Posts Tagged ‘PHRs’
Discussion of PHRs and Patient Data Access on iHealthbeat
January 29, 2012
In an new story on iHealthbeat, Barriers Continue To Limit Patient Access to Electronic Health Data, I am quoted on the topic Basically, I continue to be disappointed on the slow adoption of PHRs and the fact that Google Health is now gone. My statement at the end of the article is the most significant – how can providers strategically use PHRs as chronic disease management tools? There have been some pilot programs on this. Perhaps with the incentives to prevent readmissions and management of patients to reduce costs, such as, the Medical Home and ACOs, some provider groups will take a second look at PHRs.
At the same time, I wonder if mobile apps, which have seen huge adoption, need integration with PHRs or visa versa. Disease management and wellness activities could be tracked through apps and added to one’s PHR. This what Google Health tried to do and HealthVault still does. Yet only a small percentage of those with chronic or life threatening illnesses have benefited.
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Who Owns Your Data?
January 23, 2012
In a radio interview from Inside the Media, Hugo Campos, an e-Patient with an implanted defibrillator (ICD), talked about his desire to have the data from his device. His logical argument is that the device is now part of his body and so he should have the right to the data from the device. So far he has been unsuccessful in getting his provider or the manufacturer to assist him with this. While rights to one’s own health data is becoming a reality through the Affordable Care Act and Meaningful Use and through initiatives like the Blue Button, device data is new territory. One could argue that the data is too complex for the lay person to analyze but that is the same argument which was made not so long ago about medical records in general. With the growth of apps and health information on the web, complex medical data is becoming more accessible.
This new territory needs more discussion. See the comments on the podcast page. Also, you can follow Hugo on the ICD Users blog.
Share this:Mobile Devices, Patient Self-monitoring and Clinical Workflow
January 11, 2012
This is the topic of my new blog post on HealthWorks Collective. Already received lots of traffic on Twitter and lots of views. Would like to see more about mobile standards in health care from Motorcycle Guy and others.
The Next Wave of Technology: Social Media and Electronic Health Records
November 12, 2011
This Thursday I presented at the Senior Workers of the Twin Cities annual conference on this topic. It was helpful to discuss the value and trends in EHRs, PHRs, Social Media, and Mobile Apps. The group was receptive and had excellent questions on privacy and the digital divide. I started the talk by telling Regina Holliday’s story. The slides are below:
Google Health Ending – Not Having Broad Impact Expected
June 24, 2011
Google announced today on its official blog that it is retiring or phasing out Google Health. Stating that it’s original goal was to “our goal was to create a service that would give people access to their personal health and wellness information” using their focus on the consumer, they found a lack of the broad adoption they expected. I was there at HIMSS in 2008 when Google Health was announced by Eric Schmit and Roni Zeiger doing a demo.
They admit that “There has been adoption among certain groups of users like tech-savvy patients and their caregivers, and more recently fitness and wellness enthusiasts.” But not enough adoption to make it worthwhile to keep the shop open. They are provide means for users to export their data by January 1, 2012.
Already bloggers are busy speculating on why Google Health failed to gain traction.
- Not understanding the healthcare market, especially the challenges of working with payers
- Lack of partnerships with physicians
- Not partnering with device companies as early as Microsoft did
- Lack of incentives to use it
- Lack of a means to securely communicate with providers
- Not being tethered to EMRs with a few exceptions like Cleveland Clinic.
The reasons can go on and on. But overall, how widely have PHRs been adopted. Seen initially as a disruptive technology, but lack of trust and understand of its value by consumers has led to sluggish adoption overall. How successful is Microsoft HealthVault, Dossia and others? How about PHRs sponsored by payers? It appears that healthcare consumers are stronger adopters of social media and wellness tools and not PHRs.
So where do we go from here? Even the ePatient movement and Quantified Self are not generally strong adopters. If Google Health is worth saving, how about asking Google to hand it over to an open source community to maintain and enhance. In some cases, open source projects can gain more traction that productions by large Silicon Valley companies.
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Adoption of PHRs – Where are we going?
April 22, 2011
Two recent articles on PHR adoption caught my attention this week:
- From ComputerWorld -Consumers remain wary of personal health records – reporting on the IDC survey which shows that 23.4% reported that they were somewhat comfortable or very comfortable with Google or Microsoft collecting their health information. 28% of the respondents indicated that they would use a PHR system if their physician recommended doing so. 10% indicated that they did not use one because of infrequent need for medical care and 10% indicated they did not trust the security of Internet sites.
- Can genomics encourage use of personal health records? An extended report from a presentation by John Halamka about PHRs and genomics. He notes two things that will drive PHR adoption:
1) health plans that require more patient interaction and shared decision-making with the provider
2) features such as the ability to securely email physicians, pay bills, refill prescriptions, get specialist referrals and make appointments, that is PHRs tethered to EHRs will be the consumer’s preference. He also sees a future opportunity to integrate personal genomics into PHRs. He talks about his own experience with personal genomics.
Based on these two articles, there is reason for optimism about growth in adoption of PHRs but may be conservative growth. Drivers of that growth will be: recommendation by providers (participatory medicine), tethered to an EHR so much of the data is already there, and being future rich.
Two additional features I think will be useful for patients are: connection with social media (such as, sharing one’s data selectively with private disease and condition communities, such as, organizedwisdom.com or patientslikeme.com) and connection with wellness apps and mobile devices both of which are offered by Google Health and Microsoft HealthVault).
Share this:TEDxMaastricht – Hope in technology and participatory medicine
April 7, 2011
April 4 in Maastricht, Netherlands, was an event full of optimism but not simply about how technology can transform healthcare. Lucien Engelen envisioned this conference as about health, not healthcare and full participation by the patient as an equal partner. To what extent was this accomplished?
The answer is in much of what was said:
- health as homeostasis rather than disease and cure
- you can’t outsource your health
- inforgs -by Luciano Floridi
- society has seen the separation passion and profitability
- in education ere are too many questions for faculty to answer, students must be full participants
- use of a flight simulator as a safety team building tool
- add travel history to your personal health record
- singularity – artificial intelligence, nanotechnology, implantables, genomics, robotics, regenerative medicine
- the shock of the possible – unexpected connections
- doing the impossible – climbing a mountain six times, curing cancer in 10 years
- everyone with a chronic disease is part of a community, they just need to be invited and join
- integrate Google Body with personal health records
- Recognizing healthcare failures and learning from them
- reducing fear of disease, hospital, blindness, etc. As a major goal of a medical practice
Although these quotes may not be exact or make up a coherent whole, the point is that creative optimism gouged by new, openly available technology like social media, can be transformational now.
This was no less true than the patient stories heard throughout the day of facing disease but triumphing over it through community (often online) and hope.
As I process this event, watch for more posts on these themes.
HIMSS 11 Meaningful Use – The Spirit of the Regulation
March 6, 2011
A nice interview with Dr. Harris, CIO of the Cleveland Clinic and President of the HIMSS board on following the spirit of meaningful use, not just the letter of the regulation to create a real sea change in health care.
From Hospital and Health Networks Daily blog.
Connected for Health: The KP HealthConnect Story
September 16, 2010
In a new book edited by Louise Liang, the story of the comprehensive implementation of the EHR at Kaiser Permanent. The story begins in 2002 when George Halvorson, the new CEO, saw the need to implement the EHR not as a cost savings initiative but as a market differentiator. He laid down the challenge to accomplish this national implementation in 3 years. What this represented was not just a software implementation but an organizational change from 9 relatively independent regions to a single practice model centered around this technology. They developed the Blue Sky Vision with consumer centric focus including these themes: home as the hub, integration and leveraging, secure and seamless transition, and customization (perhaps better stated as patient-provider partnership).
The book not only provides a history of this organizational and technology change but also lays out a project management roadmap that can be emulated for smaller hospital systems and hospitals. Regardless of size, EHR implementations must take into consideration timeline, stakeholders and technical challenges. For Kaiser, the timeline affected the implementation in several ways, most notably in delaying customization of provider templates and smart forms until after the go live. Involving stakeholders, two chapters address the building of clinical content by physicians and nurses. They state, “clinicians won’t necessarily be faster, but they should be better” referring to improvements in patient safety and other clinical decision support aspects of the EHR. The role of the patient as a significant stakeholder is addressed in a chapter about My Health Manager, the MyChart product from Epic Systems which was implemented to included eVisits and patient-provider messaging.
Part of the vision from the initiation of project is value realization beyond utilizing the EHR in routine clinical practice.This involves aligning KP HealthConnect with KP values: high quality care, personal care, convenient and affordable. The three phases of value realization are: value creation, value requiring harvesting and transformation of care. This steps included everything from reducing duplication of services, to re-engineered workflows to developing metrics around best practices and clinical guidelines. Population care has become a reality including practice innovation. While most of the care management emphasizes primary care (including a chapter on Redesigning Primary Care), there is some material on specialty practices, such as, oncology.
Adding value for KP HealthConnect also means improving patient safety and enhancing research. In the safety realm, one of the most important concepts behind the EHR which should be true of every EHR is “Making the Right Thing Easy to Do.” This is where may EHR implementations fail, actually accomplishing quite the opposite and leading to open rebellion by clinicians. If the right thing is easy to do and especially easier than paper, then this single fact makes the cost worth the investment. In research, the efforts are still at early stages but include retrospective and prospective research, comparative effectiveness research and personalize medicine/genomics. As an adjunct to research, a chapter is devoted to the Archimedes Model as a future direction for KP. Utilizing EHR data, the model takes population studies to a new level by simulating clinical trials and developing mathematical predictive models.
Has Kaiser realized its Blue Sky Vision? The implementation was certainly accomplished on time but admittedly over budget (3.2 billion vs. 4 billion). At one point, the authors admit to the technical challenges which resulted in stopping the accelerated weekly implementations. Stress on the IT core systems forced a six month hold. Overall the book presents an optimistic view of EHR implementation, successful because of systematic, team approach including all regions and all professions. Many of the themes in the book are reminiscent of the optimism of Health Care Reform and EHRs which some times seem a distant dream with very gradual adoption.
Who should read this book? First, any hospital or healthcare system planning or in the midst of an EHR implementation. Second, hospital CIOs but perhaps more importantly, project managers. Project management professionals are the boots on the ground of EHR implementation and need to learn how to involve stakeholders and move past obstacles toward successful, on schedule implementation. Also, those interested in exploiting or harvesting the value of the value of the EHR in quality improvement, patient safety and research. Finally, clinicians who are involved in EHR implementations or governance will better appreciate the need for vision and the comprehensive impact of EHR on practice and potential practice innovation.
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Google Health: New Features, Fit and Trim
September 15, 2010
Today Google Health launched a major update. Many of the features were part of the demo at HIMSS 2010 include the flexible graph feature for lab results. As with the previous version, editing information is easy and intuitive. In viewing individual lab results, a definition is in the right column along with news and articles from Google Scholar – contextual information. Usability research was an important aspect of the updates which included adding new features:
In additional, new partnerships round out the offering: Fitbit, Cardiotrainer, and WorkSmartLabs. So it appears that in lieu of making Google Health a mobile app itself, they have partnered with mobile app developers particularly around wellness and exercise. Although Google Health displays well on an iPad browser in landscape view.
Three new provider partnerships are announced as well, Lucile Packard Children’s Hospital at Stanford, University of Pittsburgh Medical Center (UPMC) and Sharp HealthCare. Look forward to hearing more about these and how they are encouraging the use of Google Health. UPMC is an Epic shop with MyChart.
The announcement has led to lots of buzz in blogs and twitter including “Google Health Unbound: Can It Overcome Indifference to Personal Health Records?” and Google Health Takes a Big Step Forward by Dr. Dean Ornish on Huffington Post.
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