The PHR as a Tool to Enable Consumers to Take Responsibility for Their Own Health
Posted Jul 02 2009 6:32pm
Healthcare consumers need to take more responsibility for their own health, particularly to avoid or ameliorate chronic diseases such as obesity, diabetes, and heart disease. They also need access to the proper tools to achieve this goal. Tethered personal health records (PHRs) enable the transfer of critical health data from hospital and office EMRs to consumer-controlled records. With the exception of some health systems like Kaiser Permanente and the Cleveland Clinic, most providers have not been quick to endorse tethered PHRs. John Moore, who blog over at Chilmark Research, suggests that Microsoft is pursuing an international strategy for its PHR, HealthVault (see: HealthVault’s International Strategy ). This will presumably enable consumers to self-manage, to some degree, their chronic diseases and, in so doing, help to mitigate the rising cost of healthcare. Below is an excerpt from his note:
The key driver for all countries is not much different than what we are experiencing in the US. All are looking to reduce their medical risk profile by providing citizens and physicians better tools to manage health. Primary objectives include:
Support telemedicine with device connectivity (HealthVault Connection Center).
Provide mechanisms/systems/tools, via HealthVault, to allow citizens to better self-manage and where possible minimize chronic diseases.
Proactively engage citizens in their health by providing them with access to their personal health information leading to better, healthier and more knowledgeable decisions and subsequently, behaviors.
...Finland currently has 90% of its physicians using an EMR, but like most countries Finland continues to see healthcare costs rise. Therefore, Finland is now looking at HealthVault as a critical component to take their national healthcare system to another level with deeper, direct engagement of their citizens and thereby mitigate cost increases. (In theory this makes sense, but there is no conclusive evidence that indeed this will work. Today, most are going on faith.)
It's interesting that Finland enjoys a 90% acceptance rate among physicians for EMRs but continues to experience rising healthcare costs. My personal belief is that office and hospital EMRs, if well designed, will allow physicians to work smarter and more efficiently but will usually not reduce the cost of healthcare. The reason for this is the very high capital cost of computer purchase and maintenance, including high-priced computer support personnel. In addition, EMRs and LISs provide the opportunity to generate new hospital management reports and perform functions relating to patient safety, quality, and surveillance that were not previously available with manual systems.
As John points out, there is still no firm evidence that patient self-help (see: " Participatory Medicine" and Its Relationship to Clinical Lab Testing ), enabled by PHRs, can reduce costs. Nevertheless, I believe that it's worth a try. The challenge with tethered PHR will be convincing/forcing hospitals and physician offices to replicate patient data to patient PHRs. Most office and hospital EMRs are not designed to perform this function. In addition, much of the clinical data in these systems is not organized or phrased in such a way that it can be understood by healthcare consumers. Finally, much of the effort and capital costs to achieve this end on the part of physicians and hospitals would not be compensated under current payment systems.