The Personal Health Record Today: Peril or Promise?
By Anish Sebastian
On January 24, Apple announced the launch of a PHR feature with its iOS 11.3. The feature, Health Records, will aggregate patient-generated data such as number of daily steps or hours slept with information from the patient's EMR if the user is a patient at one of the 12 participating hospitals.
The idea is hardly innovative; the tech industry has been generating personalized mobile health apps for more than a decade, but while Big Tech has long perceived the consumer benefits of transitioning from EHRs to PHRs, the continued failure of these initiatives, including mobile health platforms such as Google Health and Microsoft's HealthVault Insights, begs the question: Is the return on investment great enough for the successful widespread adoption of PHRs?
The consumer benefits of PHRs are brought in to relieve against the limitations of EMRs and EHRs. These digital interfaces, which replace paper medical records for physicians and patients, do not facilitate patient engagement. They are incapable of patient updates and, as data repositories solely for one provider, they disallow interoperability.
With the proliferation of all kinds of internet-connected devices, eg, Fitbits, scales, and blood pressure cuffs, patients have the ability to collect quite a bit of health data from the comfort of their own homes, and they are doing so—one in four Americans own a wearable device. These kind of data allow providers to have better insight into a patient's health and make more informed decisions, hence the importance of having access to it through a PHR. The fragmentation of data across EHRs highlights the need for a personal, portable data repository that can be used across health providers, transferring control to the patient.
Health systems are constantly looking for better ways to engage their patient population, to ensure patients not only are more informed and empowered but also feel connected to the health system.
Patient portals are an attempted solution to the problems associated with patient engagement, but the health care industry's focus on this innovation rather than PHR implementation could explain why the latter has struggled to gain widespread adoption. Yet while portals increase patient access to data, their value for consumer engagement is primarily operational, not clinical.
Patients are utilizing these portals for appointment scheduling, bill payment, prescription refills, and direct secure messaging. With no standard of operation, even these basic capabilities vary widely by provider and the web-based model of patient portals is inefficient and outmoded—limited to data originating from a single provider. Most importantly, patient portals fail to address the biggest demand of consumers who are looking for more than a storage space: that data effectively manage targeted health outcomes.
Currently, each time a consumer visits a nutritionist, weight-loss coach, or primary care physician, the health data go to a different repository. The data then accumulate, fragmented and ineffective, in these different care silos; thus, the need for a PHR that aggregates data across multiple providers. Ideally, these data would be automatically populated into a patient's PHR, providing a holistic picture of the patient's health profile to any provider, thus facilitating targeted health outcomes.
If PHRs are so patently beneficial to consumers, why have they struggled to gain a foothold in the industry?
Beyond the obvious obstacles of private data exchange presented by HIPAA, the difficulties associated with deploying PHRs are manifold. Perhaps the greatest obstacle is the lack of an immediate monetary incentive (although long-term benefits could be anywhere from $13 billion to $29 billion after a period of 10 years); the widespread implementation of aggregation will have an initial negative net value. This is exacerbated by our current fee-for-service system where the medical record is primarily designed to do one thing: bill and account for transactions.
The difficulty of pulling together data from different formats further complicates the process. While consumer empowerment is gaining massive traction in the health care industry, the reality remains that for the widespread adoption of any health platform, clinicians must be the instigators.
Apple is uniquely positioned to give PHRs a stable foothold in the consumer market. They have a secure and established platform trustworthy for the passage of encrypted data and command a brand loyalty ubiquitous in the United States and elsewhere, but can they inspire clinicians to shift to a patient-controlled infrastructure? If they cannot, is their new feature dead in the water? The jury is still out.
— Anish Sebastian is cofounder of Babyscripts, a prenatal app that allows OB/GYNs to remotely monitor their pregnant patients' progress and health.