EHRs and PHRs: A Marriage of Convenience?

A few weeks ago, I had the privilege of participating on a panel at the "2009 Harvard Public Health and Technology Conference," hosted by the Harvard School of Public Health (HSPH) Public Health and Technology (PHAT) Forum. This one day student-lead conference brought together a diverse group of leaders from academia and industry in the field of health IT.

The morning session addressed the current state of electronic health records (EHRs) in the US, considered the potential of EHRs to improve healthcare quality and lower costs, and predicted the potential impact of government stimulus (ARRA / HITECH) for EHRs. In contrast, the afternoon session explored the potential for (mainly private sector driven) consumer facing health IT solutions to engage individuals to improve their health and demand a more consumer centric health care system. [For a full run-down on the day's events, check out John Moore's blog post (http://chilmarkresearch.com/2009/11/19/phat-mash-up-healthcare-it/)

New York Times technology reporter Steve Lohr, one of the morning panelists, summed up many of the sentiments expressed regarding the national push for EHRs in an article that draws mainly on statements made by co-panelists Ashish Jha and Karen Bell (http://www.nytimes.com/2009/11/16/business/16records.html?_r=1). The overall gist: despite much fanfare, evidence to date demonstrates a low prevalence of EHR adoption, and does not wholly support the assertion that EHRs have been effective in lowering cost or improving quality. And though most agree that a 21st century healthcare system should not be paper based, given the way that our current healthcare system operates (and reimburses providers), many present were doubtful that the $19B government stimulus will in the foreseeable future be successful in driving the effective use of EHRs to improve health outcomes and lower costs.

Former Google VP and current CEO of Keas Adam Bosworth kicked off the afternoon session by declaring many "legacy EHR" solutions "over-engineered" and lacking in genuine market demand. He further championed consumer facing health IT solutions (such as Keas) as an alternative strategy with which to address some of the root causes of our current woes: namely unhealthy lifestyle, an epidemic of chronic disease, and a "sick-care mess" oriented towards treating disease rather than keeping people healthy. His overarching sentiment, and one that was echoed by the "Consumer Engagement" panel on which I sat, was that in order to achieve meaningful healthcare reform, and to reorient our nation towards health, we need to engage individuals to be proactive champions for their own health - and we would be well served if health IT solutions were focused on doing so.

My biggest take-away from this conference was that, even among those championing EHRs, there is a growing awareness that given the lack of market demand, it might take a while before EHRs achieve broad adoption and meaningful utilization, and that even when they do, they are not in themselves a sufficient condition for lowering costs and improving quality. Patient centered health IT solutions (such as Personal Health Records) thus present an invaluable complement to EHRs as a more immediate solution with which to engage healthcare consumers, achieve health information exchange, and bring about a more consumer-centric healthcare system. History tells us that consumer-facing solutions will catalyze an explosion in both the use and value of health IT. For instance, when the internet was first developed, it was so complicated that it was only used by tech savvy computer scientists - not until intuitive, user friendly browsers were developed did the average consumer "go online" and the internet exploded in popularity and functionality.

Even David Blumenthal, national coordinator for health IT at HHS, recently acknowledged that the private sector, rather than government, would eventually drive health information technology initiatives in the US (http://www.modernhealthcare.com/article/20091207/REG/312089979#). As this continues to happen, I believe that we"ll see an increasingly large market for consumer facing health IT solutions to interact with (and enhance the value of) more traditional EHR technologies.