PHRs as change catalyst

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Holly D. Miller, MD, MBA, managing director of e-Cleveland Clinic, presented “Personal Health Records: Status, Challenges, Rewards, and Future Directions” at HIMSS07 in New Orleans today.

Miller cited numerous ways in which the current healthcare system is failing. The costs are skyrocketing and will be 21 percent of the gross domestic product by 2020 if they continue to increase at the current rate. Despite the amounts being spent, we’re not getting much for our money. The United States has the fifth highest infant mortality rate and the highest rate of obesity in the world. We also are experiencing an epidemic of preventable diseases – coronary artery disease, chronic obstructive pulmonary disease, type 2 diabetes and obesity. To address the growing obesity problem, bariatric surgery increased by 526 percent between 1996 and 2001.

Miller said other countries are starting to penalize patients who are noncompliant with their medications and other provider recommendations. There are signs that Americans are beginning to accept more and more responsibility for their own healthcare. For example, 1 percent has a health savings account today and that rate is projected to increase to 12 percent by 2012.

It’s a complex issue, Miller said. Barriers for consumers include privacy and security concerns, perceived value, user interface and a digital divide. She said surveys have shown that 42 percent feel that the privacy risks outweigh the benefits of EMRs and 77 percent think that their health information will be used for other purposes. More than half (59 percent) of Americans do not trust their health insurer.

Barriers for providers include the perception of more work for them, evolving paternalistic attitudes about what and how much information to release, and liability concerns.

Current PHR users are those who are the highest consumers of healthcare services as measured by the number of diagnoses and provider visits. “Does that indicate that people do not care about their healthcare until they become sick?” Miller posed.

PHRs are ideally suited to promote change and can serve as a change catalyst, she said. “Can we hold patients more accountable? Can we realign consumers’ incentives? Can we revisit pay for performance as patient-physician partnerships?”

In the future, there will be standards for all healthcare data and aggregates of all healthcare data. “That will enable predictive modeling and outcome studies leading to truly personalized healthcare,” she said.

Miller offered several steps that can be taken to increase the use and acceptance of PHRs. One is fostering centers of excellence. Studies have shown that when procedures are performed at centers that routinely have a high volume of procedures, there are lower costs, fewer complications and shorter lengths of stay. Other steps we can take include eliminating silos of information, reevaluating traditional delivery models, and fostering national discussion of who will pay for PHRs.