Info from the Markle Foundation

Had the privilage of speaking yesterday with Dr. David Lansky of the Markle Foundation (www.markle.org) about his work dealing with Personal Health Records. If you are at all interested in the subject, the Markle website provides a treasure trove of information about history, concept, and policy regarding PHRs.

Our conversation focused on a few main areas. One of them was the future of PHRs in the near and longterm future. Apparently there will be launches within the year by a few major insurers to provide online access for their clients, based on what was billed by physicians, hospitals, and labs for each patient. From a practical and business perspective, insurers may have the best infrastructure already in place to provide access to this information.

Patient Preference on PHRs: Insurers vs. Physicians One possible drawback to this arrangement, however, is a possible lack of trust on the part of patients in insurers as the safeguarders and collectors of this information. At least anecdotally, most patients cite more trust in the relationship with their primary care physicians and would be more comfortable with them as brokers for PHR information. However, physicians are not in as good of a position as insurers to provide this service, at least from an infrastructure point of view.

Provider Sentiment Regarding Implementation of PHRs: Providers who are already invested in and knowledgable about Electronic Health Records seem to be the "best case" as to chances of providing PHRs to patients. These providers tend to have grown up around computers, be enthusiastic about using technology, open to change, and willing to take on some financial risk and investment of their own time to become involved. This leaves a significant gap, though, as best case a third or less of providers fall into this category. The remaining two-thirds of providers seem to be split between those who outright resist electronic record keeping and those who are taking a "wait and see" approach.

Although there are some notable exceptions, those in the resistant category tend to be older providers who are very accustomed to paper charts and see no benefit to investing money or time in change during the remaining years of their practices. Of the "on the fence" third of providers, many are open to EHRs and PHRs as a concept, but are taking a cautious approach for financial, security, and time-management reasons. Articles advising much caution, such as those recently appearing in the Annals of Internal Medicine (link) are giving the "wait and see" element continued justification not to become involved with EHR/PHRs.

Commercial "Non Healthcare" Entities as PHR Providers: Another group looking to become providers of online PHRs is comprised of already influential IT companies such as Google and Quicken. These entities may be in an excellent position to obtain and catalog information PHRs, but will likely encounter the same or greater "trust issues" with consumers as large insurance groups.

Status of Government Efforts: I also briefly discussed with Dr. Lansk the role of federal and state government in the future of PHRs. I was happy to hear from him news that the Wired for Healthcare Quality Act is not a completely dead piece of legislation, as Senator Kennedy is attempting to reintroduce the bill this year. However, general opinion at this time is that no matter how good or neccessary the legislation might be, the government will be hard pressed to provide adequate funding to implement it.

This leaves the current situation of funding being provided to regional health exchanges through grants, and not to individual providers, groups, or medical schools as Wired for Healthcare had called for.

Another policy issue I discussed with Dr. Lansky was his recent position paper (available as pdf on the Markle Foundation site) objecting to proposals for a government PHR Certification Process. From what I could gather from Dr. Lansky, the objection is based on the feeling that mandating such certification would not address core issues and needs regarding security and data structures but become a more or less irrelevant bureacratic hurdle in implementing PHRs. Although I am not well versed on this issue, Dr. Lansky's explanation made sense to me.

Bottom Line: Dr. Lansky was an excellent source of information on the topic of PHRs. His feeling that both large and small scale trials of PHRs being implemented now by insurers, providers, commercial vendors, and academics should be closely monitored in the nearterm so that best practices can be developed from their findings.