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Will Personal Health Information Exchanges (PHIE) Lead the Consumer Medical Record Revolution and Bridge the Gap Between PHRs and EHRs? (Part 2 of 2)

Posted on August 5, 2015 I Written By

The following is a guest blog post by Cora Alisuag, RN, MN, MA, CFP, President & CEO, CORAnet Solutions, Inc.
Cora Alisuag, CEO, CORAnet Solutions
Be sure to check out part 1 in this series where we talked about the movement towards an empowered patient who controls their health record.

Lack of Interoperability Continues to Hamper Patient Record Access

However, it has been six years since the HITECH Act passed, yet most Americans seeking medical care are still unable to obtain their full medical records for a variety of reasons. Some hospitals will simply not release them or proprietary EHR system vendors not allowing hospitals, let alone patients, direct access.

This capability also comes at a critical time as enormous obstacles hamper the ability of people to obtain their medical records. This is documented in the ONC’s “2015 Report to Congress on Health Information Blocking” which concludes that it is apparent that some health care providers and health IT developers are knowingly interfering with the exchange of health information in ways that limit its availability and use to improve health and health care.

This situation is only going to worsen as the Centers for Medicaid and Medicare (CMS) is considering a change to the EHR meaningful use rule that requires five percent of patients must view or download or transmit their health data to only one patient; not one percent, one patient.

Blue Button Not Gaining traction

In the meantime, other PHR technology has been introduced, but has not gained popularity including forays from Microsoft and Google. The ONC and other government organizations’ initiative to adopt and use the Blue Button platform for exchanging healthcare data between clinicians equipped with electronic health-record systems and patients with mobile computing devices is stalled, according to a recent survey by the not-for-profit Workgroup for Electronic Data Interchange (WEDI).

WEDI questioned 274 providers, health plans, HIT vendors and claims clearinghouses in the Second Annual Survey of Industry Awareness of Blue Button, conducted late in 2014. Only eight percent of respondents noted that their organizations actually used Blue Button, down from 15% of survey respondents in 2013.

PHRs Largely Unpopular

PHRs joined the lexicon of medical terminology several years ago as a convenience way for consumers to have copies of their medical records. It was largely born out of EHR’s lack of interoperability and access. However, as far back as 2009, a Health Affairs article detailed the major factors behind the slow adoption of PHRs. The article reviewed some of the reasons and includes cost, access, interoperability, security concerns, and data ownership.

Because health records which include clinical data, laboratory results and medical images do not flow freely among multiple organizations due to lack on EHR interoperability, PHRs do not automatically receive data. This means that the data must often be entered manually by consumers—a time-consuming and error-prone process. For most consumers, this lack of safe and reliable automation makes it problematic to maintain a PHR, and a PHR that is not up-to-date likely will not be used. Unlike PHIEs, the API-EHR connectivity connection is the missing link in PHRs.

However, the authors of the Health Affairs article offered a challenge. They described a gap between today’s personal health records (PHRs) and what patients say they want and need from this electronic tool for managing their health information. They noted that until that gap is bridged, it is unlikely that PHRs would be widely adopted, but noted that in the future; when these concerns are addressed, and health data is portable and understandable in content and format, PHRs will likely prove to be invaluable.

“While we all agree that lack of interoperability continues to stymie patient health record access and PHRs might not be the ultimate solution, but if a PHIE can bridge the gap by accessing EHR data through an open API while offering the security and convenience of a PHR. I believe PHIEs offer a solution that should satisfy the spontaneity of millennials’ and more frequent use of middle-aged and elderly users,” says Tiffany Casper, RNC, CNM, MSN and President of EMR Consultants which helps medical organizations transition to EMR systems.

About Cora Alisuag
Cora Alisuag is the CEO of CORAnet Solutions, Inc., a health information technology company. She is the inventor of CORAnet technology, the software engine that drives CORAnet’s Personal Health Information Exchange (PHIE), allowing patients’ mobile device access to their complete medical records. She is also an MN, MA, CFP and healthcare industry speaker and serial medical entrepreneur.

Will Personal Health Information Exchanges (PHIE) Lead the Consumer Medical Record Revolution and Bridge the Gap Between PHRs and EHRs? (Part 1 of 2)

Posted on August 4, 2015 I Written By

The following is a guest blog post by Cora Alisuag, RN, MN, MA, CFP, President & CEO, CORAnet Solutions, Inc.
Cora Alisuag, CEO, CORAnet Solutions
It has only been about two generations since traveling medicine shows were common forums for medical information. Phony research and medical claims were used to back up the sale of all kinds of dubious medicines. Potential patients had no real method to determine what was true or false, let alone know what their real medical issues were.

Healthcare has come a long way since those times, but similar to the lack of knowing the compositions of past medical concoctions and what ailed them, today’s digital age patients still don’t know what is in their medical records. They need transparency, not secret hospital –vendor contracts and data blocking, like the practices being questioned by the New York Times. One patient, Regina Holliday resorts to using art to bring awareness to the lack of patient’s access to their own medical records.

Testifying in July 2015 before the Senate Committee on Health, Education, Labor & Pensions, Direct Trust President and CEO David C. Kibbe, MD MBA, has urged the federal government to take action to help overcome the problems impeding the sharing of health information between and among parties authorized to access electronic health data, commonly referred to as “information blocking.”

“While the responsibility for assuring secure interoperable exchange resides primarily with the health care provider organizations, and not with the EHR (electronic health record) vendors nor the government, I strongly believe there is a role for government to encourage and incentivize collaborative and interoperable health information exchange,” testified Dr. Kibbe, one of the nation’s foremost authorities on health information exchange security issues.

There are many reasons patients want access. Second opinions, convenience, instant access in a medical emergency and right of ownership—I paid for them, I own them. Other reasons patients need to view their records is for accuracy and validity. Inaccurate record keeping has even caused the EHRI Institute to cite incorrect or missing data in EHRs and other health IT systems as the second highest safety concern in its annual survey, outlining the Top Ten Safety Concerns for Healthcare Organizations in 2015.

Healthcare system executives, from CIOs to CEOs are very aware of the increasing requirements from patients asking for their records and the various state and federal laws that come into play. However, they are also aware that by making it too easy for patients to access records they risk liability and HIPAA issues. They also don’t want to provide documents that can easily enable cost comparisons or raise questions about charges.

Consumers Uniting

Riding the wave of interest in accessing personal medical records are organizations like Get My Health Data. Org. The organization was founded in June 2015 as a collaborative effort among leading consumer organizations, health care experts, former policy makers and technology organizations that believe consumer access to digital health information is an essential cornerstone for better health and better care, coordinated by the National Partnership for Women & Families, a non-profit consumer organization. On July 4 it launched #DataIndependenceDay to create awareness for the HIPAA law which states that patients must be granted access to their health information with very few exceptions. An update to those laws that was finalized in 2013 extends these rights to electronic health records.

Despite the introduction of Personal Health Records (PHRs), Blue Button technology and product introductions from blue chip technology leaders such as Microsoft and Google, there has been no significant, unifying technology to ignite pent up demand for their medical records by consumers. This lack luster interest and ongoing interoperability issues might be the unifying force to drive many consumers to consider Personal Health Information Exchanges (PHIEs) as an alternative to EHRs and Health Information Exchanges (HIEs) that unnecessarily duplicate data and risk HIPAA violations.

Will PHIEs Ignite the Patient Record Access Movement?

Frost & Sullivan, in its research report, “Moving Beyond the Limitations of Fragmented Solutions Empowering Patients with Integrated, Mobile On-Demand Access to the Health Information Continuum”, identifies Personal Health Information Exchange (PHIEs). They are described as providing individual patients, physicians, and the full spectrum of ancillary providers with immediate, real-time access to medical records regardless of where they are stored by using an open API.

The PHIE can provide access to the entirety of an individual patient record, regardless of the number of sources or EHR systems in which the patient data resides. This technology is made possible through fully interoperable integration servers that can access any EHR system with available APIs and portray the integrated data in a viewable, secure and encrypted format on a mobile device.

By leveraging the powerful simplicity of open APIs, PHIE technology can also access medical records in a way that is much more comprehensive than the closed EMR portals commonly used by doctors’ offices. Despite their pervasive use, these portals are cumbersome and expensive for patient’s use. The portals also include the same lack of interoperability that plagues hospital EHR systems.

“PHIEs can be the breakthrough everyone has been waiting for; challenging every consumer health organization, third-party payer, hospital, ACO network, and Congress to recognize the need to move away from proprietary systems. Adoption of this technology would also demonstrate the healthcare industries’ commitment to allowing patients access to their own records,” notes Dr. Donald Voltz, an anesthesiologist at Aultman Hospital in Canton, Ohio who leads a campaign for EHR connectivity.

“If done correctly, PHIEs can lead in the consumer health information campaign for change, interoperability now, quality and safety through license relationships with hospitals, payers, telecommunications companies, mobile device firms and large employers. Interoperability issues could be a thing of the past and lead to integration with leading EMR systems, integration with HIEs, VAR agreements with health and wellness IT firms and application distribution through the online market place with Google Play and iTunes,” says Voltz.

Tomorrow in part 2 of the series we’ll talk about current interoperability efforts and the challenges they face.

About Cora Alisuag
Cora Alisuag is the CEO of CORAnet Solutions, Inc., a health information technology company. She is the inventor of CORAnet technology, the software engine that drives CORAnet’s Personal Health Information Exchange (PHIE), allowing patients’ mobile device access to their complete medical records. She is also an MN, MA, CFP and healthcare industry speaker and serial medical entrepreneur.

HIM Departments Need More Support

Posted on July 16, 2015 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

As both a contributor to this blog, and an assertive, activist patient managing chronic conditions, I get to see both sides of professional health information management.  And I have to say that while health data management pros obviously do great things against great odds, support for their work doesn’t seem to have trickled down to the front lines.  I’m speaking most specifically about Medical Records (oops, I mean Health Information Management) departments in hospitals.

As I noted in a related blog post, I recently had a small run-in with the HIM department of a local hospital which seems emblematic of this problem. The snag occurred when I reached out to DC-based Sibley Memorial Hospital and tried to get a new log-in code for their implementation of Epic PHR MyChart. The clerk answering the phone for that department told me, quite inaccurately, that if I didn’t use the activation code provided on my discharge summary papers within two days, my chance to log in to the Johns Hopkins MyChart site was forever lost. (Sibley is part of the Johns Hopkins system.)

Being the pushy type that I am, I complained to management, who put me in touch with the MyChart tech support office. The very smart and help tech support staffer who reached out to me expressed surprise at what I’d been told as a) the code wasn’t yet expired and b) given that I supplied the right security information she’d have been able to supply me with a new one.  The thing is, I never would have gotten to her if I hadn’t known not to take the HIM clerk’s word at face value.

Note: After writing the linked article, I was able to speak to the HIM department leader at Sibley, and she told me that she planned to address the issue of supporting MyChart questions with her entire staff. She seemed to agree completely that they had a vital role in the success of the PHR and patient empowerment generally, and I commend her for that.

Now, I realize that HIM departments are facing what may be the biggest changes in their history, and that Madame Clerk may have been an anomaly or even a temp. But assuming she was a regular hire, how much training would it have taken for the department managers to require her to simply give out the MyChart tech support number? Ten minutes?  Five? A priority e-mail demanding that PHR/digital medical record calls be routed this way would probably have done the trick.

My take on all of this is that HIM departments seem to have a lot of growing up to do. Responsible largely for pushing paper — very important paper but paper nonetheless — they’re now in the thick of the health data revolution without having a central role in it. They aren’t attached to the IT department, really, nor are they directly supporting physicians — they’re sort of a legacy department that hasn’t got as clearly defined a role as it did.

I’m not suggesting that HIM departments be wiped off the map, but it seems to me that some aggressive measures are in order to loop them in to today’s world.

Obviously, training on patient health data access is an issue. If HIM staffers know more about patient portals generally — and ideally, have hands-on experience with them, they’ll be in a better position to support such initiatives without needing to parrot facts blindly. In other words, they’ll do better if they have context.

HIM departments should also be well informed as to EMR and other health data system developments. Sure, the senior people in the department may already be looped in, but they should share that knowledge at brown bag lunches and staff update sessions freely and often. As I see it, this provides the team with much-needed sense of participation in the broader HIT enterprise.

Also, HIM staff members should encourage patients who call to log in and leverage patient portals. Patients who call the hospital with only a vague sense that they can access their health data online will get routed to that department by the switchboard. HIM needs to be well prepared to support them.

These concerns should only become more important as Meaningful Use Stage 3 comes on deck. MU Stage 3 should provide the acid test as to whether whether hospital HIM departments are really ready to embrace change.

What’s the Mission of Your Healthcare Organization?

Posted on March 10, 2014 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Saturday I had the tremendous (that’s in the sarcasm font in case you missed it) opportunity to do a pediatric walk in visit for my daughter. Everything is fine and my daughter’s doing well. However, while I was waiting in the lobby, I saw the following sign posted on the wall:
Partners Healthcare Mission Statement

For those who can’t see images, here’s what it says:
Mission: Deliver the highest quality of care to tall of our patients.
Promise: HealthCare Partners of Nevada and its team of professionals will not tolerate nor be indifferent to poor quality.
Creed: Live our mission; Keep our promise

Someone recently described my blog focus as covering the business of healthcare. I thought that was a pretty decent description. Certainly we have an IT bend to almost all of our content, but we’re happy to write about anything that relates to the business of healthcare. It just so happens that IT is involved in almost every business aspect of healthcare.

With this focus, I think I sometimes get a little jaded when it comes to healthcare organizations motivations when it comes to the care they provide their patients. I’ve often argued for the importance of the almighty dollar when it comes to influencing doctors in healthcare. This was reinforced just today in Dr. Jayne’s post on HIStalk where she said, “At least all of our physicians were migrated to a common contract in tandem with our EHR project more than half a decade ago because we realized only money would align them with our goals.

While I still believe that the financial incentives are the best motivator, I think we need to be careful and not take it too far. Healthcare should be and can be more than just the financial incentives alone. In fact, any organization with a long term view will likely have a mission similar to the one espoused by Partners HealthCare.

I strive similarly with my blogs. Certainly I need my blogs to be a viable business and I want to continue building them to be able to reach more people. However, my goal is for my blogs to be about much more than just making a buck. I believe they have, can, and will have an important impact for good on healthcare. I’m sure I’ll overstep on occasion and my good readers will hold me accountable when I do. However, hopefully the Healthcare Scene network can stay focused on providing real value to those who read.

I should maybe consider having my wife do a guest blog post on Partners HealthCare’s above mission as well. She took two of my boys to the same pediatric office today for a scheduled appointment to get some immunizations they said were needed. After waiting an hour in a non-kid friendly exam room with two children, the doctor came in for the visit and noticed my son was acting wild. The doctor then asked if my son was ready for Kindergarten if he couldn’t sit still in the exam room. My wife quickly replied that if he hadn’t kept her waiting in a non-kid friendly exam room for an hour, then our son would have been fine. Not to mention, my son was not looking forward to the shots.

To add insult to injury, the doctor returned to inform my wife that my son didn’t actually need the immunizations. They had finally found the record and he had already had all the required shots. My guess is they couldn’t find the record because they’d had to switch EHR when their EHR vendor sunset their original EHR. This is the same EHR which the doctor had told me two days previously, “He hated even more than the previous one.” That’s almost enough for me to want a PHR for my children. However, it’s not like the school would accept an immunization record from the PHR.

One could argue that my wife’s experience above didn’t compromise the quality of care my children received. That’s true unless you consider the counseling my wife will need for being driven insane while she waited for an appointment she didn’t actually need.

Having worked in clinics, I’m sympathetic to the doctor and practice. We realize things run behind. We realize their are limitations on what child friendly things they can have in exam rooms (although, how about a TV?). We understand that records get lost or that mistakes are made when looking them up. Although, when all those things conspire against my wife, you can understand her frustration.

This discussion reminds me of a topic I’ve been talking a lot about recently. There’s a difference between quality of care and customer service. As patients we have very little understanding of the quality of care we’re being provided. We don’t really know if the quality of care we’re getting is good or not. However, we’re keenly aware of the customer service experience. If you look at any doctor ratings site, it’s all rating customer service. Yet, so many of us equate those ratings with the quality of care.

What’s the moral of the story? We can all do better. That’s the journey we have ahead of us in healthcare. Continue to improve and do the best we can to provide amazing care. This is not a one time battle that you win and move on. It’s an ongoing battle that never ends. That’s what makes it so difficult. It’s also what makes it so important.

Are Patient Portals Really Helping Patients?

Posted on December 4, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

One thing’s for sure about patient portals: They’re a hot commodity.

What’s less clear is how much good they’re doing for health care.

The popularity of patient portals stems from Meaningful Use Stage 2 patient-engagement requirements. The market for the products is expected to approach $900 million by 2017, up from $280 million in 2012, according to a report from Mountain View, Calif.-based research firm Frost & Sullivan.

Patients like at least one aspect of the portals — the ability to access their own medical records. In a recent Accenture study, more than 40 percent of consumers who can’t access their own records online said they’d consider switching doctors in order to get access.

But several recent studies suggest that currently available products have a way to go before they can consistently improve care, reduce costs or perhaps even increase patient engagement.

In a review of 46 studies, researchers found little evidence that portals were helping much of anything. The doctors from Veterans Affairs Greater Los Angeles Healthcare System and other institutions wrote that it’s “unlikely that patient portals will have substantial effects on utilization or efficiency, at least in the near term.”

Some of the limitations of the products, they wrote, included “disparities in who accesses these portals and instances of suboptimal patient attitudes of their worth.” The portals typically gave patients options such as looking at their test results, refilling prescriptions and communicating with doctors.

Patient portals likely are most beneficial, the authors wrote, when they’re part of a more comprehensive quality-improvement strategy.

Another study also found that patients, in many cases, fail to see the value of a portal — or at least some parts of it. In questions about hypothetical features, consumers showed interest in “back-office” tasks such as seeing their own medical records. But clinical digital communication capabilities, such as online video consultations with doctors, failed to impress.

The bottom line was that patient portals “may act as a complement to health-care service delivery, while substitution for clinical in-person interactions may not be viewed positively.” In other words, most people just don’t seem to be ready to give up face time with their primary-care physician.

When MU2 starts on Jan. 1, physicians will be required to give their patients electronic access to their health records. The requirement went into effect for hospitals in October.

The U.S. health care system is, with government prodding, investing a huge sum in patient portals. The idea sounds empowering for patients. But given the lack of solid evidence for a benefit at this point, it’s concerning to think the money might be better spent on something else. Let’s hope that vendors and providers are soon able to turn portals into something with tangible benefits for quality care.

Will Google Use Health IT To Make You Immortal?

Posted on November 15, 2013 I Written By

James Ritchie is a freelance writer with a focus on health care. His experience includes eight years as a staff writer with the Cincinnati Business Courier, part of the American City Business Journals network. Twitter @HCwriterJames.

When Google Health, an attempt at a personal health record, turned out to be an unqualified failure, the consensus was that people just weren’t interested.

But health care is too big, important and data-ridden a field for Google to ignore. And now the company has moved on to a concept sure to be in demand: It wants to help you live forever. Google’s new anti-aging initiative, Calico, will apparently treat mortality as a big-data problem.

But is data the path to eternal life — or even a few more good years? I’d feel a little more comfortable booking a cruise for the year 2199 if Google had accomplished something in health care already.

Google officials, including cofounders Larry Page and Sergey Brin, haven’t said much about what Calico will actually do. But the project seems to take inspiration from 23andMe, a firm that Google helped to start and whose goal is “to make it possible to create a massive genomic database and thereby understand the permutations and mutations that happen to the human genome during the aging process,” according to the Washington Post.

Time explained in a feature article that medicine “is well on its way to becoming an information science.”

“Doctors and researchers are now able to harvest and mine massive quantities of data from patients,” the magazine continued. “And Google is very, very good with large data sets.”

When you put it that way, it sounds kind of reasonable. And if Google invents a medication, an app or a device that brings about a longer lifespan, then I will certainly take it, download it, wear it or whatever is required. But I doubt the human lifespan is quite that reducible.

The rich and powerful have often hoped to use their resources to overcome their mortality. And as Pete Shanks wrote, “immortality and transhumanist ideas generally have long been a source of fascination in Silicon Valley.”

Ray Kurzweil, Google’s engineering director, is a noted futurist who believes we’ll upload our minds to computers and achieve digital immortality by 2045. It’s not clear what role, if any, Kurzweil will have in Calico.

The human lifespan doesn’t seem to have budged in 100,000 years, but that’s not to say it’s impossible. I don’t doubt that humans’ maximum time on Earth could be increased. Maybe. Someday. For the longest time, humans didn’t fly or play Minecraft, either. And it’s been done in other species.

But Shanks was right when he wrote of Calico that “what’s most aggravating is the hubris involved.” A common fallacy among highly successful people is to think that expertise in one area will apply to other fields.

Google is great at search. Its map service is also ubiquitous, and I’ve heard that its driverless car works well. But when it comes to chaotic human data, the company’s algorithms might not work as well. Take free-form language, for example. When I use Google Translate to decipher the Chinese-language Wikipedia entry for “immortality,” I get sentences like this: “If you can maintain Chang Heng unchanged, it is possible to ‘live forever,’ but before the observation Everything in the world is now, whether living or heartless thing, and both are changing all the time.” It’s an app that can be helpful, but it doesn’t give me confidence that Google can overcome the limitations of our mortal coils. It can barely understand what we’re talking about.

And Google’s track record in health care is, of course, not so strong. Google Health, introduced in 2008 as a way for consumers to collect their health records online, was defunct by the end of 2011. Few consumers found it worth the effort of entering their data, given Google Health’s lack of capabilities such as appointment scheduling, InformationWeek reported.

Let’s hope that whatever Calico comes up with proves more useful. If it can be packaged as a free download, even better.

But I’d rather see Google invest its considerable resources in something with a higher chance of a payoff.

What Value Does a Healthy Patient Get from a PHR?

Posted on November 11, 2013 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In my previous post about a Patient Controlled Medical Record, I asserted that such a thing would be a challenge to get to work in the US, but that there was a lot of potential internationally. I did provide one caveat when it came to chronic patients where I think there is potential in the US as well. Although, some argued against even that group being interested in the comments.

Let me further expound on why I think the patient controlled medical record fails for a healthy patient (and this includes people who think they’re healthy, or at least relatively healthy…ie. they don’t go to a doctor for any chronic condition). In many respects this is my talking from my own personal perspective as a young, healthy adult (although I guess all of those descriptors could be argued).

The problem for someone that’s healthy is that their medical record basically has no data. The reason you want a patient controlled medical record is so that you can extract value from the data. I don’t need to look at my online medical record to see that I don’t have any drug allergies, that I had a cold or flu 3 years ago, that I got my flu shot 4 years ago, and that when I was 15 I had a hernia operation.

The point being that my medical record is so short that there’s so little value in me trying to aggregate that record in once place. What value do I get from doing so?

I think there could be value in doing so, but not today. For example, if by keeping a patient controlled medical record I could avoid filling out the crazy stack of paperwork that’s given you at every new doctor you visit, I and every other patient would want to keep an online patient record. This should be a solvable problem, but I won’t go into the hundreds of systemic reasons why it’s not going to happen anytime soon. Although, we’ll start with the doctor preferring your allergies to be in the upper right corner in red. Now scale that request up to 700,000 doctors.

Similar to the above item, there are other ancillary functions (ie. appointment scheduling, prescription refills, message your doctor, etc.) that could be tied to your medical record that would make people want to use a PHR or other similar system. However, most people would use it for the ancillary functions and not to be able to control their medical record in one place. For many of the ancillary services this portal will need to be tethered to a PHR.

One trend that I hope will change my description above is the wave of new health sensors that are hitting the market. As those health sensors get better I believe we’ll see a new type of portal that is attractive for even a “healthy” person to visit. This concept coincides with what I call Treating a Healthy Patient. All of this new sensor data could make it worth my time as someone who thinks I’m healthy to check and aggregate my data in one location. The volume of data available would be much more than what I have stored in my memory and so it will make sense for me to visit somewhere that stores and processes my whole medical record.

How these portals full of health sensor data will work with doctors is a topic for another blog post. Until then, I’ll be surprised how many healthy patients really get on board collecting their patient data in a patient controlled medical record.

Mobile PHRs On The Way — Slowly

Posted on October 24, 2013 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

On-demand mobile PHRs are likely to emerge over time, but not until the healthcare industry does something to mend its interoperability problems, according to a new report from research firm Frost & Sullivan.

As the paper notes, mobile application development is moving at a brisk clip, driven by consumer and governmental demands for better quality care, lower healthcare costs and improved access to information.

The problem is, it’s hard to create mobile products — especially a mobile PHR — when the various sectors of the healthcare industry don’t share data effectively.  According to Frost  & Sullivan, it will be necessary to connect up providers, hospitals, physician specialty groups, imaging centers, laboratories, payers and government entities, each of which have operated within their own informational silos and deployed their own unique infrastructures.

The healthcare industry will also need to resolve still-undecided questions as to who owns patient information, Frost & Sullivan suggests.  As things stand, “the patient does not own his or her health information, as this data is stored within the IT  protocols of the EHR system,  proprietary to providers, hospitals and health systems,” said Frost & Sullivan Connected Health Senior Industry Analyst Patrick Riley in a press statement.

While patient ownership of medical data sounds like a problem worth addressing, the industry hasn’t shown the will to address it.  To date, efforts to address the issue of who owns digital files has been met with a “tepid” response, the release notes.

However, it’s clear that outside vendors can solve the problem if they see a need. For example, consider the recent deal in which Allscripts agreed to supply clinical data to health plans.  Allscripts plans to funnel data from participating users of its ambulatory EMR to vendor Inovalon, which aggregates claims, lab, pharmacy, durable medical equipment, functional status and patient demographics for payers. Providers are getting patient-level analyses of the data in return for their participation.

Deals like this one suggest that rather than wait for interoperability, bringing together the data for a robust mobile PHR should be done by a third  party. Which party, what it will it cost to work with them and how the data collection would work are the least of the big problems that would have to be solved — but might be that or nothing for the foreseeable future.

Parents Using PHRs More Likely To Get In All Well-Child Visits

Posted on October 18, 2013 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Parents using an integrated PHR were more likely to take their young children to all recommended well-child visits, according to a Kaiser Permanente study reported in iHealthBeat.

More than 4.3 million members are registered to use Kaiser’s PHR, My Health Manager, on During the first half of this year, patients have viewed 17.5 million lab test results, sent 7.4 million secure e-mails to their care providers, refilled 7.1 million prescriptions and scheduled 1.8 million appointments, reports News-Medical.

The study, which was published in The Journal of Pediatrics, analyzed data on more than 7,000 children ages zero to two living in the Northwest U.S. and Hawaii.  The children were enrolled in KP health plans between January 2007 and July 2011.  To determine the appropriate number of well-child visits, researchers  used performance measures listed in the 2010 Healthcare Effectiveness Data and Information Set that state that children aged 0 to 15 months should attend at least six well-care visits, News-Medical says.

The study found that in the Northwest region, children whose parents used the Kaiser PHR during the study period were 2.5 times more likely to bring their child to the recommended number of well-child visits. These children were also 1.2 times more likely to get all of their immunizations.

In Hawaii, meanwhile, children in this group were two times more likely to get all well-child visits, but results related to immunizations were statistically insignficant, iHealthBeat notes.

While it may be too soon to call it a trend, this is one of a growing number of projects which use the PHR concept to help patients engage and take responsibility for their health behaviors.

For example, this summer Howard University Hospital rolled out a mobile PHR for pre-diabetic young adults designed to help them take control of their health.  Howard has given the young adults in the program — aged 18 to 24 and diagnosed with pre-diabetes — access to a mobile version of the NoMoreClipboard PHR for their smartphones.

The program sends a variety of text messages to the young adults targeted by this intervention, which include reminders to interact with the PHR. The program participants are also given a FitBit Zip wireless activity tracker which keeps track of steps taken, distance covered and calories burned per user.

Projects like these, which help patients make the PHR the fulcrum point for better health, are a smart way of using the technology. I expect to see a great deal more of this “PHR=patient engagement=better health” model going forward.

Patients Eager To Access Medical Images Online

Posted on July 19, 2013 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

A new study suggests that making medical images accessible online to patients might be a fruitful method for getting patient engagement up in time for Meaningful Use Stage 2, reports EHR Intelligence.

The study, by IDR Medical and Carestream Health, surveyed 1,000 patients who had recently had an imaging study done, in an effort to examine patient views of patient portal use prior to engagement requirements falling into place with MU Stage 2.

It found that patients were very interested in accessing medical images — as well as the clinical notes accompanying the images — with 68 percent saying it was “extremely likely” they would do so if given the opportunity, according to EHR Intelligence.

Survey respondents were particularly interested in using a portal to access their children’s medical images, with 90 percent saying that they would do so if they could. Meanwhile, 82 percent of people wanted to view their own images.

The researchers assumed that older patients would be less likely to use an online portal, but that other patients who frequently get images taken or already access health data online would probably access a portal often.

While elderly patients aged 71 and above were indeed less likely to be interested in portal use, patients aged 50 to 70 had the most positive attitude toward patient portals.

Not surprisingly, patients who already had access to a patient portal were also very positive about access imaging studies online, the site notes. When given a choice of methods by which they could review imaging studies, 79 percent of patients said that an online portal would be their first choice, either by itself or in addition to hard copies of images and reports.

While some providers have worried that they’ll have trouble getting patients to interact with online patient portals, it seems clear that putting images and interpretative notes online can help, if this data is any indication.

Now, some clinicians have worried that at the extreme — an overly-engaged patient who raises time-consuming questions over trivial details — online patient portals will turn out to be a headache.

But to date, as my colleague Jennifer Dennard notes, the portal-fueled pesty patient isn’t materializing. Perhaps both the portal and the patients have matured to the point where they can support each other.