The Last Mile: Personal Healthcare Monitoring

Improved outcomes for patients with chronic diseases depend in part on the ability to monitor the patient's health and to pro-actively manage and intervene as needed. Connectivity to the home and home health devices represents "the last mile" in this effort.

On November 18 HL7 announced the release of the Personal Healthcare Monitoring Report (PHMR) Implementation Guide (warning: zip file). This Draft Standard for Trial Use (DSTU) guide was co-developed with Continua Health Alliance.


The PHMR conforms to the Continuity of Care Document (CCD) standard:

• According to HL7, PHMR "describes how to use the CCD templates for communicating home health data to an electronic health record".
• This opens the potential for home health device information passing to a regional health exchange or a personal health record.
• Further, Healthcare Information Technology Standards Panel (HITSP) has stated that the Continua Health Alliance architecture is intended for incorporation into the HITSP Consumer Empowerment specifications for Remote Monitoring (IS 77) for Home Healh Devices, such as a "Personal Area Network" device.

Other recent vendor announcements are taking related paths to close this last mile, although their support for the PHMR Implementation Guide has not been announced.

On November 10, Microsoft announced a pilot with Cleveland Clinic using Microsoft's HealthVault. "The pilot will be a physician-driven, invitation-only opportunity offered to a group of Cleveland Clinic PHR users in the areas of diabetes, hypertension and heart failure. Cleveland Clinic plans to enroll approximately 400 patients and aims to demonstrate that the program will enable patients and physicians to better manage and track chronic diseases from home, using the patient’s own computer....Patients will be provided HealthVault-enabled digital devices, such as blood pressure monitors and glucometers, and asked to perform regular health monitoring. By connecting the device(s) to their home computers, their health information will be uploaded, with their consent, to a personal HealthVault account controlled by the patient, and then sent to their Cleveland Clinic MyChart account. This data will create an online log of the readings that will be available to the patient’s physician."

And on the same day, Intel announced it's piloting its 510(k)-approved Health Guide. "Pilot studies in the United States are currently planned with health care organizations such as Aetna, Erickson Retirement Communities, Providence Medical Group in Oregon and SCAN Health Plan. The goals and objectives are to assess how the Health Guide integrates with different care management models in the home. These first studies focus on the ability to demonstrate improved health outcomes for conditions such as heart failure, diabetes, hypertension and chronic obstructive pulmonary disease."