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Google Health PHR is being retired after all

June 27, 2011 6 comments

An official Google Blog post on 24 June announced that  Google Health will be retired in January 2012 as it has not resulted in the broad impact anticipated at its launch three years ago.  Patients will be able to download their data through January 1, 2013. Google Health’s no-cost, secure, online, open source, patient health record made available to health consumers, was expected to improve health care by enabling patients to be partners in the management of their health.

Most health records worldwide are still paper-based, and those in electronic format may be scattered among hospitals, doctor offices and specialists. Technology standards and data ownership issues are yet not clearly defined, so populating personal health record with data can be an onerous task.  Adoption of personal health records involves a fairly steep learning curve and a change in cultural mindset.   Finally, the cost of housing data and creating applications to make the data useable and secure is high.  Though disappointing, it is perhaps not surprising, therefore, that Google has pulled out of the personal health record space.

In Canada, Telus Health Space has moved into personal health record provision, building on the Microsoft Health Vault platform,  partnering with hospitals, health care associations, and academic research initiatives to standardize technologies and encourage development of applications to make PHRs more useful and user-friendly.  Telus Health Space is not free, however; it  is only available to users for a fee, which might make it a more sustainable business model.

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BodyMaps: a new consumer health research tool

June 7, 2011 5 comments

Today I read about an amazing new tool called BodyMaps, in a TechReview article by Brittany Sauser.  Body Maps was created by Healthline, a consumer health information provider, to enable anyone to learn more about the bones, muscles and blood-vessels that make up the human body, using an interactive, visual search tool that allows users to explore the human body in 3-D.  The best part is that it is very easy to use.  You can click on the “body menu”  which produces a list of links to various parts of the body, or you can search by body keyword, or easiest of all, click on part of the image provided.  For example, I clicked on the knee and got a close up image of just the knee, I could then explore various layers – the bones, blood vessels, muscles and  joints, which I could rotate for 360 degree views of the knee.  I could also see an MRI of a real-life knee joint, and watch videos showing osteoarthritis, total knee replacement and more. This is a fantastic reference resource – go to BodyMaps and see for yourself!

Peer to peer healthcare– resources and personal reflections

The internet makes it possible for any of us to proactively manage health problems through research. We can locate facts, statistics, opinion, advice, experiences of others experiencing similar health problems, and academic and practitioner research. We can find this in a variety of media – print, video and audio.  How we go about the research and how we use what we find makes interesting study.

There is no question I would be lost without the ability to comb the internet for research relating to a health problem. However, getting to a satisfactory solution or to the point where I can formulate possible solutions to my particular need and/or questions to discuss with a health professional can be very time-consuming. And in instances where research turns up innovative or non-traditional approaches to treatment,  dilemmas of choice, access, cost, trust and communication can make for a very frustrating experience.

As an example, here is a recent, health-related problem tackled by my family.  Last year my mother, in India, needed a hip replacement.  My sister in India checked with her network of friends and acquaintances in Mumbai for recommendations of surgeons.  She communicated that information via phone and e-mail to the rest of us situated in three different countries. Some of the doctors had websites we could look at.  After Mum saw the doctor, she was told she needed a total hip replacement and provided with options and costs of hip prostheses from which she had to choose one.  The choices were for oxynium, cobalt/chrome on metal, ceramic on metal, metal on metal, cemented or non-cemented, 28” or 36” or 44” head (!)   We had to make the choice in a day or two.  The initial response was to choose the most expensive – surely that would be the best?  However, upon drawing on our pooled knowledge and research (discussions with product vendors;  knowledge of products this doctor was most familiar with; information from sites like NOAH and the Mayo Clinic; product descriptions at vendor sites; power point slides by van Langelaan on clinical and economic aspects of cemented and cementless hip prosthesis;  and particularly the Australian Joint Registry summary statistics; and 10 year data from the New Zealand Joint Registry on revisions)  we decided that the most expensive was not the best option.  Based on the research and on Mum’s age and condition of her hip, we opted for a combination of poly and metal, cemented with a 36” or larger head.  It appears to have been the right decision. However, we could only have a 28” head as a 36” was not available (!?!).

A Pew Internet and American Life Project report of its Peer-to-peer healthcare (February, 2011) study offers some insights into the circumstances that influence consultation with health professionals and/or with peers.  The results are interesting, though not surprising.  The majority consulted a health professional with a health issue, a little over half turned to family and friends for support and about a fifth turned to others who had the same health condition.  A very small proportion of health consultation and support from professionals took place online.  Peer-to-peer interaction with family, friends and fellow patients was most helpful in matters of coping with illness, particularly when dealing with rare disease.

The what, why and how of implementing Personal Healh Record Systems

September 14, 2010 Leave a comment

Electronic health record (EHR) systems have greatly improved efficiency and safety in health care delivery: consolidating patient information, tracking prescription use, and enabling decision support.  These systems are controlled by the healthcare providers, some of whom can and do make patient information available to them electronically or via specially requested printed reports.  Patient health record (PHR) systems, introduced in the last couple of years, are a new development, allowing patients improved ability to access their health record at any time outside the care setting, and to even control information and access to that information.  While there are obvious concerns about privacy, control, and legitimacy, the attraction of PHRs to providers and policy makers is the ability to engage patients in their care and, in doing so, to improve care as well as control costs.

The PHR market is still very immature, but there are a number of approaches and developments already underway internationally, with vendors offering a range of possibilities.  Two reports may be useful to those considering the why, what and how of implementing a PHR system:

A 2008 report: The Value of Personal Health Records, by the Center for Information Technology Leadership (CITL), synthesized the best-available evidence and expert opinion into a simulation model of costs and benefits in different PHR scenarios to develop the value proposition of a PHR system.

CITL considered two primary components in a PHR system: infrastructure and applications utilizing the infrastructure. The PHR infrastructure included components and functions that would allow patients to collect and share their health information. Privacy and security functionality are expected to be embedded throughout the PHR system in both infrastructure and applications. The CITL model estimated costs to develop the PHR infrastructure; and the applications to support:

  • information sharing (medication history and test results);
  • information self-management (remote monitoring, web-based educational support); and
  • information exchange (medication renewals, appointment scheduling, e-visits).

Although the model has only been validated by a consensus review process among domain experts and so may differ dramatically from what will actually be experienced, CITI hopes that this will provide a framework for analysis and that extrapolation from the model can facilitate predictions of potential value to those considering employment of PHRs.

A more recent report by Alberta Health Services: Engaging the patient in healthcare: an overview of Personal Health Record Systems and Implications for Alberta, presents a very through and useful overview of PHRs, evaluation of PHR capabilities, a comparison of vendors and benefits and caveats of PHR systems.

There are three distinct categories of PHRs, differentiated by their underlying IT architectures:

  • Stand alone: For example, WebMD and RevolutionHealth: that offer an external user interface and data repository, allow patients to create profiles based on their medical history,  health-tracking that can identify patient risk factors for a range of diseases,  and enable users to connect directly with one another , but they don’t automatically interact with EHRs.
  • Tethered: Offered by large healthcare IT vendors that are predominantly focused on EMR/EHR solutions, for example: Eclipsys Sunrise, Epic Systems MyChart, Cerner Health Connections, and McKesson HorizonWP, who offer a PHR system as an extension of the provider’s health information system, allowing patients to view their personal information through a patient portal. These modules can include tools that enhance patient-provider interaction (e.g., e-scheduling, e-visits, pharmacy requests), disease/health management (via dashboards), and financial services. They offer limited decision-support and social networking capabilities, but most vendors are partnering with services such as GoogleHealth and Microsoft HealthVault to broaden the range of services and make patient data portable beyond the provider’s internal systems. Recently, Telus acquired an application by Sunnybrook Health Sciences Centre in Toronto: MYchart that enables patient access to health records, messaging to providers and clinicians, and limited health-management trackers. However, it apparently offers little ability to scale and interact with multiple systems.
  • Interconnected: Google Health, Dossia, Microsoft Health Vault, and Telus HealthSpace (in Canada) are the major players in this market, which is just getting started.  The  interconnected PHR.combines elements of stand-alone and tethered PHR systems, providing an external repository of health information that users can control and to which health systems can connect. The PHR functions as the user interface for a broad set of IT functions that can be linked to or built into the PHR through the vendor’s development tools. These systems can also collect data from multiple repositories across multiple settings or health systems. Telus HealthSpace is a licensed version of Microsofl HealthVault, but data is stored in Canada. Also, while most major players currently in the interconnected PHR systems market offer their solutions for free, Telus will charge health systems to build onto HealthSpace.

Apparently an interconnected PHR need not necessarily replace a tethered PHR, but be used in addition, to provide the user interface and access point for patients, with the tethered PHR system providing the connection with other IT capabilities (e.g., secure physician email). The most successful PHRs implemented at large health systems today have taken this approach (e.g., Kaiser Permanente, Cleveland Clinic, Beth Israel Deaconess Medical Center).

This white paper is the result of a two-week investigation, which included interviews with McKinsey experts in global healthcare and IT, and an expansive literature review, and analysis of industry and market research.  As the report points out, there are over 200 vendors in the fledgling, but rapidly growing PHR market, so there is a high degree of variability in both the nature and scope of product offerings.  This value of this report, therefore, is in understanding what is available, what is possible, and how to make the choice between alternative systems.

How will Ontario’s new rules for generic drug costs affect us?

Effective July 1, 2010, the Ontario government has fixed the price of generic medicines at 25% of the price of the equivalent brand name drug.  In addition, approximately $800 million a year currently paid by generic drug companies to pharmacies in rebates will be banned.

Per Ontario’s Health Minister Deb Matthews, this will bring cost savings to taxpayers who support the provincial drug plan for seniors and social assistance and those who buy their drugs directly or get them from a work benefits plan. Pharmacists don’t agree.  They say the rebates fund important patient services and without them patients will bear the cost in the form of higher service fees and there will have to be cutbacks in service. This is confusing. Why are rebates covering pharmacy costs?

A 2007 Canadian Generic Drug Sector Study by the Competition Bureau showed that pharmaceutical costs comprised $19 billion — the 2nd largest component of health care spending. Generic drugs play an important role in helping curb these costs as patents on branded drugs begin to expire.  So why target generic drug prices as a form of cost-cutting?

In  Canada’s Drug Price Paradox, the Fraser Institute’s annual study of generic drug prices, the 100 most commonly prescribed brand name and generic drugs sold in Canada are compared to an identical group sold in the United States.  According to the most recent analysis, the generic drug prices in Canada were, on average, 112% higher than US prices in 2007. This was attributed to the fact that in Canada provincial policies restrict and distort competitive market forces that would naturally regulate drug pricing, like the Ontario Drug Benefit Plan (ODB) that directly reimburses pharmacies instead of consumers.  How?

As explained in a Fraser Forum article, Ontario’s generic drug pricing debacle, the ODB accounts for 45% of total prescription drug costs in the province. ODB recipients must pay a small flat fee surcharge to a pharmacy when they have a prescription filled, and that, apparently, is all. The pharmacy dispenses the drug and is reimbursed by the government for the full cost of the drug provided, plus a mark-up and dispensing fee. This reimbursement scheme insulates consumers from the proportional cost of the drugs they use, encouraging overuse and reducing incentives for comparative shopping. The current reimbursement system also allows generic drug makers to offer price rebates to retailers in exchange for a monopoly on sales. Furthermore, the ODB reimburses pharmacies for generic drugs at a fixed percentage of the cost of the original brand-name drug.  With the fixed percentage reimbursement, retail pharmacies have no incentive to compete on prices to win sales, so the rebates pharmacies receive are not passed on in the form of savings to consumers.

In a recent paper: Generic drug pricing in Canada: components of the value-chain Aidan Hollis, from the Department of Economics at the University of Calgary, offers a useful way to frame the problem of fair pricing for generic drugs by relating them to the core components of cost: litigation, production, and pharmacy services.  The paper proposes that each component of this value chain be paid for separately:

  • Litigation: As generic firms must address all patents for a branded product remaining on the Health Canada Patent Register before they can enter the market, the costs of litigation can be substantial.  Hollis advocates using a royalty to reward successful litigation that benefits payers, so that generic drug producers have an incentive to introduce the cheaper drugs into the market.
  • Production: The design of pricing policy, rather than being fixed at an arbitrary percentage of a brand price, should be flexible to accommodate the costs of production which can vary according to circumstances. The paper advocates encouragement of a competitive market framework to pay for production.
  • Pharmacy services: Unlike drug manufacturers, Hollis believes that pharmacies are in a position to exercise considerable market power, despite their apparent competitive position. Pharmacies also possess very strong market power as buyers. Thus Hollis feels that price regulation can be justified, and advocates a transparent, independent regulatory process to set dispensing fees for pharmacies.

As Ontario struggles to contain the costs of health care, it seems that arbitrary price controls are not the answer.  The system needs a overhaul.

New eHealth Platform has potential to allow Canadians manage their own healthcare.

June 3, 2010 1 comment

On May 31, 2010, British Columbia based Telus Corporation announced launch of a new consumer ehealth service, TELUS health space, powered by Microsoft’s HealthVault. This will allow Canadians access to their personal health record (PHR) files on the internet or on mobile devices, potentially empowering individuals to be better involved in the management of their health.

The concept of Web-based patient controlled health records is relatively new. Microsoft launched HealthVault in 2007, Google launched its platform, Google Health in 2008.  These PHR services (or patient-controlled health record (PCHR) as they are also called) were originally marketed directly to consumers. However, an article in Health Data Management Magazine observed a change in strategy– these services are now being offered in partnership with hospitals and emerging health record banks. Partnerships are also being aggressively sought with medical device manufacturers to establish connectivity to various medical devices for home health monitoring, as well with hospital infrastructures to increase capability for data integration and disease management services.

Apparently, this is the first consumer health platform in Canada to achieve Canada Health Infoway  pre-implementation certification for providing a secure, interoperable application environment and personal information health platform, and it is also the first international deployment of HealthVault.  Telus Corp. is Canada’s third-largest wireless carrier. It is creating an online medical database with Microsoft Corp. to expand its telecommunication services to the health-care industry. While it has faced flagging revenues due to competition in the mobile phone industry, its health-care business is expanding by more than 10% a year and the unit is profitable, according to an article in Businessweek. Telus expects to license its PHR software to healthcare organizations, including provincial governments, health authorities, hospitals, insurers, individual practitioners and employers.

Patient controlled health records have the potential to revolutionize healthcare, but there are some challenges to overcome.  Privacy regulation compliance, data integrity assurance, interoperability of devices etc. are technological challenges that are being addressed.  However, the full potential of PHRs to revolutionize the healthcare system will only be realized when providers are adequately persuaded of the benefit of sharing data, and patients and providers have access to the education and the tools they need to effectively work with the system.

Personally Controlled Health Records (PCHRs): Excellent idea — but understand the risks, be informed and use responsibly.

March 17, 2010 1 comment

GoogleHealth and Microsoft HealthVault introduced the novel idea of a PCHR in the last two years, which allows patients to securely access, add to, and maintain, their personal health records on any computer with internet access. This was a paradigm shift – patient records are generally only accessible via specific request from the hospital or the doctor’s office where they are stored. Often, access involves a cost and only provides information specific to the request.  While concerns were voiced about data accuracy of data in the records, privacy and security and possibilities of misinterpretation of the data, among other things, a few innovative hospitals and health organizations embraced the concept and offered their patients access to their records via GoogleHealth and Microsoft Vault.

The idea has caught on and personally accessible health records are now being promoted via new systems that are being created to help patients manage their health.  In Canada, the Sunnybrook Health Sciences Centre’s eHealth initiative has recently made a service called MyChart™ available to Sunnybrook patients. MyChart can contain personal and family health details, online appointment requests, online patient questionnaires, clinic visit notes, medication re-fill notes, test results, the official electronic patient health record, links to relevant diseases and personalized health information.

Last Monday (March 1) McGill University Health Centre launched Unani.ca, which allows anyone with Internet Access to maintain a list of personal health conditions, medications, allergies and family medical history.

This is a wonderful development. However, care must be taken to inform users not only about the benefits and the technical capabilities, but about the risks and the parameters of responsible use necessary to ensure the system is used to its maximum benefit. This cannot be stressed enough!