Personal Health Records: The Vision and the Current Reality
(Editor's note: This guest blog is written by Erica Drazen, the managing partner of the Global Institute for Emerging Healthcare Technologies at CSC. The mission of the Global Institute is to monitor worldwide trends, conduct multi-country studies and evaluate emerging operational practices and technologies that have the potential to improve performance of health industries around the world.)
The idea of a personal health record (PHR) is compelling. A patient could use a PHR to review test results, retrieve information on all the medications they were prescribed, request refills, schedule appointments, record information they felt was missing from the record and get answers to simple questions by securely emailing their provider. They could also get reminders about services they need to receive (a flu shot, a blood test to monitor medications, etc). Providers and patients would no longer play "telephone tag" or have unnecessary face-to-face visits. Unfortunately, that vision is not the current reality, and Google's recent announcement to discontinue Google Health - due to poor adoption by consumers - confirms that despite several attempts, PHRs had not received wide adoption in the marketplace.
Current PHRs are one of three types instead. The first type of PHRs is "tethered" to electronic health records (EHRs) and made available to patients through their ambulatory care provider. These have the advantage of being automatically populated with information from the EHR (medications, allergies, test results, etc) and also usually provide the capability to email with providers and request appointments and medication refills. The disadvantage is that they only contain information from providers that share an EHR - if care is received outside that practice, information is missing.
The second type of PHRs is fed by information from the health insurer and covers all services the patient receives (that are paid for by the insurer), however the depth of the information is limited. For example, information on medications would be available; information that a test was administered would be available - but not the test results.
The final type of PHRs is "untethered" where the patient enters most of the information into the system so that they can access it when needed. The clear disadvantage is the burden on the patient to collect and then enter the information. This type of PHR is the least popular. A 2010 California HealthCare Foundation survey found that only 6 percent of PHR users had used an untethered PHR. The lack of adoption may explain why Google announced that they were exiting this marketplace.
Overall adoption of PHRs is low - the high estimate is that 10 percent of patients have used some type of PHR capabilities. But this will likely change in the near future. The financial incentives to implement EHRs will increase the amount of information that will be available to populate PHRs. The next stage of requirements to receive meaningful use incentives will also include connecting with patients via secure email and encouraging patients to access information electronically.
The PHR model needs to continue to evolve to meet consumers' needs and provide value to all participants.