Medicare.  Ideally, lifetime PHRs should involve major cooperative efforts and investments across the total range of stakeholders in PHM, which means just about every individual and organization in the country.

There may be some argument as to who should take leadership roles, and there will undoubtedly be many who would rather “camp on” and benefit from what others do without making any investment, themselves.  But the potential combination of PHRs and PHM, is at least as great in terms of reducing the incidence and prevalence of disease and injury in the first place, as it is in terms of making sickcare investments and efforts more efficient and of higher quality.

7 Comments »

  Paul wrote @ July 17th, 2007 at 11:15 pm

But no one has the ability to get medical records from the multitude of Electronic Medical Record Systems on the market today… Until now. The EMRy STICK is the only stand alone PHR capable of automatically obtaining your medical records from your doctor’s system. All other products require you to enter your information manually or pay a subscription to have someone else do it for you. Sorry for the plug but it is hard to become known among the likes of “mammoth U.S. employers”

  Jim wrote @ July 18th, 2007 at 9:04 am

Data from a news release this morning suggests that most americans have no idea what a PHR is, and have no idea what the benefits of the PHR might be. So, it is important that as we begin the education process to teach Americans what the benefits of a PHR “will be” that we not intertwine the ideas of EMR and PHR. A PHR is just that, “personal”. While an EMR (electronic medical record) will be far more detailed and contain data that a qualified physician might interpret. Some EMR data is useful in a PHR, such as lab results, etc.. But it shouldn’t be too cluttered. Here’s the real issue, in my mind, once we have all this data about ourselves and we begin to use it in general wellness initiatives (the ultimate goal) how do we transport or send it to the care giver so that it is integrated within their system? This is the goal of the CCR standards effort, and one day this is all going to make us healthier and happier.

  Steven Hacker, MD wrote @ July 18th, 2007 at 9:06 am

As a physician and the founder of PassportMD.com, I completely agree with your comments. PHR’s are clearly here to stay, and ultimately will be a tool for consumer to enhance safety and mobility. Currently, as Paul, points out there are theoretical limitations in some PHR’s, given that some require manual input, but , that is by it’s very definition the core of a PHR. If the user is unable to input his own info and manage it, than , it is not a PHR. There are many PHR systems that work universally with physician’s offices, PassportMD is one of them, to obtain medical records from a doctor regardless of the doctor’s offices software, EMR’s, or paper charts, the key is to be able to retreive your records effortlessly or seamlessly.
The challenges of PHR’s remain commercializing what is becoming a commodity item as well as mass market adoption and motivation. Motivation will occur inevitably on multiple levels. Dossia’s recent news is a symptom of big corporate America trying to do something in a grandiose swipe rather than a “one by one” approach. Ultimately, all of this will work out and corporate America will include PHR’s with the appropriate incentives for motivation.

Steven M Hacker, MD
Founder & CEO
PassportMD, Inc
http://KeepSeniorsHealthy.blogspot.com

  D. Wells wrote @ July 18th, 2007 at 2:35 pm

The LAST thing your newest doctor wants is a mish-mash of your Personal Health Records. He/She doesn’t want it on a memory stick, a CD or by downloading it from some databank. Most of the time, doctors don’t even look at the 6 page history you complete in the waiting room.

Doctors want to deal with Today’s problem today. Hi, there, Mr. Patient, and what brings you in today? They want to diagnose and treat and they prefer to do both in less than 2 minutes so they can get on down to exam room 7.

If you insist on bringing a wheelbarrow of data in, they will politely drop it into your chart folder (or, if they use an EMR system, they might scan the papers into an image file and append it to your EMR).

  Timothy Collins wrote @ July 20th, 2007 at 12:39 am

Its true that there is increased awareness about maintaining personal health record among individuals today.Despite many benefits offered by use of PHR, there is no comprehensive PHR provider in the market today.
A recent study by Forrester Research titled “Teleconference: Are consumers using personal health records?” noted that 28% of U.S. households formally track health and medical information.
Educating public about benefits of PHR is one of the key step towards wide spread adoption of PHR.

  Wanda J. Jones wrote @ July 20th, 2007 at 5:15 pm

Before being grandiose enough to try something at a huge scale, the simple foundational idea is that individuals should become accustomed to carrying basic information with them every time they see the doctor. Only 30% of physicians are on computer, so the use of paper is still widespread. In 1977, I designed a “Life Log” the size of a nr 10 envelope to carry in handbag or jacket pocket. It lists all doctors who have some of my medical record, all tests and procedures, all meds, expenditures and hospital admissions. I find it helps me remember when I passed certain milestones, how long I have been on estrogen, and the like. The marginal value of an electronic life time record is largely off-set by the errors that will inevitably creep in from being the repository of data from so many sources. And–doctors really care about today, as Tim Collins wrote.

  Ronald D Whiting wrote @ August 10th, 2007 at 3:18 pm

It appears that I am talking to the chior here so I a can at least put my nickel in. I believe in PHR’s so much I invested in a company that has delveloped a superior product called SafeKey. I am just like Victor Kiam who bought Remington. He liked the company so much he bought it! If your as old as I am you will remember the commercial. How I got there is that I have become an “angry patient” filling out the same forms all the time when I go see mine, my wife’s and my father’s doctors. It has happend to me countless times that I get to the current doctor visit and find out the other doctor has not sent the radiology results to the current doctor and it has been 3 weeks. Or, I have to go pick up the MRI report at the hospital. Guess what, I still have to pay my current doctor for the office visit even though he does not have all the information available to make a proper diagnosis. Health care is the only industry I know of that you can screw up and still get paid on a redo and maybe still not fix it. I know this for a fact since my accounting practice clientele is only made up medical practices and one hospital. I think D. Wells is going to the wrong doctors. Thier probably the arrogant ones that don’t even listen to what the patient is saying to them. All they want to do is bill a 99213 or 99214, get paid and move on to the next exam room. However, “most” of my doctor clients embrace having the PHR informaiton available to them. Yes, they do not want to wade through countless paper, but they read the highlights and maybe glean just a little bit of additional information that could save a life. My dad is 89 and is failing. He has about 4 doctors attend to him. A cardiologist, internist, nephrology and orthopaedic. Guess what a nightmare that is keeping up with what each one of those guys are prescribing let alone the tests that are ordered. THAT is why I am angry and therefore set out to do something about it. Yes I have read all there is to read (and experienced) about PHRs and EMRs by the pontificating PHD’s and govnermentals out there postulating the yeas and neas when most don’t have a clue as to how doctor’s office operates. YES, there is a way to get information from the fancy EMR’s and Yes there is a way to privately communitcate with health care providers, and YES there is a way to automatically update records and YES there is a way to keep it entirely private and secure. But, the answer is not storage on a web server. That is a complete joke. What happens when the infamous secure web server “goes dark”. Tell that to the victims of Katrina. Does does anyone here think that Wal-Mart, Intel, Dossia are really interested in a patient’s well being. I doubt that. It’s all about money and control. HIPAA was a pharmacuetical company’s dream. There are 2 little paragraphs buried in the so called “policies” that give them the “right to sell” anyones health information AND identity. That has recently been discoverd and verfied by some journalist doing an article on CVS and Walgreens. The PHR acronym is as it should be. A “personal” health record that is entirely in the control of the patient. Not the insurance company, not the government, not the doctors. I firmly believe that PHR’s will be driven by the patient. Baby boomers will demand it. And as you know, if a baby boomer demands it, they get it. Go ask the AARP. Well it was nice chatting with you all. See you in the marketplace or the golf course.

Ronald D Whiting CPA
Member SafeKeyNet, LLC
http://www.safekey.net
ronw@safekey.net

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