Over on the ever so popular healthcare IT (HIT) rumor mongering website, HIStalk, there has been a running stream of comments since yesterday regarding PHRs that began with a comment by the owner of the site, Mr. HIStalk himself, more or less agreeing with comments by the CEO of EMR vendor Cerner. It appears that Cerner’s CEO, in a recent interview, dissed both Google Health and HealthVault calling them nothing more than “electronic shoeboxes”.
In some respects he is correct. Today, it is far too difficult for consumers to have an independent, untethered PHR, or in the case of HealthVault, a data repository for their records as the consumer must frequently load up all the data via self-entry. Even getting claims data into an untethered PHR is difficult, but it appears that insurers are moving a little faster in that direction than most providers.
But this is changing and the change will accelerate over time as more Integrated Delivery Networks (IDNs), and large hospitals networks (Beth Israel Deaconess, Cleveland Clinic, Medstar, and even maybe Kaiser) begin to provide their customers with an ability to load their medical records up to a 3rd party service thereby enabling portability and consumer control of their records.
Getting back to HIStalk…
In a desire to set the record straight, at least from my vantage point which arguably is well-informed, I provided a fairly lengthy comment on HIStalk in response to comments that preceded it to clear the air. Admittedly, the tone is sharp but after awhile, I really do tire at the amount of dis-information and illogical assumptions that are bantered about.
1) Google & MS are businesses, they are public companies, they have shareholders, so of course they have a business case for defining and supporting their efforts in healthcare, including these consumer plays. I don’t have a problem with that at all as long as they are up front about it, which they have been to date. Actually see their entry into the market as raising the overall quality, security and privacy of PHR solutions going forward, which is a very good thing.
2) In speaking with numerous 3rd party PHR vendors as part of compiling the recently released PHR Market Report, these vendors universally reported that EMR vendors refuse to play ball. The EMR vendors drag their feet in opening up their systems, even when their customers ask them to. No EMR vendor has a vested interest (ie business case) to support opening their systems. Unfortunately, standards are not mature enough nor adopted widely enough to make it happen either. These vendors will be kicking and screaming till the end. Google and Microsoft have the clout and resources to change this dynamic, which we are now beginning to see.
3) Epic MyChart and any other EMR consumer portal certainly has advantages, but all patient portals are tethered and always will be to the host EMR. These systems do not provide a longitudinal record of health for the consumer and should the consumer move, change physicians, whatever, its not like the consumer can easily take that tethered PHR and all the data in it with them. Google and Cleveland Clinic as well as BIDMC are providing portability and from what I hear, much to the chagrin of Epic. Epic hates this!
3b) In addition to the tethered issue, patient portals also do not capture the full health record for those who may have multiple physicians.
3c) And let us not forget the disintermediation of healthcare with medical tourism and retail clinics. An EMR-centric patient portal can not and will not address this issue.
Many changes are afoot and as I outline in our market report, the entrance of Google and MS into this market has some extremely broad ramifications across the entire healthcare sector that I don’t believe we can even begin to imagine in our wildest dreams.
Stay tuned, “The Revolution Will Not Be Televised”
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