Chilmark Research is becoming increasingly uncomfortable with the PHR acronym for Personal Health Record. There are a couple of reasons for this:
1) The term is a hold-over from the physician-centric term EMR and thereby firmly attached to that conceptual framework. But does the average consumer really need to adopt an EMR architectural construct for their PHR? Unlikely. The consumer needs their own unique and self-empowering “system” to more effectively manage their health and interact with the healthcare establishment.
2) A Personal Health Record connotates just that, a record, a file cabinet of dumb data. How useful is that? Well, some have found it useful, to say manage their medications or children’s immunization records but it is an extremely small percentage of the population. Today only about 3.5% of the US population is using a PHR. In fact, when Chilmark digs deeper into its PHR numbers we find that of that 3.5% of PHR users, a significant majority are not using simple PHRs but more complex systems or platforms that allow a user to not only view their medical records, but leverage their data, typically in an automated fashion, to advise them (making that data actionable), drive transactional processes to simplify their interaction with the healthcare system and provide guidance.
That is not to say a PHR is unimportant – far from it.
What is important is that a simple PHR (using Markle’s definition) is actually of little value to your average healthy consumer. There is simply not enough there to engage consumer, which comprises about 75-80% of the population and even among the ill, as adoption rates show, the value proposition of a PHR is typically too low to drive significant adoption.
What is working and seeing adoption at fairly high rates are Personal Health Platforms (PHPs) that leverage a consumer’s health data, be it claims, labs, demographics, etc. to take a given action. There are also those, such as Kaiser’s or Group Health’s that also combine numerous transactional processes (appt scheduling, Rx refils, eConsults, etc.) that consumers/members also find extremely valuable.
But what may become a problem in the future is that policy makers are currently advocating, within the context of “meaningful use,” that physicians offer their patients/consumers a PHR by 2013. Now what does that mean? Is it simply providing access to one’s records, a consumer-centric portal view to the EMR with no record portability? Will it be just an e-file cabinet bolted to the floor of the EMR? If so, we are left with the same problem that has plague PHRs from the beginning, no one wants a dumb file cabinet, especially one you cannot move (no portability). We liken this to a perverted form of online banking where one can go see their bank account balances, but not conduct any transactions, no online bill pay, no funds transfer, nothing.
It is indeed time to retire the PHR term and begin talking about platforms they allow one to move beyond simply looking at the latest medical records, labs or med lists, but provide them with guidance and suggested actions that they can take to better manage and improve their health and/or the health of their loved ones.
Part Two, coming tomorrow, will outline a framework for assessing the attributes of PHPs.
John:
I agree with you that “most” PHRs today are dumb data stores – and “platforms” like HealthVault have the potential to create real utility.
However, disagree that we need another term – too many out there already. A PHR means different things to different people – that’s a given. What exactly do we accomplish with a new name? It shifts focus – the focus should be on how we define PHRs in a comprehensive manner so that while its use interpretation can be flexible – it will also in the aggregate deliver benefits across the continuum of care.
A more comprehensive definition – one that takes into consideration meaningful use is a better way to advance the use of PHRs by all the stakeholders (patients included). The HHS/ONCHIT has the forum to advance such a definition.
We have enough standards, and we have enough technologies already in the market — we just need to “define” and “regulate” it better – and achieve better adopton by creating meaningful applications – ones driven by better definitions not nomenclature.
An example – HITECH Subtitle D (Privacy) has a number of considerations to advance the utility of PHRs further – by bringing the data handling closer to HIPAA considerations (Business Associates-PHR providers and Covered Entities face similar penalties for breaches, etc). A good start – and when Physicians (covered entities in general) have the comfort level to look at PHRs as equals with EMR records – we achieve even better utility of PHRs.
Look forward to your follow-up commentary.
Tom,
Thanks for the thoughtful comments. Chilmark struggled with whether or not we wished to introduce yet another acronym into an industry sector that has more than its fair share. But being the analysts that we are and analysts just have this penchant for creating acronyms, we have proposed one here to address the market for consumer engaging apps that have at their foundation the proverbial file cabinet of personal health record data, but then transcend that with capabilities and tools that actually make that data “work” for the consumer.
Our biggest fear today is that within the context of “meaningful use” the definition of a PHR that must be provided by a physician, clinic or hospital may end up being nothing more than the bolted to the floor (no portability) file cabinet. If that is indeed the case, we will fail to engage the consumer/patient in a meaningful way that promotes care coordination and ultimately better outcomes. Thus, we decided to strike out in a new direction in an effort to move the discussion beyond the narrow PHR definition that is prevalent today and unfortunately may now be being used by CMS rule making honchos for meaningful use.
John,
You make a compelling case for moving away from the PHR term as it has historically been used and interpreted. To think of a PHR as only an extension of an institutional EMR is restrictive. As you know Project HealthDesign has proposed to refer to these tools/resources as Personal Health Record Systems, with the accent on Systems that enable “meaningful use” for consumers in terms of supporting healthy behaviors. The data repository itself is necessary but not sufficient to bring value to consumers/patients. I can agree with substituting the term “platforms” for “systems” if it gets greater traction in the evolvling discussion about “meaningful use” for consumers/patients. Fundamentally is is about behavior change and tools/resources, plaftorms, or systems that help achieve that goal are needed. We have a series on the RWJF Reform Nation blog that attempts to drive home this point –
http://rwjfblogs.typepad.com/healthreform/2009/08/last-but-not-least-meaningful-use-for-patients-and-consumers.html#more
DKA
John:
“nothing more than the bolted to the floor (no portability) file cabinet”—– Having built one of the early versions PHR platforms (even before HIPAA) – I understand your concern. And it applies not just to PHRs but to EHRs in general
It behooves the PHR platforms to push even harder – expose the capabilities of their platforms – and entice application developers to use their portable back-ends.
In general – our intentions are similar on many fronts – we just seem to have different approaches (and perhaps a few different underlying assumptions).
As long as we all start with a few similar intentions – we have the basis for a good debate on how to achieve the full potential of PHRs.
And don’t be so harsh on your analyst thinking – a provactive proposition quite often begets a meaningful debate!!
Look forward to your follow-up commentaries.
Cheers!
@ David Ahern
“To think of a PHR as only an extension of an institutional EMR is restrictive.” – I am not sure anyone is suggesting this route – and if they are – it would not help achieve the full potential of PHRs.
“Fundamentally is is about behavior change and tools/resources, plaftorms, or systems that help achieve that goal are needed.” – AGREE!
You guys do some great work over @ Project Health Design – RWJF – Thanks!
WebMD has been very comfortable for about 10 years using BOTH the “Platform” and “Record” terms. They’re complementary to each other. If the PHR – which, whether we like it or not, is what people tend to understand – is a solution that helps a consumer to gather, store, manage and share their data, then it can be an important part of a Personal Health Platform. Our “Health and Benefit Manager Platform” supports four solution suites: Health Management (HRAs, coaching services, etc), Health Records, Benefit Decision Support, and Provider and Treatment Decision Support. The Platform serves as the foundation for these components of the consumer experience, and it is driven by the data managed through the health record (defined as a personal health record :). So we have grown very comfortable with these two ideas living together.
David, as you know we are well aware of the great work RWJF has done on this topic, including Project Health Design that has brought forth some very intriguing ideas/concepts that will more fruitfully engage the consumer/citizen. As mentioned in this post and the following one published yesterday, Chilmark has come the belief that there is a need to establish a new definition of a consumer-centric health model, the Personal Health Platform that at its foundation may have the PHR, that file cabinet of data, but through a platform approach of associated apps, tools and services, the platform makes that data actionable. We did consider the term “systems” but platform has more relevance in the context of IT.
In the end though David, we both have similar intentions: seeing the fruition of platforms/systems that contribute to behavioral change and long term better health for the citizen and the nation.
Phil,
As we point out in Part Two, platforms are nothing new and we actually use WebMD as a prime example for indeed, WebMD has taken a platform approach for several years now, though I did not realize it has been a full decade! In Part Two Chilmark more clearly articulates the reasons why the PHR term may ultimately come back to haunt us in the guise of meaningful use recommendations. The industry and policy makers need to begin thinking and promoting platforms (or at least allow easy portability of one’s health records to a platform) if indeed we wish to see citizens meaningfully use their personal health records.
John,
Interesting discussion which I still struggle with in the naming of out mPHR (Mobile Personal Health Record). My experience if that it really doesn’t mater what you call something it is how it is marketed. For example the first time i heard the name “Yahoo” I thought what is a yahoo. A friend of mine that wrote the business plan for yahoo while working on his MBA a Sanford told me that the name was a bit of a shock to him in the late 90’s but everyone knows what Yahoo is today.
Many non-clinical people that I speak to do not know what an EMR/EHR/PHR is but they do have a concept of a Personal Health Record. I belive the real challenge is the marketing and we need Physicians to embrace the use of patient provided data. As you know most physician only trust empirical data, so this is a challenge.
Your banking analogy is correct, there are still banks that have online banking without bill pay or bill presentment. I will not use a bank that doesn’t provide integration to Quickbooks. The market will set the standarda and PHR without meaningful use will lose market share.
Jeff Brandt motionPHR for iPhone http://www.motionPhr.com
MyMedBox for Android http://www.myMedBox.info