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Health Records: This Time, It’s Personal
By Phil Marshall, MD, MPH, WebMD HEALTH SERVICES
New technology-enabled healthcare brings with it the opportunity for more precise diagnoses, monitoring, treatment, and management. And these new capabilities can improve health outcomes.
But our experience with the healthcare system today is far from the future we imagine. In fact, even the use of the phrase “healthcare system” is misleading. While organizations such as Kaiser Permanente, Health Partners, and the Department of Veterans Affairs have truly connected systems for delivering consistent care, America does not.
The healthcare IT stimulus package, which includes approximately $19B for electronic medical records (EMRs) in doctor’s offices and hospitals, and an infrastructure called the National Health Information Network (NHIN) that will allow EMRs to securely communicate, promises to help create such a system. But development of the NHIN and the adoption of EMRs will take many years, and even when fully deployed there is no clear notion of how the average American will connect to their healthcare using the NHIN. If our goal is to support good health for all Americans, then we need to consider what the experience of real Americans is going to be.
In short, we need to make it personal.
The use of the phrase “healthcare system” is misleading.
Importance of a personalized healthcare experience
A positive healthcare experience is highly dependent on a patient’s relationship with a personal physician, but the number of primary care doctors has been consistently decreasing for several years. The number of U.S. graduates entering family practice residencies dropped by 50% between 1997 and 2005. In 1998, half of internal medicine residents chose to go into primary care compared to only 20% today.1 This can lead to doctors who are unfamiliar with their patients’ health history and an impersonal experience fraught with the opportunity for medical errors and unnecessary or redundant procedures.
We’re left with the challenge of providing a personalized,
cohesive healthcare experience across a fragmented collection of providers and institutions.
We’re left with the challenge of providing a personalized, cohesive healthcare experience across a fragmented collection of providers and institutions. And the NHIN connecting all doctors may take years to materialize. In the meantime, how can Americans achieve a personalized and cohesive healthcare experience?
The advent of the personal health record
The personal health record (PHR) can help the most motivated of all healthcare stakeholders – the consumer – gather, store, manage, and share essential health data. Employers, health plans, integrated delivery networks, and independent vendors such as WebMD have joined in that effort.
For 10 years, WebMD has provided PHRs for hundreds of large employers and health plans, and has the largest base of PHR users in the U.S. In addition to allowing employees to enter their own personal health data, many employers and health plans are importing claims, lab, and medication data. This automated health history can help drive better health-related decisions by the consumer and help them improve their health. For example, integrating information on drug costs and alternatives into the PHR helps educate consumers about their options, and rule-based recommendations can alert consumers to opportunities to improve their care.
For 10 years, WebMD has provided PHRs for hundreds
of large employers and health plans, and has the largest
base of PHR users in the U.S.
But even with automated claims feeds, consumers see personal health records as potentially doing much more. The Markle Foundation identified the PHR features consumers felt would be most valuable:2
Role of PHRs in lowering healthcare costs
A recent study conducted by the Center for Information Technology Leadership estimated that interoperable PHRs can save the American healthcare system $19B. But these savings will only be realized when interoperable PHRs become commonplace.
In the meantime, a recent WebMD study examined two matched cohort groups over a year’s time to compare active PHR users to a control group. While results may indicate correlation rather than causation, the differences were striking. Active PHR users have a preventive screening compliance rate that is 8% higher than the control group, had significantly larger decreases in their prevalence of depression and stress, and reported 10% fewer missed work days (compared to the control group’s 33% increase in missed work days). Frequent PHR users managed their health risks better than the control group, and showed a net medical cost savings over the control group of $75 per person, per year.
Frequent PHR users managed their health risks better than
the control group, and showed a net medical cost savings
over the control group of $75 per person, per year.
Making the future of healthcare personal
Imagine when every American is able to connect their PHR online to any care provider in the country, ensuring that their lifelong health history is available and up-to-date no matter which doctor they see and no matter which EMR system their doctor has implemented. Imagine if any patient in an emergency has his essential data immediately available, helping to improve the quality of the care he receives. And imagine if a significant number of lab tests and x-rays could be avoided because previous exams were easily available, and if a percentage of doctor visits could be replaced with online consultation.
The ingredients necessary to realize this future are rapidly emerging, and while interoperability with EMR systems is an important component, none of these scenarios must wait for a national network of connected EMRs. The patchwork of disparate providers and systems could be effectively bridged in the near term with interoperable PHRs.
With simplicity in mind, and with a high level of connectivity, we have an opportunity to make the healthcare “system” a little more personal for all Americans.
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