Lessons from the failure of stand-alone PHRs

Personal Health Records have been promoted as significant ways for patients to keep track of their health information, and do so in a way that is portable and owned by patients directly.

After an initial flurry of entry into the PHR arena in the past 4 or 5 years, many such ventures have withered away. Notably, Revolution Health, launched in 2005 by AOL co-founder Steve Case, recently announced the shutdown of their service, citing underutilization as the cause. The once-hot field has dwindled, leaving Google Health and Microsoft HealthVault as the main offerings with any name recognition and traction. What lessons can be learned from this experience?

The biggest failing of the consumer-oriented PHR offerings has been their reliance on motivated patients to enter their information themselves – the systems have been stand-alone and not integrated with the EHRs used by doctors or hospitals. There has been some ability to import lab test results into PHRs, but the setup is cumbersome and uptake has been low. And efforts to pull in data directly from insurance companies (based on billing data, rather than direct clinical data) have been fraught with populating PHRs with “garbage” data.

Anecdotal experience by physicians has been that patients don’t use PHRs, and prefer that the physician enter the data on their behalf, or export it from the EHR (if there is one). The problem for physicians is that there simply isn’t enough time to do that in a typical 15-minute visits, and many of the stand-alone PHRs are not compatible with the systems the doctors use.

Given that leaving data entry to patients is inefficient, and a sure way to minimize adoption rates, the most successful PHR-type systems have been created by healthcare organizations and have direct benefit to patients: (1) secure email communication with physicians, (2) online appointment scheduling, and (3) the ability to look at information entered by their physician, including diagnoses, medications, immunizations, lab results and xray results. In short, there needs to be a compelling value proposition in order that patients use such tools.

That leaves the vision for “PHRs of the future” as looking like this: (1) be directly connected to the physician EHR, so that summary information is available automatically and updated real-time; (2) allow for interaction between the patient and the office, such as scheduling and secure emailing; and (3) allow for patient-entered supplementary information, which can then be seen by the physician’s EHR. The PHR needs to be portable, stay with the patient across all settings of care (moves to other geographies, switching doctors or health plans, hospital or nursing home stays, etc.), and visible from any web-connected computer (even from mobile devices, such as smartphones).

A number of value-added health 2.0 companies offer consumer-oriented services and data gathering tools – such as diabetic calorie counters, or daily weight scales for people with congestive heart failure, or a myriad other such innovations. These kinds of services can well be plugged into the “PHRs of the future” so that their output feeds into the PHR, is visible and manageable by the patient, and (due to the “live” connectivity with the physician EHR) visible by the physician as well.

The emerging e-patient movement wants to be able to manage their health, have access to their health data, and is clamoring for a tool that accomplishes this vision. The current evolutionary step of disconnected PHRs has not achieved this – as evidenced by the lessons learned from the Revolution Health demise. The promise of the next step of integrated PHR-EHRs, however, stands to be truly revolutionary.

This will require a web-based, SaaS-oriented EHR platform open to interconnectivity from an emerging field of PHR-associated applications. This is the vision behind the efforts of Practice Fusion, as it develops and matures its EHR and its interconnected PHR.

Robert Rowley, MD
Chief Medical Officer, Practice Fusion, Inc.