The provider market has always been a key market for PHR vendors, but most PHR adoption and deployment efforts are led by a provider’s marketing department to improve customer service and increase retention. That is beginning to change.
In Chilmark’s periodic calls with numerous PHR vendors we are beginning to see an uptick of interest among providers in PHRs that goes beyond serving the marketing department’s objectives. Providers are now looking to PHRs to assist them in their efforts to improve care transitions (inpatient -> outpatient), reduce hospital re-admissions, and leverage telehealth for chronic care management. In each of these cases there is money to be made (pay for performance and disease management programs) or saved (CMS & payer rules not reimbursing hospital re-admits within specific time period).
When Chilmark published it’s iPHR Market Trends report last year we identified the provider market as one of the key markets for PHR solutions (25% of those interviewed stated provider market was primary), with the other two key markets being payers (15%) and employers (35%). At that time, however, it appeared that the provider market was not particularly attractive to most independent PHR vendors as providers typically gravitated to their EMR vendor for a tethered PHR such as Cleveland Clinic’s and Kaiser-Permanente’s use of Epic’s My Chart. For those providers with more complex, multiple legacy EMR environments, the PHR solution they typically deployed was a basic patient portal such as MEDSEEK.
But as providers’ needs for their PHR platform have become more complex, the lack of investment by EMR vendors in their PHR solutions is beginning to show. This lack of investment is unlikely to change as EMR vendors now focus their efforts on chasing ARRA (Stimulus) funding.
The situation for patient portals is not much better. As a first generation outreach mechanism for marketing departments, a PHR based on portal technology was fine. But what leading providers are beginning to discover is that most patient portal solutions are pretty generic, simplistic apps that are not capable of delivering the more advanced functionality they are now seeking.
What are leading edge providers looking in these independent PHR solutions?
Ability to aggregate and present relevant, personalized information to the consumer. This goes beyond basic generic content and simple reminders that are currently found in most PHR solutions. The Mayo Clinic’s recent launch of the HealthVault app, Health Manager, is a move in that direction.
Deeper, richer customer experience (content, biometrics, feedback/interaction) that is pertinent to their specific chronic disease for improving disease management and reducing avoidable hospitalizations. PHR vendor NoMoreClipboard is currently working with Howard University on using their platform for diabetes management in the District of Columbia. Cleveland Clinic has an interesting ongoing biometric trial using HealthVault’s Connection Center.
A clinician interface to the PHR to facilitate their interaction and use of the app with the consumer. This might include consumer generated biometric data seamlessly feeding into the clinician’s workflow. May also include embedded clinician decision support as well.
Capabilities to more effectively manage care transitions from inpatient to outpatient settings and thereby reduce re-admissions within the critical 30 day window after discharge. The recent launch of MyNYP.org is an example of such for cardiac patients at New York Presbyterian.
Looking ahead
The provider market is the largest PHR market today and it is likely to stay that way for years to come. PHR vendors looking to serve this market, however, need to rethink their strategies and begin delivering solutions with deeper functionality than what most have on display today. The days of simple tethered PHRs that are nothing more than a patient portal view of an EMR will fade over the next few years as providers seek to capitalize on new opportunities for consumer engagement that go beyond marketing but are reimburseable and/or save them precious cash.
It’s proof that PHRs are truly an immature market. The proof is in the shortage of features, the shallowness of information, and the abysmal quality of design for these first-gen PHRs.
If you can think back to first generation ATMs, the interfaces were pretty awful — but we were more than satisfied because of the utility they offered us.
Unfortunately, with PHRs users/patients won’t be satisfied with merely having limited access to data. They’ll quickly come to expect the same level of sophistication they expect from online reservation systems, online banking, and e-commerce.
Let’s see how long it is before a second generation of PHRs (such as Polka, for example) starts gaining traction in the market.
The problem is that the PHR market is incredibly fragmented. At last count there are 75+ independent PHR vendors out there.
Vendors need to stop making me-too tethered PHR sites and focus on value-added applications that give actionable data.
Claudio,
Just have to ask, how many PHR apps have you actually used? You are taking a pretty broad brush to the sector, that may be true overall, but there are some interesting apps popping up here and there.
Indeed, the market is still quite immature, after all, the first web-based PHR was introduced less than a decade ago. While maturity is needed in the apps, it is difficult to draw comparisons to other online transactional processes such as you referenced. What a CHF patient needs is quite a bit different than one wih diabetes or asthma or simply a healthy individual that is looking to track and trend diet, immunizations, etc. And then there are those who may be managing the health of an elderly love one, again, a completely different set of needs.
So yes, it is immature, most PHR apps are poorly designed and consumer engagement/adoption remains lackluster, which may ultimately be the biggest challenge of all for this sector.
Lincoln,
Yes, there are far too many PHR apps for a market that is absolutely tiny in terms of total revenue and users. It is very easy to put one of these apps together and launch it into the market and once there, really doesn’t take much to keep it going. That being said, many of these vendors will simply fade away.
We, Chilmark Research, is indeed starting to see some newer apps coming into the market that break away from the dated PHR model that was really nothing more than an online filing cabinet with incredibly simplistic tools.
Also agree on the whole tethered-PHR issue, a dated model who’s time has come to pass. Will write more abut that in upcoming post.
Hi, John. I find this very interesting. Looking at your article from the patient perspective, where do you see the “participatory” part of patient input? I see output for patients, but I don’t see input. Did I miss it?
I believe a collaborative model where both patient and healthcare provider input information is mandatory for optimal healthcare. Although there will be patients who will never use it (just like ATM’s if using Claudio’s analogy), the option should be there for those who will. And in a relatively short time, most people WILL. Like other technological trends, the growth of use is almost exponential (Hawkins,Kurzweil, etc.)
Regards
Hi Robin,
Today, most provider PHRs have little if any participatory features beyond the transactional processes I mentioned, e.g., making appts, Rx refill requests, billing, lab results viewing and maybe an eConsult. Beyond that, very little.
Part of the point of this post was to bring to light that some providers are now beginning to look at more participatory activities/interactions btwn patients and clinicians. Still very early and only a few are doing this, but this may be a trend in the right direction – sure hope so.
Also, let us not lose sight of the ARRA Stimulus funding and “meaningful use” wherein care coordination might be defined as not only clinician to clinician sharing of health data, but clinician to patient. Keeping my fingers crossed that HHS will see it that way.
Hi John,
To your point, I recently read about the testing of digital at-home visits based on a PHR platform. The patients select a participating physician, share their medical files as necessary, and get a digital consult either by ichat, phone or video conferencing. It will be interesting to see if it does well and spreads in usage. Certainly could be an effective way that PHRs could help reduce clogged ERs, and get people care for conditions appropriate to this management style.
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