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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.

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.

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!