HIMSS President Slams PHRs: I Wonder Why?

According to an interview in the WSJ Health Blog, Steve Leiber, the chief executive of HIMSS, is nervous about personal health records (PHRs) (see: How Personal Health Records Could Make Care Less Efficient). Here is an excerpt from the note (boldface emphasis mine):

...Steve Leiber — who runs Healthcare Information and Management Systems Society, the trade group for health IT — pointed out a potential downside to the patient-centric records. “Physicians aren’t going to trust it,” he said. That could be trouble if patients opt for the personal records and try (because of privacy concerns, say) to keep their medical information off of a doctor or hospital’s electronic medical record.

John of the Chillmark Research blog places this remark from Leiber into the appropriate context and comments on it (see: HIMSS Leader Raises Doubts on PHRs). Below is an excerpt from his comment:

... Leiber should provide full disclosure that HIMSS receives a boat-load of money from the EMR vendors that have a lot to loose should records begin migrating beyond the four walls of a hospital. First, it will force the issue of interoperability, something EMR vendors are loathed to adopt for like any other industry, interoperability gives the buyer choices and easier paths for migrating from one system to another. Also, these vendors are beginning to offer their own tethered-PHR, which is simply a consumer-centric EMR portal to their records. A PHR that resides outside of the EMR limits their market opportunity.

Mr. HIStalk joins the fray with the following comment:

Steve [Leiber] of HIMSS says doctors won’t trust PHRs. I’ve been saying that all along, but he’s got more vested interest since EMR vendors pay HIMSS while PHR vendors probably won’t. He’s right, though: duplicated tests don’t cost a doctor or patient anything, so why should the doc put themselves at risk by trusting someone else’s information, no matter what the source? I bet they redo a lot of tests even when the paper records are right there in front of them. That’s how defensive medicine works.

I have posted a number of previous notes about PHRs, the most recent of which is the following: President of eClinicalWorks Discusses PHRs and Patient Portals. I have the following responses to Leiber's remarks:

• A physician's trust or distrust for a PHR is largely irrelevant. The PHR is, and will continue to be, a tool adopted by healthcare consumers for their own uses and not those of physicians. Physicians have access to their own office and hospital electronic records. They will always turn to these "sources of truth" although they themselves are not infallible.
• The major challenge at hand regarding PHRs is not whether patients "keep their medical information off of a doctor or hospital’s electronic medical record" but rather how to replicate physician office and hospital information to the PHRs in order to make them more useful for consumers. Information copied to PHRs from a "source of truth" needs to be made permanent and validated with a digital fingerprint such as a hash value. PDF files also serve the same purpose.
• John of Chillmark is correct in speculating that EMR vendors are suspicious of system interoperability but I believe they are generally supportive of tethered PHRs. Such products can generate additional revenue without jeopardizing client control.
• What's really worries Leiber and the EMR vendors, from whom he takes his orders, is the likes of Microsoft's HeathVault and Google Health. Note that the latter company has recently created a partnership with the Cleveland Clinic (see: Google CEO Discusses New Partnership with Cleveland Clinic). What Leiber and the EMR companies fear is that Microsoft and Google will launch a fully-featured EMR/PHR combo that will deliver both value and functionality. Microsoft already has an EMR product in the market (see my previous note: Microsoft Renames and "Integrates" Its Healthcare Software Line). You can browse the home page for Amalga, the Microsoft Hospital Information System.
  

Comments

[Sherry Reynolds]

The banking system is the best example to look at to discern the direction that ERMs and PHR's will go. Your online banking records are similar to a EHR (with real time data and little opportunity to enter your own information but you can move information - data money to pay bills).

A PHR is like using Quicken. You download from Schwab, the Bank, etc and can add personal notes and additional transactions that don't show up elsewhere. You can't upload to your bank but you can then use the data to do your taxes - which is then validated against your brokerage and banking records.

Some of us are working to develop "health record banks" where you can deposit both EHR and PHR data. We are even using smart card technology to streamline registering new patients (think of how we use a debit card).

The private sector has had 20 years to resolve the problem but hospitals are the biggest purchasers and they have a vested interest in not sharing data.

So either consumers will demand convenience and interoperability or the big purchasers like Medicare and Medicaid will step up to the plate and put it in their contracts. No interoperability? No payments.

[John Norris]

As was noted, PHR's include a whole lot more than old lab reports.

How about data that the doctor asks the patient to report anyway? Up-to-date family history, medications (and supplements), alternative therapies, record of pain.. there is a lot of data that the clinician trusts the patient to self-report. PHR's could make it much easier for both.

[John]

Hello Bruce,
Thanks for referencing my post on Leiber's comments to the reporters at WSJ. Just wish to clarify that yes, the EMR vendors are not adverse to PHRs, as long as they are tethered to that EMR they installed and of course it is their PHR that the customer is using. These tethered systems, while having that direct link to the treasure trove of clinical data, will not be all that useful to a consumer that is dealing with a number of care givers - thus the need for the untethered, independent PHR that resides outside the EMR system.

And as I pointed out in my post, there are some heavy hitters in the medical establishment that support the efforts of Microsoft & Google, so I'm not so sure that Leiber has it right regarding physician views.

[The PACS Designer]

Since I've been working in the healthcare bleeding-edge space for decades the concern about security of patient information has grown exponentially with the incorporation of the Internet in the healthcare value chain.
Like any personal information, let the buyer/user beware of possible intrusion into their personal life. Since I'm sure there will be many styles of PHR's offered to consumers, just as there are many flavors of ice cream, the end results will vary depending on information, and where it is stored but at least it will give the consumer membership in the evaluation team that can be assembled to treat your medical condition should it need treatment. Since the PHR is intended to be patient driven, why not promote it as a tool to improve the speed and quality of that treatment from a team approach.