CanadianEMR: EMR Comparisons, Ratings, Directory Services and Expert Discussions

As Health Information goes Digital, Patients may Spot Unpleasant Surprises

A recent article in the Huffington Post pointed out an important issue regarding digital health records.

When Kaiser Permanente started giving patients online access to their medical records nearly five years ago, it offered the same lab reports doctors saw—complete with warning flags highlighting any abnormal results. The capital letters – such as “H” for “high” -- alarmed many patients. So now the giant health plan has modified the policy for most of its members. It displays lab results in a more neutral way, showing patients how they compare to normal ranges and advising them to contact their health practitioner with any questions. The experience at Kaiser reflects the sensitivities that can arise over how much medical data patients should be entitled to view and how quickly—a debate that’s intensifying as medicine enters the digital era.

As Health Files Go Digital, Patients May Spot Unpleasant Surprises

One of the fears of physicians is that providing their patients with access to online health information may increase workload because of examples as described above? It is easy to become alarmed by information that is not well explained.

Do you think this is a legitimate concern? How can these types of issues be addressed?

To add your thoughts or comments, click on the 'Comments' link

A Hiccup for Personal Health Records - Revolution Health Discontinues their PHR Service

A couple of years ago I created a Personal Health Record on the Revolution Health web site in the US. This was more of an experiment than a need to create a PHR for myself, but I was very interested to see how PHRs worked and how they could be used by 'consumers' of healthcare.

Revolution Health Group was launched in the US in July 2005 by Steve Case, who previously co-founded America Online. There was much fanfare at the time about the company and the impact it was going to have on the healthcare - much the same as what AOL did for personal Internet use.

This morning I received the following email from Revolution Health:

Thank you for being a loyal user of the Revolution Health Personal Health Record. Unfortunately we will be discontinuing this service as of the end of February 2010 and removing all records, information, and data from the Revolution Health Web site.

So that you don't lose the information you've entered into the system, we strongly suggest that you download your personal records as a PDF to print and save for future reference. To do this, simply follow these instructions:

Log in to your Personal Health Record
From any page of your record, click on the "printable version" link on the top right corner of any page. When you see a pop-up box asking you to "Select the following sections to include in your print out," simply make sure that the sections you want to print and save are checked and then click the "Submit" button.
Once the PDF is created (this only takes a moment), you can print directly from it and/or save it to your computer. To print the PDF, click on the printer icon at the top left of the page. To save it, click on the disk icon to the right of the printer icon.
If you encounter a problem printing or saving your records, please e-mail our customer service department at CustomerCare@revolutionhealth.com for assistance. Even after the Personal Health Record is no longer available, Revolution Health and our partner sites will continue to offer you the same great health information and community pages as always. We hope you continue to visit Revolution Health often to take advantage of our offerings.

Thank you,
The Revolution Health Team

Unmet expectations? Difficulty to reach a critical mass of users of the PHR? Inability to develop a sound business model that was actually generating revenue for the founders? Too much competition from the likes of Google and Microsoft? The answer is probably a combination of the all of the above.

Healthcare is a tough environment and in order to have a truly valid Personal Health Record, it needs to connect the patient with their healthcare providers (hospitals and physicians). Knowing that 80% of healthcare is provided outside of the acute hospital setting, the real challenge in building a solid value proposition for PHRs is how to connect them meaningfully to their physician's EMR. While this is a concept that I believe makes sense, Revolution Health is an early victim of setting the bar too high and expecting people to change too quickly. In 20 years time, will Personal Health Records be a key mechanism for patients to connect with the healthcare system and their care providers? In my opinion, a resounding yes. However, it is just going to take longer than initially projected and we don't yet understand the Political, Policy and Privacy implications and drivers that will be necessary to make it happen.

To add your comments or questions, click on the 'Comments' link below.

GP Rating Service - NHS Choices

Rating services are here to stay in the UK and now extend to GPs.

The Department of Health has launched a controversial online rating service to let patients rate and compare GP practices via its flagship website, NHS Choices.

Patients can upload comments on how easy it is to get an appointment at a particular practice, how highly they would recommend the practice, how well patients are treated by staff and if they feel involved in decisions about their care.

The DH said the ratings service would give patients all the information they need to choose between England’s 8,300 practices, following the recent announcement that practice boundaries are to be scrapped.

View the NHS GP Ratings Service

In North America, we have RateMD.com - the unpopular and controversial web site to rate physicians across the US and Canada. What are your thoughts, should ratings be available and officially sanctioned for GPs and Specialists? Is it possible to achieve an accurate and dependable rating? To add your thoughts, click on the 'Comments' link.

Online Patient Engagement

I have long been fascinated by the use of technology to engage "customers" outside the confines of the organization delivering a service.  For example, it never ceases to amaze me to listen to people nearly giggle with delight about the ability to print their own airline boarding passes at home.  They are doing the work of the airline staff, using their own supplies to do so and are more than happy about it!

Given this fascination, I was more than a little intrigued about the recent story about an Ohio pain clinic that has rolled out what it calls "online physical therapy"

http://www.bizjournals.com/dayton/stories/2009/08/31/daily46.html

According to the article, "The program is available at no cost to patients and is accessible through online videos and animations designed to teach various therapy exercises to patients in their own homes."  While simple in concept, this service could offer the same convenience and lower operational costs as online banking or web airline check-in.

Mike

Google Health Adds New Feature

I started one of the first commercial Internet Services Providers in late 1989, nearly 4 years before the first web browser hit the market.  For about 5 years the ISP market was dominated by small players.  In the mid 1990's, when the Internet went mainstream and small companies like the one I founded were flourishing, the major players such as Microsoft, Bell, and Rogers entered the market and soon thereafter began to dominate.  I see history repeating itself in the Personal eHealth market as Microsoft and Google enter the market.

Both Microsoft and Google have been aggressively developing and promoting their respective Personal eHealth services.  Google's latest announcement touts the ability to share your health information with others. 

Check out the article

The article notes that with this new feature "people will be able to share Google Health with their families and caregivers. But obviously the big next phase is people offering to share these records with their physicians. We’ll see but this may well be the killer app the PHR has been looking for—after all now a doctor just needs one Google sign-in which they almost certainly have anyway, and they can see all the Google Health PHRs of the patients who start sharing their records with them. And they will. This has the potential to be really disruptive."  Do you agree with this prognosis?  Do you see patients and physicians using a service like Google Health to share health information?  If so, will doing so be as transformative at this article suggests?

What is the Value of a Personal Health Record?

In a report published by the Centre for Information Technology Leadership (C!TL) on Personal Health Records (PHRs), some very practical recommendations are made regarding the value of the PHR.

However the report also points out that PHRs are an emerging healthcare technology and the value proposition for PHRs is not yet clear. This is necessary if PHRs are to bring true value to the healthcare system and be sustainable. In addition, there are a number of issues from a privacy and security perspective that need to be understood and resolved. That being said, there are a number of areas in which Personal Health Records have the potential to be very useful.

"The Value of Personal Health Records report examines the value proposition for implementing personal health records (PHRs) thoughout the US.

This analysis quantifies the cost-benefit of a variety of infrastructure, administrative, and clinical PHR functions including:

• Sharing of complete medication lists
• Sharing of complete test results
• Appointment scheduling
• Medication renewals
• Pre-encounter questionnaires
• E-visits
• Congestive heart failure (CHF) remote monitoring
• Smoking cessation management

CITL modeled these eight functions for provider-tethered, payer-tethered, third-party, and interoperable PHRs, examining differing deployment strategies to achieving 80 percent adoption by the US population. The report includes a detailed cost model for each type of PHR system.

Download a copy of the report

To add your thoughts or comments, click on the 'Comments' link below

Hawaii launches on-line health service

There are many facets to Personal eHealth from google searches about a specific condition or medication to on-line delivery of health care services.  I was intrigued by a recent announcement from the Hawaii Medical Services Association (HMSA), an independent licensee of the Blue Cross and Blue Shield Assoction which provides health insurance to more than half of Hawaii's residents.  Their new Online Care service connects individuals seeking medical care with participating physicians either by phone or online using Web-based videoconferencing or secure chat.  The service is highly interactive, with individuals able to have a real-time conversation with a physician.

According to HMSA, "Online consultations are not meant to replace in-person doctor visits; they simply provide another health care choice for talking to a doctor about a non-urgent condition or getting advice or answers."  In addition to providing advice about non-urgent conditions, physicians can also refill prescriptions, discuss medication discussions, or explain generic drugs. 

One interesting aspect of the Online Care service is its use of Microsoft's HealthVault, a secure repository of an individual's health and medical infromation that is controlled by the individual, not by a healthcare provider organization.  I have been following HealthVault for some time and will write more about it in future posts.  The Online Care services uses HealthVault to store and retrieve personal  health information. Since each person's HealthVault is controlled by them they can decide what information they wish to share and with whom they want to share it.

According to HMSA, participating physicians "have a great degree of flexibility, convenience and freedom while practicing online. These doctors can now see patients from home if they so choose. Doctors can also log on as they please; they don’t have to schedule a specific time and can work at any time of day for however long they choose."

What do you think of the Online Care service?  It is a model that could work in Canada?  Do you think that online delivery of specific healthcare services is a viable model? Can it offer real benefits to patients and physicians?

IBM, Google and Continua Health Announce Alliance for Personal Health Records

ARMONK, NY – February 5, 2009 – IBM (NYSE:IBM), in collaboration with Google and the Continua Health Alliance, today announced software that will enable personal medical devices used for patient monitoring, screening and routine evaluation to automatically stream data results into a patient’s Google Health Account or other personal health record (PHR). According to the release, once stored in a PHR, the data can also be shared with physicians and other members of the extended care network at a user’s discretion.

To read the full press release, click here

Google Health vs. Microsoft HealthVault Compared

In a very interesting study, by User Centric, Google Health and Microsoft HealthVault were compared.

Abstract:

During December 2008 and January 2009, the user experience research firm User Centric conducted an independent comparative usability study of two existing online personal health record applications, Google Health and Microsoft HealthVault. (Neither Google nor Microsoft commissioned or participated in this study in any manner.) During this study, 30 participants completed key tasks using each PHR application and provided qualitative feedback, ratings and preference data on five specific dimensions: Overall usability, utility (usefulness of features), security, privacy and trust. Participants performed up to seven tasks on both Google Health and Microsoft HealthVault, which included three tasks that explored each application's unique features. Midway through the study, a third PHR application, MyMedicalRecords.com, was added to gather additional qualitative data.

User Centric's study found that both Google Health and Microsoft HealthVault had flaws in the user experience that were seen as factors that would reduce the participants willingness to adopt personal health record technology.

However from my perspective, these are early days yet and we will learn more about how individuals use PHRs over time and through iterative improvements.

To read the article, click here

To add your thoughts or comments, click on the 'Comments' link below

Personal eHealth

Welcome to my first blog post on CanadianEMR.  My name is Michael Martineau. I have had the pleasure of working with Dr. Brookstone for the past few years and played a small role in helping him transform his CanadianEMR blog into the innovative service that it has become.   Recently, I suggested that he devote some space on the site to the emerging "Personal eHealth" (also referred to as "Consumer eHealth") market.  I have been tracking this market for several years and feel that we are going to see a significant increase in activity over the next 6 to 24 months.  Given my strong interest in "Personal eHealth", Dr. Brookstone offered me the opportunity to create content on this topic for CanadianEMR and I gratefully accepted.

Who am I?  I am a 30 year IT industry veteran with considerable Internet and healthcare IT expeirence.  I was a founding executive of two Internet Service Providers (ISP) and created an eHealth consulting practice for a Canadian market research firm.  I am currently the Chief Operating Officer for a healthcare software vendor specialiing in software for hospital health records departments.  I have a regular column in Healthcare Information Management & Communcations Canada magazine and have presented at several conferences on the topic of Personal eHealth.

As I examine and analyze the emerging Personal eHealth market, I have a strong sense of déjà vu.  The first ISP that I helped start was at the very forefront of providing general consumer access to the Internet.  Even in the early 1990’s, prior to the advent of what we know call the Web, I could see that the Internet was going to have a profound impact on the way that we communicated and conducted business.  I get the same feeling when I look at Personal eHealth and it’s potential.

Like the Internet that enables it, Personal eHealth will dramatically change the way that we think about our health and the manner in which we look after it.  In my blog posts I plan to show you why I think this way and, hopefully, engage in a dialog that helps us each better understand the potential, the reality, and the pitfalls of Personal eHealth.  My goal is to stimulate debate and to generate a better understanding among all parties of how Personal eHealth can be best integrated into our healthcare system.