Today, the California Health Care Foundation (CHCF) released a consumer survey report looking at perspectives on healthcare IT, privacy of personal health information (PHI) and use of internet tools, such as PHRs to manage their health or health of a loved one.
Having reviewed the slide deck and survey/data report (have taken the liberty of posting both, see below), following are some initial impressions:
Inclusive survey sampling a broad cross-section of the US, including age, racial and socio-economic classes.
Surprising PHR adoption at 7% of respondents (our own research in this market pegged adoption at ~3.5%). Highest adoption out west (see slide 7), likely the result of Kaiser’s big push on the PHR front with their MyChart. Nearly 90% of PHR users use it for personal health(i.e., not in a caretaker role).
One of the more bizarre findings was that 58% of respondents were likely to use a PHR from a provider (OK, that is logical) but 50% said they would use one from a payer (see slide 13)! Using a PHR from a payer? That flies in the face of numerous studies that have found that consumers trust payers with their PHI about as much as they trust their employers – very little. Something strange going on here.
Also on slide 13, the survey reports that Google and Microsoft are about as likely to be used in this capacity as an employer sponsored PHR. Such a finding does not bode well for the employer-led platform, Dossia, Google Health or Microsoft’s HealthVault
Another bizarre result was that of the various demographics that currently use a PHR, nowhere on this list was the female head of household (see slide 6). This is quite contrary to the experiences of others, including WebMD and other PHR providers who’s number one user is the family CMO, the mother.
Arguably the best findings from this survey are:
- PHR usage leads to a more informed and engage consumer.
- Lower income, less educated PHR users and those with chronic diseases derive the greatest benefits through PHR usage.
- Privacy concerns drop by nearly 50% once someone begins actually using a PHR.
While there are some aspects to this survey that give one heartburn, or at least cause puzzlement, overall this is a good cut at providing a snap-shot of where we are today in the use of such tools by consumers. We still have a long way to go to drive further adoption, but PHR adoption/usage does appear to provide broader societal benefits. Now the question is:
How will policy makers use these results to guide future decision making as we move further along the path of ARRA, HITECH and clinician adoption and use of HIT. To date, there has been very little out of Washington that addresses the consumer. Hopefully, this will act as a wake-up call for without consumer/citizen support much of the intent of the HITECH Act will be wasted.
[slideshare id=3712365&doc=chcfphrslides-100413133958-phpapp02]
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The CHCF survey highlights several encouraging trends and provides an informative snapshot of consumer engagement with PHR technology in the U.S.
There is broad acknowledgement that no single solution exists for the ailments of the healthcare industry, but we think that technology can help to engage consumers as active partners in their health and wellness. As manifested in the survey results, one of the biggest challenges we face to broad scale adoption of online health solutions like PHRs is in growing awareness across consumers and healthcare providers of the value that these solutions can provide to all parties.
Any and all efforts in engaging consumers in their health management are to be applauded. However, as others have pointed out, there are limits to the value that PHRs can provide if tied to a specific provider, health plan or employer. The information becomes tethered to the organization and its value is lost in the event that the user changes jobs or relocates. With Microsoft HealthVault, we have moved beyond the scope of a traditional PHR, and developed an online platform that supports a wide variety of health and wellness applications and connected home healthcare devices. In this context, consumers can share their health information across family members, healthcare providers, and any number of other stakeholders within the healthcare system – while maintaining control of the information. We have enabled a free exchange of data so that it is accessible wherever and whenever it is needed and can be acted on for meaningful results.
The importance of this kind of approach cannot be overstated when the ultimate goal is to allow every consumer to keep their health information handy and secure, so that it’s always available to them, their family, and their trusted network of caregivers when and where they need it.
David Cerino, General Manager, Microsoft Health Solutions Group
David,
In complete agreement with you that a payer or provider-based PHR is of limited utility as most are completely tethered to the sponsor and thus do not provide data liquidity, portability and often little actual consumer/citizen control of their own PHI.
Somewhat sad that in this day and age, there are still those who do not wish to willingly relinquish this data to th citizen for them to store and share as they see fit. Seriously, this is their data, their health we are talking about and they did pay for it after all.
One area that remains a bit of a puzzle is the future role of Personal Health Platforms such as HealthVault, Google Health and Dossia and the role of HIEs. With significant federal funding now being poured into the establishment of HIEs and of course meaningful use, data sharing, etc for care coordination, I wonder if these HIEs will become the de facto home for most citizens to access their data and will there be enough citizen/consumer facing services within an HIE to meet their needs. Time will tell.
We are still just beginning on this journey, many bridges to cross but together, hopefully, we can make a difference for as the CHCF survey found, citizens are deriving some significant value from access to and use of their PHI to manage their health or the health of a loved one.
John, First, thanks for the report.
As for the HIE and their connection to commercial PHRs such as HealthVault or Dossia; this has been brought up in the HITOC meeting and received little traction. I am planning to speak to the Oregon HITOC meeting about this subject later this week. If the ONC and CMS want to get patients evolved more with their health they will need to include PHRs in the plan.
The NHIN top down approach will take years to design, implement, and get buy-in then connect where commercial PHR that exist today have the ability to exchange health data between patients and providers today with very little cost.
IMHO, (ha) I think that the commercial PHRs will play more of a role in the overall HIE. These system are in place now and at a minimum could meet the ONC’s NHIN somewhere in the middle.
Jeff Brandt
http://hieconnect.net
John, you make an interesting point about the future role of PHPs, as more HIEs are established. HIEs are playing an increasingly significant role in improving the quality, safety and efficiency of healthcare by enabling health information to be shared and patient care to be coordinated.
From our perspective, personal health platforms are complementary to the growth of HIEs. Both initiatives share the same goal — better patient care through access to critical information — and need to work together in order to enable a patient-centric model of care. HIEs are focused on connecting targeted professional networks around a patient’s clinical care – typically within a specific region. PHPs like HealthVault enable connections between HIEs by making the consumer the trusted conduit of their personal health information, connecting otherwise unrelated organizations. As bridges between HIE systems, PHPs allow more circumscribed HIE systems to benefit from the more flexible PHP connection that is facilitated by the patient. PHPs also extend HIEs’ value further, by empowering consumers to become active partners in their health – enabling connections to medical devices and to wellness applications for a more holistic view and level of engagement in their ongoing health management.
David and John, based on both of your comments regarding HIE’s and PHP’s and their interplay , how does the integration or access to health & wellness information for the consumer fit into these structures? There are many options for the consumer at the “employer based program level” as well as the “consumer” level? Who and what will drive this?
That’s a tough question Kris for which I do not believe there are any clear answers for at this point in time. What remains to be seen is how HIEs, whose primary purpose is to serve the clinical community, will provide the consumer with access to and potentially control of their PHI. For example, will a consumer be able, through proper security protocols, log-on to their local HIE and download those records, or better yet, set up an automatic transfer of such files to another site (Google Health, HealthVault, etc) whenever there is an update to their records. Once their PHI resides in one of these consumer-facing services, the consumer can invoke various apps to better manage their health as the apps wil pull from a consumer’s unique PHI. This will provide a higher level of customization and Chilmark believe a better value proposition than what we have seen to date. Of course, the devil is always in the details and much still needs to be done before we arrive at this point.