Health information, as we move from paper-based recordkeeping to a digital platform, is increasingly becoming inter-connected. Lagging decades behind other sectors, health documentation is just now emerging from the legacy of illegible paper documents packed into file racks in doctors offices and hospitals, with segmented slices of a patient’s story captured in each location. Remember, on average patients see something like 19.7 physicians in their lifetimes, which is a testament to data fragmentation.
Many things are all contributing to a strong wind compelling physicians to pick up a computer and use it in day-to-day clinical life. Federal incentives, peer recommendations, improvement in technologies and emergence of low-cost (even free) options all add to this trend.
Historically, medical documentation has been doctor-centered. After all, the chart notes captured in patient records are created by health care professionals, and document the findings and recommendations given during a clinical encounter. It is a medico-legal record.
Increasing, however, a patient-centered approach has emerged, and has taken on several forms – from consumer-driven health products, to Internet-empowered e-patients, to participatory approaches to healthcare decision-making. An early response to this was the creation of independent, free-standing Personal Health Record (PHR) systems – like Google Health, Microsoft Health Vault, and the like. However, after an initial flurry of activity in the marketplace, these products have withered from very weak adoption – some of them have even gone out of business.
Why has this occurred? Is it that “patient’s simply don’t care,” as some naysayers have claimed? Quite the contrary. Our own experience has shown an avid interest by patients in their own health data – people simply don’t want to have to enter their own data themselves, and keep it up as things change. The patient-facing portal needs to be an active window into the data that is being created by health professionals.
Beyond that, patients want access to their own data across all settings of care, that builds over time, and follows them wherever they go – securely, safely. Patient-centered, patient-owned, as the slogan goes. We are a ways from getting there, but that is what the future looks like.
There are some models that provide glimpses of what this might look like – the Kaiser system, for example, has an integrated EHR-PHR that is fairly well received by patients, but suffers from being a “walled garden” (only accessible if you are within the Kaiser system, but not from outside their self-contained world).
A change in mindset from EHR vendors will need to accompany the change to a unified collection of patient-centered, longitudinal health data – the proprietary “walled garden” approach needs to be abandoned. Instead, what will emerge will be a data-driven healthcare platform, where EHRs, PHRs, mobile apps, etc., are all merely portals into that data. Companies that position themselves in this open-platform way, as custodians of health data in ways that are accessible yet tightly secured, will be the models of success in the future.
At Practice Fusion, we see this vision. We envision a robust PHR offering, where patients can (for free) see their own data, populated by what is found in their physician’s connected EHR; can comment and annotate their own data (which, in turn, is visible to their physicians); can be a secure communication channel with their health professionals; can capture data from enabled devices (like blood glucose monitors, or any of a myriad mobile health apps now appearing on the market); can be a portal to trusted health education resources; can be a place where wellness and disease-management prompts can be viewed; and which can be shared with others when needed (like the emergency room, or a new doctor on a new health plan or in a new geography).
The list can be augmented considerably. But, bottom line, a connected PHR-EHR portal that builds a shared data repository which is patient-centered and life-long – that is what PHRs need to look like. We’re not there yet, but “we can see it from here.”