by Doug Dormer, Member, HIMSS Social Media Workgroup in the Personal HIT Taskforce and HL7 PHR Work Group; and Tim McKay, Member, HL7 PHR Work Group
In April, our friends David Rowe and Mary Griskewicz wrote an excellent post for this blog titled PHRs after Meaningful Use: Extending the Provider’s Workflow into the Patient’s Home that concludes: “It’s a future that is in plain sight. All we need to do is work together to develop and follow the roadmap that will guide us there.”
While completely agreeing with this optimistic prediction, we find ourselves once again asking why we aren’t there now, or at least, why we aren’t moving faster on this important roadmap? In answer, we find the same persistent barriers that have held this promising future at bay for so long.
The majority of consumers now view the Internet as a primary source of health information ahead of their physicians and health-related social media sites like PatientsLikeMe.com give irrefutable value to consumers. Still, PHRs, and truly interoperable patient portals that are integrated into the provider work flow, show
- generally dismal rates of adoption,
- low rates of persistent use and, for those reasons,
- a poor overall impact on either health outcomes or cost.
Clearly, meaningful use and changing payment models (like the Medicare Shared Savings Program, new Medicare penalties for high rates of avoidable re-hospitalization and recent insurer-driven Physician Group Incentive Payment programs) are raising the financial incentives to reward change. And some organizations have responded with innovative PHR and patient engagement solutions that show consistently high adoption and continued use, with some showing significant improvement in health outcomes and cost.
Kaiser Permanente’s patient portal, kp.org, is actively used by 4 million of its members—approximately 70% of Kaiser Permanente adults with Internet access. Kaiser’s success is in large part due to having PHR/EMR workflows synergistically benefiting both providers and patients, based on defined use cases and system needs—in effect, the application of an internal functional profile that has guided success of the program.
And Centerstone, the nation’s largest not-for-profit provider of community-based behavioral healthcare, is rolling out a patient engagement solution that includes social media, online clinical tools and a PHR designed expressly for substance abuse recovery. This patient engagement solution, including the PHR, is not just an incidental extension of work flow; it is central to Centerstone’s model for effective service delivery.
But these success stories, including others at leading institutions, such as The Cleveland Clinic, Mayo Clinic, and the Veterans’ Administration, are still the exception.
Simply put, for most providers, the incentives are still insufficient to adopt this core change in the provider-patient relationship.
We all know the barriers:
- concern over privacy,
- complex interoperability requirements,
- payment models that still do not compensate adequately for these new forms of provider-patient interaction, and
- the prospect of unknown risks and liabilities.
As an industry, we are gradually coming to terms with each of these barriers. However, at core, there is a lack of confidence in the PHR system itself.
What exactly does this PHR information mean?
- Who entered it?
- Is it complete?
- Can I trust it?
And, not least, if I, as a physician, provide information from my EHR to a PHR that shows my name as the source,
- Can I be assured that this information associated with my name will not be altered once out of my control?
These are weighty questions that cannot not be glossed over lightly. Fundamentally, these result from a lack of standards for personal health record systems, and the absence of a certification process that can give confidence to all stakeholders.
HL7, a global authority on standards for interoperability of health information technology, has been working on standards for personal health record systems since 2005. Working in collaboration with the HL7 EMR Work Group, the HL7 PHR Work Group is developing standards that will help address the above concerns by bringing consistency in terminology and requirements without constraining innovation.
The present draft HL7 standard, referred to as the PHR System Functional Model, is in the process of being reconciled to the latest set of EMR standards. National and international standards bodies will vote on these standards, once completed, before they are published as an approved standard, hopefully later in 2012—just in time for Meaningful Use Stage 2.
In developing this standard, the Work Group has contemplated a broad range of established and emerging issues, including:
- security and privacy,
- differences between the needs of providers and consumers, and
- consumer alteration of professionally sourced data.
One key part of the PHR System Functional Model is the development of Functional Profiles—essentially, subsets of the complete standard that apply to a certain application or use-case scenario. For example, a PHR system sponsored or offered by an insurer may need to comply with one subset of the standards, whereas a physician specialist, such as an oncologist, might need a very different subset of standards for its PHR implementation. These Functional Profiles will simplify the process of applying the standard to any specific use case and should increase their adoption.
As the HL7 committee completes this present set of standards, work has already begun on the next set of standards (or at least updates) by considering the impact of social media, mobile devices, and other changes that are revolutionizing healthcare.
While the standards alone will not overcome all barriers to adoption, they are an important step on the roadmap. Although not yet final, the present draft standards, which are available today as the basis for future certification, allow providers to move with confidence toward this new world of patient engagement. With these new standards, the future is indeed in plain sight.
The HL7 PHR Work Group is open to anyone. You can find out more information at http://www.HL7.org.
Doug Dormer is founder and CEO, White Pine Systems, LLC. Tim McKay is Director of Digital Integration at Kaiser Permanente.
