Health IT is now a consumer buzzword

The pre-HIMSS show excitement has started building. I think this should be one of the most vibrant--and overwhelming--shows in the history of HIMSS itself. Why? Well, in part, it's because this has to be one of the first times in any of our professional lives when health IT went from the concern of group practice administrators and hospital leaders a topic that seems to interest everyone but my grandma. On the other hand, I'm not sure I like where this is going. Let me explain...

One of the most obvious indicators that health IT has gone public that there are bills and proposals directly affecting the industry mounting up daily. These days e-prescribing, PHRs, EMRs and health information exchanges are on the lips of elected officials who could barely use their own Blackberry otherwise. While President Bush has encouraged much of this, if the Democrats seize the White House, I don't think that's going to change. Health IT has moved from esoteric to a matter of mainstream discussion, and that's that.

This is something of a problem. After all, while legislators may be well-intentioned, they're usually not subject-matter experts, so they may not have a realistic picture of what problems you face. Besides, while they have to win some ill-defined popularity contest--if EMR is the flavor of the week in the mainstream press, well, then, everyone should have one--you just want to make sure your organization keeps delivering good care. We're talking a slight conflict of interests here.

I don't know about you, but when I'm at HIMSS, I'm usually more interested in talking with vendors who are solving non-trendy problems in a sensible way than listening to rah-rah new stuff. That's particularly true now that consumer interest has seeped into the industry and begun influencing how products are developed, sold and presented to you.

But hey, I don't want to be too cynical. Maybe there's some things that are both praised by the vox populi and worthy of being implemented. All I know is, when I'm at HIMSS, I'm planning to keep my trendiness quotient to a minimum

What's a PHR?

One view comes from America's Health Insurance Plans: "The industry model personal health record (PHR) is a private, secure web-based tool maintained by an insurer that contains claims and administrative information." Makes sense if you're a health plan, definitely.

Or what about AHIMA's take: "A PHR is an electronic, universally available, lifelong resource of health information maintained and owned by the individual." Should calm the nerves of the privacy advocates, no?

The HIMSS definition takes us in a slightly different direction: "To enable the goals of reducing medical errors, improving quality of care, and improving the validity of information available to care providers, Personal Health Records (PHRs) function to consolidate an individual's medical information in one place." This one doesn't dwell on a patient's rights so much as the comprehensiveness of the data, which is of course a wrinkle worth considering.

Yes, I think it's pretty clear what the intent of various employer- and healthplan-driven PHRs is (cheaper, better care), but that's not enough. You can know that you want to ride from Phoenix to Denver without knowing what parts are needed to build a car.

I'm taking up this issue again, in part, because that the indefatigable folks at HL7 are voting on a functional PHR model over the next few weeks. While I'm delighted to see some consensus building on key PHR functions (such as wellness reminders or prompts to look at lab results), that still begs the question of what the ultimate goal of a PHR is. Quick: tell me in one sentence what your PHR effort is trying to accomplish. Not so easy, is it?

When it comes to PHR content, some key unanswered questions include:

* What is the core clinical data set a PHR must contain to deserve the name? Patient medical history, drug allergies, care plans, genetic data, what?
* Does the name "personal health record" imply that it's largely or entirely maintained by consumers, or are consumers merely its custodians?
* What's the benefit of maintaining a PHR? (No, I don't agree that the answer to this is obvious.)
* What is the minimum amount of data a PHR must contain to be useful?

Yes, I realize that health plans, employers, software vendors, standards groups and even consumers will have to do a lot more talking before they arrive at a shared conclusion on these issues--and that technology never moves ahead without some fuzzy logic in between--but in my view things are still too fuzzy. As I see it, it's critical to get bit more clarity on core issues like, say, whether a PHR should be populated by claims data, consumer self-reporting, EMR data or a mix before more dollars are spent. In the mean time, let's not put the cart before the horse, shall we?

HIMSS08: Google unveils details of PHR

So, the Google boys have marched into town with their own PHR, which they demonstrated last week for a marveling crowd at HIMSS08. At a modest booth on a side alley at the exhibition, Google was premiering a simple PHR interface consisting of only few text links, including a link to a feature allowing users to search for doctors, and another accessing Google Scholar to search for medical information. The PHR's key function was a link to a utility allowing users to import records from varied provider systems, then store the records online. Of course, Google CEO Eric Schmidt has been making the rounds assuring privacy advocates that the search giant won't share these records without the patient's consent, but as I understand it, since Google's not a provider they're not required to meet HIPAA standards unless they feel like it. How long that will last, particularly if competitors like Microsoft and Revolution Health begin to loosen their standards?

As we've previously noted, the records will be accessible through the same name/password combination consumers use to access other Google features, such as Calendar and Gmail. OK, readers, I'm sure you know far more than me on this front, but isn't that a fairly weak security method to store extremely private information? When I asked one of the young Google-ites manning the booth this question, he brushed it away. I don't know about you, but that didn't impress me much.

Microsoft kicks off PHR initiative

Microsoft launched a free PHR last week, working in cooperation with a wide variety of partners whose role it will be to help populate the record with useful medical data. The move puts Microsoft into competition for mindshare in an increasingly hot industry sector already peopled by technology rivals like Google and the massive employer-backed PHR effort Dossia. However, in lining up clinical partners, Microsoft is arguably ahead of its competitors, who are still largely at the talking stage in their efforts.

Partners in the PHR effort, HealthVault, include the American Heart Association, Johnson & Johnson LifeScan, New York-Presbyterian Hospital, the Mayo Clinic and MedStar Health. Rather than waiting for consumers to enter their own health information, Microsoft is counting on these partners to provide at least some of the content. For example, New York-Presbyterian has agreed to begin populating HealthVault PHRs automatically with basic patient data. Johnson & Johnson LifeScan, for its part, wants to enable its blood glucose monitors to feed readings into HealthVault accounts.

Google, Microsoft Question Government's Health IT Plans

On Thursday, Google and Microsoft executives urged Obama administration officials to consider Web-based technologies as they work to promote electronic health record adoption, Nextgov.com reports. The executives expressed their views during a meeting of the recently founded President's Council of Advisors on Science and Technology, or PCAST. At the meeting, Google Chair and CEO Eric Schmidt said the administration's current health IT plans encourage medical professionals to use outdated health IT systems that could hinder innovation. Craig Mundie, Microsoft's chief research and strategy officer, suggested that health IT objectives should emphasize medical data management (Brewin, Nextgov.com, 8/6).

PCAST Details

The new White House council features leading scientists and engineers from around the country. Some of PCAST's members include:

• David Blumenthal, national coordinator for health IT;
• Aneesh Chopra, President Obama's chief technology officer; and
• John Glaser, adviser to the Office of the National Coordinator for Health IT.

The group will provide Obama with guidance and policy recommendations on issues related to innovation, science and technology

Electronic Health Record Links Care Givers And Cardiac Patients

Electronic health records of patients helped them stay healthy even two years after they left the program by keeping them in touch with their care givers electronically, according to a study. The program at Kaiser Permanente, which reduced cardiac deaths by 73 percent, linkedcoronary artery disease patients and teams of pharmacists, nurses, primary care doctors, and cardiologists via the electronic health record system. The researchers said that the study was the first randomized study to evaluate a follow-up system for patients discharged from a cardiovascular risk reduction service. The ClinicalPharmacy

Cardiac Risk Service at Kaiser Permanente Colorado combines Kaiser Permanente's industry-leading electronic health record, Kaiser Permanente HealthConnect, with proactive patient outreach, education, lifestyle adjustments, and effective medication management. The two-year randomised trial of 421 patients found that patients discharged from the program kept their lipid and blood pressure levels at controlled, healthy levels by receiving electronic reminder letters. "Because lack of adherence to medications and failure to maintain treatment goals are so high among heart disease patients, we wanted to find out what would happen to the patients after they were discharged from the program but remained in contact with the health care system through our electronic health record," said the study's lead author, Kari L. Olson. He added: "The takeaway message here is that we can help support patients in maintaining treatment goals and medication adherence, which is often a challenge with most chronic conditions. Using technology and integrated systems already in place, we can help keep patients healthy for longer and deliver continuity of care in a cost efficient manner."

For the study, 421 patients in the program with well-controlled blood pressure and cholesterol levels were randomized so that 214 continued in the program to receive intensive direct counseling from the care team. The other 207 patients were discharged from the program back to their primary care physician. The patients who were discharged from the program had electronic reminders in their chart to ensure their lipid panels were ordered annually, with the results sent directly to their primary care physician. The discharged patients also received reminder letters generated by KP HealthConnect, indicating they were due for a lab test.

The most important finding of the study was that the patients discharged from the program maintained control of their risk factors with the help of electronic reminder letters. The EHR intervention was as effective at keeping cholesterol and blood pressure in check, compared to the more intensive counseling approach offered to those patients who stayed enrolled in the program. After going through the program, the patients were found to have an 88 percent reduced risk of dying of a cardiac-related cause when enrolled within 90 days of a heart attack, compared to those not in the program. The number of patients meeting their cholesterol goal went from 26 percent to 73 percent, and the number of patients screened for cholesterol went from 55 percent to 97 percent. The coordinated, evidence-based care, enabled by KP HealthConnect and an electronic care registry, increased the survival rate dramatically among patients enrolled in the service. It is estimated that more than 135 deaths and 260 costly emergency interventions were prevented annually as a result of improved care.

CDC turns to social, mobile media for swine flu updates

The outbreak of swine flu, otherwise known as the H1N1 virus, has pushed government agencies, particularly the Centers for Disease Control and Prevention, to embrace all kinds of social media and mobile technologies for disseminating information and attempting to quell fear. YouTube, Twitter, RSS feeds, podcasts, embeddable widgets and informational e-cards are all parts of the strategy.

In fact, the CDC is getting record traffic to its swine flu site, and has had twice the number of people sign up for email alerts than for the peanut recall earlier this year.

"Public health agencies are our largest sector of clients," Scott Burns, CEO of technology contractor GovDelivery, tells Government Computer News. "CDC and the state health agencies do the best job of this type of communication. I think they would make the private sector jealous."