After decades of struggle and a year of debate, health reform is now law in United States. President Obama administration’s healthcare goals have been very clear from the beginning: extending insurance coverage, modernizing the healthcare delivery system and emphasizing on preventive and wellness care. It is quite clear now that the healthcare delivery landscape will steadily move towards a new direction where there will be an emphasis on cost and the government will actively participate in ensuring quality care and value to consumers. Strikingly healthcare reform bill hopes to curtail cost by turning the systems emphasis from quantity of care to quality of care. Care providers would be paid for how well they work in an integrated fashion rather than how many things they do to make patients well.
Quality healthcare no longer means provision of best treatment in state of art facilities but emphasis on preventive care and disease management. This driving factor is leading the evolution of care delivery from provider centric to patient centric. This furthermore leads to an urgent need of convergence and integration of the entire care delivery landscape comprising of patients, providers, payers, pharmacies and government bodies. Healthcare information technology (HIT) is a set of key solutions that are set to make this integration possible. Personal Health Records (PHR) is one such powerful tool that has an ability to empower patients and connect them with their healthcare providers.
But the question arises: Can it be made possible that patients collate their medical data in a web space and enable easy access of the same to their care delivery organizations. Can PHRs advance such a goal?
Can They Do “IT”
Healthcare information today in the US is in a disparate form and certain pressing steps have to be urgently taken. One such step is introduction of PHRs which enable management, access and sharing of individual health information in a private and confidential environment. PHRs also enable patient-clinician share clinical outcomes and plan disease management online thereby reducing geographical barriers and most importantly improving efficiency and quality of care.
How & Who of PHRs – The Business Landscape
PHRs can be classified with respect to the platform they are based on i.e. web based, stand-alone etc. Furthermore product vendors market them based on different types of revenue models. The direct-to-consumer sponsored PHRs are the ones where consumers pay a fee. Other solution offerings include those from the health care organizations, employers or the health insurance companies.
There are multiple players (estimated more than 200 worldwide) who offer PHRs and since this market is still in a very nascent stage. HealthVault (Microsoft), Google Health (Google), WebMD Health Manager (WebMD) are few of the prominent web based PHRs in the market. Microsoft and Google are expected to proliferate and do well in this market, courtesy to their online presence, technical superiority and world wide acceptance. Other players in this space include CapMed, MyMedicalRecords and MyHealthRecords.
Active Health Management (Aetna) and Dossia are directly working with large US corporations for storing and sharing health records. Furthermore providers like Alexian Brothers Health and New York Presbyterian Hospital have introduced health record services.
Adoption Standpoint – GO or a NO GO
Government Fuelled Driver The government is pushing for positive change in healthcare delivery and has initiated concrete steps i.e. insurance for all, healthy lifestyles and has strongly promoted adoption of HIT. eHealth Initiative blueprint was designed in 2007 to advance the goal of most Americans having access to secure electronic health records by 2014. Furthermore the Health Information Technology for Economic and Clinical Act (HITECH) enacted under American Recovery and Reinvestment Act of 2009 has reserved huge funds to encourage doctors and hospitals to adopt electronic health records. PHRs are bound to be an integral part of these state wide solutions promising continuum of care and cost savings and would enable the government succesfuly deploy the various regional health information network (RHIO) or national health information exchange (HIE) initiatives. These moves by department of Health and Human Services are bound to fuel growth in adoption of PHRs.
Rise in Preventive Care & Disease Management In recent years patients have realized the importance of health data management. Leading healthier lifestyles, interaction with clinicians and deciding on the care pathway, health service and insurance have become prominent. PHR definitely provides a welcome solution and provides an assurance to today’s patient manage his disease much better. Rise in internet consumerism (74% of the US population have an access to internet in 2009) is also adding to the prospect of PHRs.
Pitfalls
Without doubt PHRs are highly beneficial and hold tremendous promise but there are certain critical concerns that are holding back its mass success and sustainability.
Legal and Regulatory Issues Most of the Americans are very concerned about identity theft and fraud and the possibility of their personal information getting elsewhere. Privacy of data is another major challenge that poses an uphill task for the vendors. Furthermore there is a possibility that non compliances and modifications in data may arise and lead to medical malpractice.
The Battle for End User Buy-In Provider support in this case seems imperative and judging by the low adoption rate of electronic health records in US, PHR buy-in seems difficult at this stage. With the data being entered and managed by the patient the providers can challenge its accuracy and legitimacy. In other words lower adoptions can be further fuelled by possibility of physician distrust of patient-initiated health information.
On the patient side implications such as ownership, data exclusivity and health information safety will hinder the player’s ability to convince the patients.
Interoperability Interoperability issues and difference in technology platforms as offered by vendors and IT solutions as used by provider could also lead to weakedned buy-in on the provider side. The vendors would have to build the solutions on a platform that can be adapted to work with any health data standard.
What Lies Ahead
Successful PHR adoption would definitely bring about a remarked change in care delivery and shift the focus to patients and consumers. The ultimate objective of PHR – cost savings and quality of healthcare would definitely be achievable then. As far as patients privacy concerns, a trusted third party in a hospital or provider would be the key. Furthermore as online banking or purchasing has become a commonplace, PHR as a solution also would settle in soon.
But coming to the real promise of having a completely integrated ecosystem of healthcare providers, health centers, pharmacies, diagnostic labs and all other stake holders, PHR is just a small step!!
