Latest News - April 13, 2009

A physician contends that the EHR is "the final stage in the forced metamorphism of physicians from thoughtful professionals to clerk-typists from the Katherine Gibbs School of Medicine."

The Boston Globe tags Google Health with service inaccuracies due to the use of inaccurate or imprecise billing code data.

McKinsey reports that "health care costs, health care coverage, and household income have contributed to growing disparities between different income groups in the United States."

Obama signs order creating White House Office of Health Reform headed by Nancy-Ann DeParle and announces joint DOD/VA initiative on lifetime medical records.

Opponents of public health insurance get ready for battle.

Kaiser CEO calls for health reform.

Brian Klepper recaps the progress on the Continuity of Care Record (CCR) standard.

NewYork Presbyterian Hospital provides patient/consumer-controlled Personal Health Records.

Chicago's Daily Herald reports on the the benefits of the electronic health record and the concerns regarding privacy.

A rural doctor switches to electronic medical records and the New York Times reports that she will never go back.

Value of Personal Health Records

The Center for Information Technology Leadership (CITL) has estimated that Personal Health Records (PHR) can deliver savings of $21 billion annually.

Architectures

CITL's full report evaluated four different PHR architectures: 1) Provider-tethered, 2) Payer-tethered, 3) Third party and 4) Interoperable.

Tethered architectures refer to providers or payers providing the data integration to the PHR. The Third Party architecture refers to manual aggregation of health information but without the ability to integrate back to the clinical and administrative systems "in their native formats". In the Interoperable architecture, patient information flows into the PHR using standards based health information exchange from sources throughout the region and from there can be machine interpreted by the clinical and administrative systems.

Costs

The Provider-tethered architecture provides a limited view of the patient, compared to an interoperable regional approach. This architecture also requires a very large number of implementations to support 80% PHR adoption:

• Provider - 26,000
• Payer - 706
• Third Party - 3
• Interoperable - 428

The number of implementations is a major factor driving the total national installation costs.

Savings

The CITL value chain model is used to estimate the value of the PHR functions including:

1. Information Sharing
1a. Complete Test results
1b. Complete Medication lists

2. Information Self-management
2a. Congestive Heart Failure Management
2b. Smoking Cessation Management

3. Information Exchange 3a. Appointment Scheduling
3b. Medication Renewals
3c. Pre-Encounter Questionnaire
3d. e-Visits


Four of these functions contribute 95% of the value: Sharing of complete test results ($7.9); Congestive heart failure management ($6.3), e-Visits ($4.8), and Medication renewals ($1.1).

The annual steady state net value for the Interoperable architecture comes in tops at $19 billion, followed by Third-Party and Payer-tethered at $11 billion with Provider-tethered trailing at a whopping negative $29 billion.

News Analysis

So what are the strategic implications for Healthcare Organizations (HCO's)?

• HCO's won't be able to carry this on their shoulders - - the costs are prohibitive.
  
• HCO's will need to ensure that their clinical and administrative systems can interoperate using national standards and can participate in regional health information exchange initiatives.
  
• HCO's should look to collaborate and invest in PHR's that are building towards an interoperable standards-based technology platform and are able to connect with multiple providers in the region.
  
• HCO's will need to develop strategies which distinguish between the 1) Personal Health Record (patient-centered) and 2) the portals which connect the HCO to the patient/consumer (HCO-centered).

The strategic implications align well with a recent presentation to AHIC of PHR adoption which favored a Utility Service Model.

Many thanks to Blackford Middleton and CITL for permission to reproduce excerpts from the report.

Mobilizing Personal Health Information - Consumer Perspective

How will consumers "mobilize" their personal health information?

On July 29, the American Health Information Community (AHIC, "The Community") examined how consumers may access, use and share their personal health information (PHI). This article highlights the consumer perspective.

Utility Service Model

John Moore from Chilmark Research compared several business models for PHI delivery. These include: 1) Consumer approach to manage health, 2) Employer and healthplan approach to reduce costs and manage risks, 3) Provider approach for consumer (patient) retention, and 4) Utility service model approach to "create an ecosystem".

The utility service model consolidates multiple data sources into a secure repository available to multiple applications and services. This model scores very well, with the notable exception of portability which is "under development". Moore scored the utility service model as the only approach with the potential for high rates of adoption.

Consumer Interest

Carol Diamond of Markle Foundation's Connecting for Health organization surveyed public attitudes towards Personal Health Records (PHR). Markle's survey found only 13.5% of respondents very interested in using a free web-based PHR and another third somewhat interested.

Markle contends that the establishment of privacy and information practices are critical to consumer PHR adoption.



















Markle's Connecting for Health Common Framework and Framework for Networked Personal Health Information define clear "price of admission" requirements for PHR adoption, but are they sufficient to achieve adoption?

Standards and Interoperability
Connectivity with healthcare organizations will be required to make PHR's easy to access and manage. Jeff Blair, Lovelace Clinic, made the case for the Nationwide Health Information Network and standards based interoperability as foundational elements to achieve adoption.

Editorial comment: Where are the incentives?
The one missing ingredient in all of this: financial incentives for patients and providers. Why are payers and employers more interested in PHR adoption? They are dealing with the pocketbook issues of how population health affects their P&L.

Google and the Personal Health Record

Google has announced the official launch of the Google Health Personal Health Record.

Will Google Health's foray be a game changer?

There are more than 30 different personal health records distributed today in the US, with at least 15 or so in serious contention for market share. With this kind of fragmentation, there are substantial challenges to integration.

The industry has responded with high interest to Google, Microsoft and Revolution Health's entrance into the Personal Health Record space. They both bring consumer "neutrality", advanced web technology know-how and are rapidly playing catch-up in the domain.

The privacy aspects of this are significant. Will patients trust Google with their health information?

Google's announcement includes early partnerships with Cleveland Clinic and Beth Israel Deaconess in Boston.

Beth Israel will allow patients to upload their own health record into Google Health. This gives the patient electronic access to their provider's health record and standards-based portability that they control. Significantly, this approach can help resolve a couple of the thornier problems of health information exchange: patient identification and authorization. The patient is able to authenticate to the various HCO's. The patient also now has control over the record and can decide when and with whom it should be exchanged.

The major vendor enterprise clinical systems' advantage has been their tight integration with their own personal health records. In rural areas where there's a dominant Academic Medical Center, or dominant ambulatory vendor clinical system, this advantage will continue to be compelling. In more competitive healthcare environments, that advantage will likely be mitigated by standards-based exchange of health information among heterogenous systems, including mediation through the Personal Health Record.