Google Health: Is It Good For You?

“Slowly but surely, using the Internet for your health needs is becoming as mainstream as shopping on the web: no longer futuristic, but is it for everyone?  And perhaps more importantly, are mainstream commercial health platforms from companies like Google and Microsoft really useful for people with specific chronic illnesses?  I thought it would be interesting to hear their side of the story.
So please welcome Missy Krasner, Product Marketing Manager for Google Health, whom I was lucky enough to catch up with for an interview last week.”
Article
Amy Tenderich, The Health Care Blog, 7 October 2008

PHR Platforms Race: HealthVault Updated, Consumer Interest Still Unproven

“Last two years brought unprecedented interest in Personal Health Records (PHRs). Started in healthcare industry outlets the excitement crossed over into traditional media and the expectations are high.”
Article
Hippocrates, Trusted MD, 7 October 2008

Integrated personal health records: Transformative tools for consumer-centric care

“Background
Integrated personal health records (PHRs) offer significant potential to stimulate transformational changes in health care delivery and self-care by patients. In 2006, an invitational roundtable sponsored by Kaiser Permanente Institute, the American Medical Informatics Association, and the Agency for Healthcare Research and Quality was held to identify the transformative potential of PHRs, as well as barriers to realizing this potential and a framework for action to move them closer to the health care mainstream. This paper highlights and builds on the insights shared during the roundtable.
Discussion
While there is a spectrum of dominant PHR models, (standalone, tethered, integrated), the authors state that only the integrated model has true transformative potential to strengthen consumers’ ability to manage their own health care. Integrated PHRs through transparency of information and the capacity for iterative communications can improve the quality, completeness, depth, and accessibility of health information provided by both clinicians and patients; provide access to highly specific health knowledge for patients; ensure portability of medical records and other personal health information; and incorporate auto-population of content. Numerous factors impede widespread adoption of integrated PHRs: obstacles in the health care system/culture; issues of consumer confidence and trust; lack of technical standards for interoperability; lack of HIT infrastructure; the digital divide; uncertain value realization/ROI; and uncertain market demand. Recent efforts have led to progress on standards for integrated PHRs, and government agencies and private companies are offering different models to consumers, but substantial obstacles remain to be addressed. Immediate steps to advance integrated PHRs should include sharing existing knowledge and expanding knowledge about them, building on existing efforts, and continuing dialogue among public and private sector stakeholders.
Summary
Integrated PHRs promote active, ongoing patient collaboration in care delivery and decision making. With some exceptions, however, the integrated PHR model is still a theoretical framework for consumer-centric health care. The authors pose questions that need to be answered so that the field can move forward to realize the potential of integrated PHRs. How can integrated PHRs be more rigorously evaluated and moved from concept to widespread practical application? Would a coordinating body expedite this strategy? How can existing initiatives or new policies serve as catalysts to advance integrated PHRs?”
Article
Don E. Detmer, Meryl Bloomrosen, Brian Raymond and Paul Tang, BMC Medical Informatics and Decision Making 2008, 8:45doi:10.1186/1472-6947-8-45

Some light behind the dikes?

In my last blog entry I concluded that there seems to be some confusion in The Netherlands on the structure and functioning of EHRs, especially concerning patient access. In an extended article, Martijn Hulst gave last week an overview of the issues concerning implementation and adoption of EHRs in The Netherlands. Some of his points:

• Pilots are hardly progressing
• GPs resist a country wide roll out
• Patient access has not yet been considered
• Commercial PHRs are now considered alternatives.

He concludes that it should not be a matter of ICT professionals, as it is now, but a strategic issue, concerning all stakeholders (politics, insurers, medical professionals, hospitals, patients), almost certainly requiring a major paradigm shift. September 30, an article appeared in Qure, saying that Nictiz (the Dutch National Institute for Healtcare ICT) has made a secret plan to start a pilot in patient record access as soon as possible. According to the article there remain a number of concerns:

• Up till now, the national switch point (LSP) was only accessible to medical professionals.
• In concept, patients would get access via an electronic national identification pass, but due to procedural problems it might still take a couple of years before it can be implemented.

The proposed alternative to give patients access to the LSP would be to use the Digital ID number (DigID), already used by about half of the population. However, this procedure (log in on a central website with the use of the DigID, receive a confirmation SMS message with a code which gives access to the LSP) is considered of medium safety by the CBP. Nor is clear which data the patients will be able to see as there is only a small number of providers connected to the LSP.
During the last couple of years I have often talked and written about the fact that the concept of a separate EHR and PHR is fundamentally wrong. In Europe, nobody has experience with commercial PHRs, only the Americans do. It is therefore good to keep a close watch to what their reactions are, a couple of months after the introduction by Google and Microsoft. I was glad to read what Bruce Friedman had to say:

“I have come to the conclusion that there is very little future for the so-called untethered PHRs, which is to say web-based stand-alone PHRs. The only ones that will thrive are those with links to hospital EMRs such that some of the medical information contained in the hospital electronic records can be replicated to the tethered PHRs.”

Vince Kuraitis came to a similar conclusion recently, however, as I have said in the Im-Patient Blog, you can discuss the way EHRs and PHRs are joined. In my view, and I wrote and said it many times, most recently in the article “The Impatient Patient“, both should be one integral record:

“a container of links to all medical information about the citizen stored at hospitals, GP practices, pharmacies, independent lab and exam facilities, etc., together with the input from devices, paramedics. The citizen must be able to add his input (comments, over-the-counter-drug use, lifestyle, etc.), to make corrections as well as to decide who is going to see which part of his data and if/how his de-identified data will be used.”

It seems, the Dutch are making a step in the right direction.

Lodewijk Bos

Recommendations for Hospitals Regarding a PHR Relationship

“I have published a number of previous notes about personal health records (PHRs) including a recent one about Health Vault with a reference to Google Health (see: Some Clues About the Microsoft Healthcare IT Strategy). I have come to the conclusion that there is very little future for the so-called untethered PHRs, which is to say web-based stand-alone PHRs. The only ones that will thrive are those with links to hospital EMRs such that some of the medical information contained in the hospital electronic records can be replicated to the tethered PHRs. It is impractical to suggest families will assume the onerous task of hand-entering even a small portion of their health records to a web-based system.”
Article
Bruce Friedman, Lab Soft News, 3 October 2008

Rhode Island to create HIE; gives patients control over PHRs

“Rhode Island will build a statewide health information exchange (HIE) as a result of Gov. Don Carcieri Monday signing into law the Rhode Island Health Information Act of 2008.
The state has tasked the Rhode Island Quality Institute, a private agency, to run the voluntary HIE. The institute has received a $5 million federal grant to build the network but will seek additional funding from the state and health insurers, according to the Providence Journal.”
Article
Health Imaging News, 1 October 2008

Finally, Dossia Goes Live

“In what seems like ages since the first announcement of the formation of Dossia, the third platform play for personal health information (the other two being Google Health and Microsoft HealthVault), Dossia has moved from a an extremely limited pilot of ~20 Wal-Mart employees (guinea pigs) to now become a part of Wal-Mart’s 2009 health benefits package for all employees. Employees will be provided a personal WebMD PHR with WebMD sitting on top of the Dossia utility data service. Wal-Mart issued a tepid PR yesterday announcing a number of health & wellnesses programs for their employees with the Dossia announcement showing up at the bottom of the list.”
Article
John Moore, Chilmark Research, 1 October 2008

The search is on

“Data privacy remains a top concern as Google seeks more users, partners for its new personal health-record platform.”
Article
Rebecca Vesely, Modern Healthcare, 29 September 2008

PHR Recommendations Included in Report

“Personal health records that serve merely as online filing systems will quickly become irrelevant, according to a report from Chilmark Research, Cambridge, Mass. To succeed, the report states, PHRs must “combine data analytics with personalization features and communication to deliver consumer-specific, clinically validated, actionable information”.”
Article
Health Data Management, 1 October 2008

iPHR 2008 Market Report: Executive Summary

“This 20pg Executive Summary, which is being offered for free, highlights the findings of Chilmark Research’s recently published comprehensive report on Internet-based Personal Health Record (iPHR) market, which was released in late May 2008. Exec. Summary provides an overview of market trends for Internet-based PHR solutions as well analysis on the future impact of major platforms from Dossia, Google and Microsoft.”
Report
Chilmark Research, October 2008

Public Comment - CCHIT Certification Commission for Healthcare Information Technology

“Welcome to the very first public comment period for Personal Health Records draft criteria for certification:
Public Comment - CCHIT Certification Commission for Healthcare Information Technology.
There is an introductory document that accompanies the PHR criteria that I encourage all commenters to read.”
Article
Ted Eytan MD, 29 September 2008

HealthVault Surges, Google Flounders

“Late last week I received a note from Sean Nolan, Chief Architect for Microsoft’s HealthVault. While Sean and I certainly share a passion for the home town team, the Red Sox, he was not writing to share the joy of seeing the Red Sox capture a play-off berth. No, Sean was writing to tell me about his latest post, a post where he discusses where HealthVault is today and how one might use HealthVault to manage their personal health.”
Article
John Moore, Chilmark Research, 29 September 2008

The HealthVault Nickel Tour

“A couple of weeks ago now we shipped a bunch of new HealthVault stuff — in particular, we’ve significantly enhanced the tools available directly on healthvault.com. We had a bunch of our best designers rework the site’s content, styling and navigation, and added editing and graphing capability for a set of core data types. This stuff is really exciting to me because I believe it helps users answer the question, “How do I get started?” And most importantly, the investments we’ve made in controls for viewing, editing and graphing HealthVault data will ultimately make their way into our SDK (Software Development Kit) — reinforcing again our commitment to making it easier and easier for our partners to build great HealthVault applications.”
Article
Sean Nolan, Family Health Guy, 26 September 2008

The benefits of personal health records

“Online personal health record applications, available through a growing number of federal employee health plans, have a variety of forms. But they all are designed to give federal employees a convenient way to track, view and manage personal health information and share that information with providers. Employees can put all their information in a PHR and print it as needed to take with them to medical appointment. More advanced PHRs have access to databases that provide drug interactions and generic versions.”
Article
Mary Mosquera, FCW.com, 29 September 2008

The Confusing Issue of the PHR – Personal Health Record

“This too is fast becoming a confusing issue, who and what do you choose?  CMS has their pilot program working and just added the Department of Defense to who have original Medicare and also receive Tricare benefits the options to use the personal health record, called MyPHRSC and the information is provided via a Medicare Contractor, not direct from Medicare.”
Article
The Medical Quack, 25 September 2008

Innovation Principles: What Might Healthcare Sector Learn from Others

“I’m here today at my alma mater, MIT to attend Technology Review’s annual conference, EmTech (short for emerging technologies). And why am I attending an event that appears to have little relevance to healthcare? Well, there is one session this afternoon addressing EMRs and another tomorrow on personalized medicine, but those are periphery to my real reason to attend.”
Article
John Moore, Chilmark Research, 24 September 2008

Health System Leaders Fight Resistance to PHR Adoption

“Health systems nationwide are in varying stages of implementing personal health record applications. The thought is that the technology can provide clinicians with a gold mine of data that will be helpful in improving both efficiency and care quality, while providing consumers with the tools necessary to take a more active role in their health care. Despite the benefits, resistance remains.”
Article
Kate Ackerman, iHealthBeat, 24 September 2008

Yes, Virginia, There Are System Benefits to Be Gained from Providing Patients Access to Their Own Health Information

“In the 1960s, Pierre Trudeau popularized the phrase “The Just Society” when he took over as the federal minister of justice. Four decades later, we have evolved into “The Informed Society,” where consumers from all types of businesses and industries are playing larger roles in both the purchase and the development of products and services. One has to look no farther than the World Wide Web and the fascinating growth of sites such as YouTube (www.youtube.com) and Facebook (www.facebook.com) for evidence. In healthcare, however, such “grass roots” contributions have been slower to come to the fore, although recently initiatives like Google Health, Microsoft HealthVault and PatientsLikeMe are emerging as alternatives to the status quo. One reason for this latency in healthcare is a lack of familiarity with the system that uses language and jargon that is not accessible to the average consumer. Further, there is a lack of appreciation on behalf of consumers regarding the benefits resulting from the role that empowered patients can play. In addition, there are no “information access” points whereby communication between patients and the system can be affected. Ultimately, patients lack the encouragement, education and means surrounding their potential contribution.”
Abstract
Kevin J. Leonard, David Wiljer and Sara Urowitz, Healthcare Quarterly, 11(4) 2008: 64-68

New Frontiers in PHRs

“Normally talk about “new ecosystems” might be heard at a wildlife conference, but it dominated the presentations given in Washington on September 17 during a conference on “New Frontiers in Personal Health Records” sponsored by the Robert Wood Johnson Foundation (RWJF).”
Article
Stephen Barlas, Digital Healthcare & Productivity, 23 September 2008

Academics and PHRs: RWJ’s Project HealthDesign Rolls the Carpet Out

“Last week, the Robert Wood Johnson Foundation (RWJ) hosted a one day event in Washington DC. Purpose of the event was to showcase the nine PHR-type solutions that have been developed under the multi-year, $5M Project HealthDesign (PHD) umbrella. Seven projects were funded at academic institutions the other two, beltway bandit consulting firms.”
Article
John Moore, Chilmark Research, 22 September 2008

Cell Phone App to Link to HealthVault

“Wilkes-Barre, Pa.-based AllOne Health Group Inc. will integrate its AllOne Mobile software with the HealthVault initiative of Redmond, Wash.-based Microsoft Corp. This will enable consumers to access and transmit their personal health information using cell phones and smart phones.”
Article
Health Data Management, 22 September 2008

PHR Certification Looking for Input

“Now, I am no fan of the whole CCHIT initiative to develop a certification process for PHRs as this market is far too immature. But continue on they do and whether I like it or not matters little for the simple fact that a gargantuan organization representing millions, (hint their acronym is CMS) will demand that any PHR they push to their constiuents have such certification. At this point about the only thing I can hope for is that the group in charge with creating the standards for certification keep it loose and not too prescriptive.”
Article
John Morre, Chilmark research, 19 September 2008

Practice-Linked Online Personal Health Records for Type 2 Diabetes Mellitus

“Background  Web-based personal health records (PHRs) have been advocated as a means to improve type 2 diabetes mellitus (DM) care. However, few Web-based systems are linked directly to the electronic medical record (EMR) used by physicians.
Methods  We randomized 11 primary care practices. Intervention practices received access to a DM-specific PHR that imported clinical and medications data, provided patient-tailored decision support, and enabled the patient to author a “Diabetes Care Plan” for electronic submission to their physician prior to upcoming appointments. Active control practices received a PHR to update and submit family history and health maintenance information. All patients attending these practices were encouraged to sign up for online access.
Results  We enrolled 244 patients with DM (37% of the eligible population with registered online access, 4% of the overall population of patients with DM). Study participants were younger (mean age, 56.1 years vs 60.3 years; P < .001) and lived in higher-income neighborhoods (median income, $53 784 vs $49 713; P < .001) but had similar baseline glycemic control compared with nonparticipants. More patients in the intervention arm had their DM treatment regimens adjusted (53% vs 15%; P < .001) compared with active controls. However, there were no significant differences in risk factor control between study arms after 1 year (P = .53).
Conclusions  Previsit use of online PHR linked to the EMR increased rates of DM-related medication adjustment. Low rates of online patient account registration and good baseline control among participants limited the intervention’s impact on overall risk factor control.”
Abstract
Richard W. Grant; Jonathan S. Wald; Jeffrey L. Schnipper; Tejal K. Gandhi; Eric G. Poon; E. John Orav; Deborah H. Williams; Lynn A. Volk; Blackford Middleton, Arch Intern Med. 2008;168(16):1776-1782,

Research teams unveil ‘next-generation’ personal health records

“Nine research teams from across the country unveiled “next generation” prototype personal health records (PHRs) on Wednesday as part of an 18-month, $5 million grant program sponsored by the Robert Wood Johnson Foundation.
Article
Diana Manos, Healthcare IT News, 19 September 2008

From PHRs to PHRSs

“Personal health records (PHRs) are evolving toward becoming Personal Health Record Systems (PHRSs).…that’s my key takeaway from attending the Robert Wood Johnson Foundation (RWJF) Project Health Design (PHD) conference in Washington D.C. on September 17.”
Article
Vince Kuraitis, e-CareManagement Blog, 18 September 2008

Cloud computing puts your health data at risk

“The advent of “in the cloud” medical records services, such as Microsoft HealthVault and Google Health, promises an explosion in the storage of personal health-care information online.
But these services pose sticky privacy questions — unless you know how to protect your personal medical records.”
Article
Stuart J. Johnston, Windows Secret, 18 September 2008

Design Teams Unveil Innovative PHR Applications that Help People Take Charge of Their Health

“Nine research teams from across the country today unveiled innovative prototypes of personal health record (PHR) applications that provide a glimpse of the “next generation” of PHRs. The PHR applications are the result of 18 months of intensive research and design by multidisciplinary teams from some of the most prestigious institutions in the nation. The prototypes range from a medication management system to help children with cystic fibrosis manage their disease (housed in an age-appropriate form, like a stuffed animal or cell phone), to a sophisticated “conversational assistant,” a computerized tool that helps people with congestive heart failure manage their health from home through a series of voice-activated questions and responses that they can quickly share with their medical providers.”
Article
Robert Wood Johnson Foundation, 17 September 2008

(CCHIT): An Invitation to Participate in Developing a Certification Program for Personal Health Records

“I am posting this invitation from the Certification Commission for Health Information Technology in its entirety, because I am Co-Chair of the Personal Health Records Workgroup alongside Lory Wood from the Good Health Network. I’ve been very impressed with the experience and talent that the group has brought to this first step and I have learned a ton. The input of the public is the next step. I encourage everyone to get involved.”
Article
Ted Eytan MD, 16 September 2008

It’s About the Patient: Peter Neupert on Consumers, Standards, and what HealthVault Needs to Succeed

“Peter Neupert is Corporate Vice President, Health Solutions Group, at Microsoft, which is charging into the personal health record field with HealthVault.  After the recent spat of articles and editorials in Health Affairs debating health IT strategy, I was eager to hear Peter’s view on the “standards first?” controversy and how Microsoft sees the emerging consumer health world.”
Article
Malorye Allison, World Health Care Blog, 16 September 2008

House Lawmaker Introduces Bill To Create Nationwide EHR System

“On Monday, House Ways and Means Health Subcommittee Chair Pete Stark (D-Calif.) introduced a bill designed to create a nationwide system of electronic health records, CongressDaily reports.
Under the bill, physicians who use an approved EHR system would be eligible for up to $40,000 over five years in Medicare incentive payments, while hospitals could receive several million dollars. Eventually, the Medicare incentive payments would be phased out, and Medicare reimbursements would decrease for health care providers that do not use an approved EHR system.”
Article
iHealthBeat, 16 September 2008