For the past 18 months, I have been working very closely with the American College of Physicians (ACP), a professional association in the US representing 129,000 Internal Medicine specialists, students and residents. This has been a very enriching experience. I'll share more about this work at a later time.
In 2008, the ACP prepared an eHealth policy statement entitled E- HEALTH AND ITS IMPACT ON MEDICAL PRACTICE (.pdf). Reading it today, almost 3 years later, the majority of the document remains spot-on in terms of the current state of eHealth and physician health IT.
A segment refers to Personal Health Records (PHRs). In light of Revolution Health's decision to shut down their PHR (for which they had only attracted approximately 6,000 members), this is an insightful piece.
Current PHR use remains low among patient-consumers and varies among PHR providers. Kaiser Permanente reported in 2005 that 6% of their Kaiser Permanente Northwest region were registered users of their Kaiser Permanente HealthConnect application; the system had been in place since 2002. Cigna reported in a 2007 story on PHR usage that their adoption rate since the launch of its myCIGNA.com to its 7 million subscribers averages less than 9,000 per month.
A study conducted by UNC-Chapel Hill identified three skills needed by consumers using PHRs:
- Basic computer literacy, e.g., navigation skills, typing/entering data into a system, managing files;
- Basic understanding of medical/health concepts and terms; and
- Experience with personal recordkeeping, e.g., observation and collection of personal health habits and clinical information. Attitudes that are likely important to increased consumer PHR use include a sense that creating, maintaining, and updating a PHR is worthwhile, and that the sharing of information through PHR applications carries no greater risk to the privacy, confidentiality, and security of their protected health information (PHI) than the technologies deployed in current electronic health information exchanges.
The policy recommendation by the ACP is as follows:
- ACP believes that patient portals or PHR applications provide the greatest benefit to patients when used collaboratively with physicians.
- ACP believes that there may be value in physician review and analysis of summarized information in a patient’s connected or freestanding PHR, and that an emerging responsibility may be one of periodic review, analysis, and a resulting set of actions by the physician.
- ACP believes that payers should compensate physicians for the additional work of accepting, reviewing, validating, and analyzing data from a PHR, as well as the additional work of responding to this information, which may include deleting, modifying, or adding medications or other treatments.
I believe that physician interaction and integration with the EMR in the physician practice are critical dependencies for successful adoption and use of Personal Health Records, something that was predicted by ACP in 2008.
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