A forum to discuss ideas, approaches, standards, and architecture to establish and support open interoperability among healthcare IT systems.

Friday, June 23, 2006

Personal Health Records: The Fast Track to EHR?

Many healthcare organizations are working furiously to institute an Electronic Health Record within their environnment. Some have EHR systems already purchased, and are grappling with the impacts of trying to deploy them into the mainstream of care delivery within their organizations. Others have addressed these issues and are tackling the cultural difficulties of making the EHR an asset and not "additional work" for their caregivers. Most organizations, however, have not yet made the commitments to embrace an EHR.

Matters get further complicated when we look across organizations. Of organizations that have EHRs, those EHRs are not necessarily interoperable. Even within a given product suite, organizations may choose to deploy differently, and even use varied content standards making this interoperability challenging or near to impossible, especially if the intent is to share information in a computer-actionable ("computable") form.

In the United States, there is significant buzz around Regional Health Information Organizations (RHIOs), which are working through interoperability challenges at regional and local levels. The issue, however, is that people are mobile and do not exist exclusively within a RHIO. True, a significant portion of people's healthcare is geographically centric, but the business drivers aren't entirely there at the moment to promote regional interoperability.

But what about all of the grass-roots regional integration that is occurring?

True, there is a groundswell of regional activity happening. That said, the functional breadth of what is being integrated is still very small, and many of these solutions are but one-off demonstrations that do not form the foundation for bigger things. At present, the drivers aren't there. Healthcare providers want people to use their services, so the business impetus isn't there. Payers achieve some benefits, but since people change health plans more than geographies, the driver isn't really there either.

Enter the Personal Health Record. As the "computer generation" begins to age, we are facing health challenges that weren't concerns at younger ages: hypertension, obesity, diabetes, and all of the other "joys" that come with middle or advancing age. What is different between today's forty- and fifty-somethings and those of yesteryear is that today's folks grew up with computers and have a mindset of personal empowerment. "Entitlements" that other generations came to expect are largely gone, and what has replaced them is a personal ownership of issues, including our health.

Nobody has as compelling interest in an individual's health information than they do. With the emergence of the Web as a ubiquituous source of information, people are taking matters into their own hands: researching disease conditions, investigating medications, researching alternative treatment, and so on.

It is my believe that this is the community that will drive healthcare to adoption of EHRs. If you look at other market sectors, such as banking, customer service has driven an e-enabled business model. Consumer demand created supply. The same will hold for healthcare. Having to provide personal identifying information dozens of times will become increasily unacceptable. Submitting to duplicate tests already performed adds cost and burden on the patient. Individuals will seek a place to retain their trusted information, even if that comes at a financial cost (so long as those costs are reasonable). People pay small fees for monthly bill-paying convenience, and I believe they will do the same for health information.

As these knowledge sources begin to grow--both in terms of content and marketplace acceptance--pressures on health provider organizations will increase to use that content and integrate that into their workflow. Individuals will opt-in to plans that reduce hassle in their already over-complicated lives. This creates the Gladwell "tipping point".

The byproduct of this will be health IT interoperability. At the point there are sources of content and marketplace drivers to use that content, the pressure will be there for solutions that work. Health interoperability is not about exchanging a handful of data fields among a regional community--it is about providing critical, high-quality health information to providers at the point they need it for clinical decisionmaking (either for intervention or for wellness). Our job as the health IT community is to work the hard problems through so that we are ready to respond to these marketplace challenges.


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