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"Ready, Fire, Aim" - The PHR Story (Text Version)

Slide presentation from the AHRQ 2009 conference.

On September 14, 2009, Kim Slocum made this presentation at the 2009 Annual Conference. Select to access the PowerPoint® presentation (436 KB).

Slide 1

"Ready, Fire, Aim"-The PHR Story

Kim D. Slocum
September 14, 2009


Slide 2

Consumer Use Of Electronic PHRs Remains Very Low

(Thumbnail graphic in corner-photo of a section of a computer keyboard with a lock and chain surrounding it) Keep Paper

Records 40.0%
Neither 57.3%
Already Use 2.7%

SOURCE: Markle Foundation Survey-June 2008


Slide 3

Consumer Interest In PHRs, Even When Offered At No Charge, Remains A "Mixed Bag"

"Some Internet technology companies and health care organizations are inviting individuals to join free online electronic personal health record services. You could obtain, store, and update your health information on a secure web site. You could control which health care providers can see or update your PHR, and you could automatically receive valuable information from the Internet related to the medical and health conditions and interests you indicated in your PHR. How interested would you be in enrolling in such a free online PHR system?"

Very Interested 13.5% (31 Million)
Somewhat Interested 33% (75 Million)
Not Very Interested 26.2% (60 Million)
Not At All Interested 27.4% (62 Million)

SOURCE: Markle Foundation Survey-June 2008


Slide 4


(Thumbnail graphic in corner-a question mark)

  • Impact of health & computer literacy
  • "Who do you trust?"
  • The "Quicken" effect?
  • Can the successful model be replicated widely?


Slide 5

Who Is The "Average" Consumer?

(Thumbnail graphic in corner-photograph of an presumably "average" American)

  • Mean household income of ~$60,000 (median is ~$50,000)
  • High school graduate, maybe "some" college
  • Current post-tax expenses equal 80% of pre-tax income (95% for median income)
  • Minimal financial assets
  • Reads at 6th-8th grade level
  • Roughly 30%-50% chance of being "health illiterate," "health innumerate" or both


Slide 6

Chronic Disease Patients Are Older, Less Educated And Less Computer Literate Than The General Public

(Thumbnail graphic in corner-photograph of an elderly couple standing side by side) 

  Living with Chronic Condition No Chronic Conditions US Population
Aged 65+ 29% 15% 17%
Less than high school education 25% 10% 12%
High school diploma 31% 34% 33%
Some college 27% 26% 26%
College degree or more 18% 29% 28%
Use computer at work, school, home 52% 75% 71%
Use internet or eMail 51% 74% 70%

SOURCE: Pew Internet & American Life Project


Slide 7

The General Public Thinks Physicians Are The Most Trusted Source For Personal Health Records

(Thumbnail graphic in corner-photo of a section of a computer keyboard with a lock and chain surrounding it)

  • Physicians: 60 %
  • I would not trust any of these entities: 18%
  • Company created specifically for the purpose: 8%
  • Hospital: 8%
  • Government: 2%
  • Insurer: 2%
  • Employer: 1%

Source: Harris Interactive Strategic Health Perspectives 2007


Slide 8

The General Public Believes Personal Health Records Are For Doctors And Patients, Not Plans

(Thumbnail graphic in corner-photo of a section of a computer keyboard with a lock and chain surrounding it) 

  A personal health record would be a valuable tool to track the progress of my health All physicians treating me should have access to information contained in my personal health record My personal health record is for my own use and should not be provided to other parties My insurer should have access to my personal health record information
2007 76% 80% 53% 27%
2008 81% 83% 50% 26%

Source: Harris Interactive, Strategic Health Perspectives 2007, 2008


Slide 9

What Data Are Included?

(Thumbnail graphic in corner-a question mark)

  • Insurers & employer-sponsored PHRs consist mostly of claims information
    • Measures what care was delivered and how much it cost
    • Of little use in managing clinical course of care (unless lab values and medication histories are included)
  • Provider-based PHRs are often patient-centric shared views of an enterprise-specific EMR
    • Measures why patient sought care
    • Describes clinical outcomes
  • These two data sets need to be combined-does this require NPI? Better developed interoperability standards? Fundamental philosophical changes in attitudes toward data sharing?


Slide 10

The "Quicken" Lesson

(Thumbnail graphic in corner-photograph of box containing "Quicken" financial management software)

  • Personal financial management software has existed since the early 1990's
  • "Cult status" during early years
  • Rise of internet, on-line banking required to drive widespread popularity and use
  • EHRs and HIEs are probably healthcare's "parallel construction"


Slide 11

Integration Of PHRs With Electronic Health Record

(Primary graphic-Pie chart containing results of "HIMSS Vantage Point" Survey conducted May 2008) 76% of HIT professionals agreed with the statement that personal health records need to be integrated with electronic medical records in order to have value in patient treatment. 15% of respondents disagreed with this statement and 6% offered other responses and 3% did not know.

76%: More than three-quarters of survey respondents believe that personal health records (PHRs) need to be integrated with an electronic medical record (EMRs) in order to have value in patient treatment.

Source: HIMSS Analytics Vantage Point, May 2008


Slide 12

The "Kaisinger" Model

(Thumbnail graphic in corner-computer keyboard with hands over it, presumably typing something)

  • Most PHR success stories involve integrated delivery system providing essentially 100% of medical services to their members
    • Many of the economic barriers confronting other physicians, hospitals, and patients do not exist there
    • Data integration issues far less pressing
  • Kaiser Permanente based its system on an EHR containing nearly all relevant clinical information and included the ability for patients to do simple transactions with their physicians
  • Is this success currently scaleable to other sorts of environments?
  • Technology is not the only issue to be addressed


Slide 13

My Conclusions

(Thumbnail graphic in corner-cartoon drawing of a stick figure breaking through the tape at the finish line of a foot race)

  • US health care desperately needs HIT to be either sustained or reformed
  • The main task we face is deploying EHRs and building HIEs
  • If these are accomplished, and patients are given access to their own data, the PHR problem largely solves itself
  • In general, patients' interests will be better served by EHRs and HIEs than by dedicated PHR products
  • There will be a time to devote resources to "bespoke" PHRs, but not until "job one" is complete
Current as of December 2009
Internet Citation: "Ready, Fire, Aim" - The PHR Story (Text Version). December 2009. Agency for Healthcare Research and Quality, Rockville, MD.


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