Federal attention (and presumably resources) has turned from EHRs and HIEs to personal health records (PHRs). The following report refers to comments by Dr. Robert Kolodner, President Bush's head of health IT:
You can see the whole report here: ONC fields tough questions Town Hall meeting.
Kolodner said that most Americans will have EHRs by 2014, and personal health records will drive that effort. Progress will increase in pace as a tipping point toward healthcare IT adoption is reached, Kolodner said.
ONC plans on backing these words with resources. The next round of federal contracts for health information networks are due out in April, and according to Kolodner, the next projects will be required to "empower patients to manage their own data." Speaking further, Kolodner said:
They have to enable the patient to identify how they wish to view their own information, to choose how the trust to share data, to control access to data by others, and for how long.... Individuals will also be able to correct errors in their health information. The actual correction process will at first be manual, but in the future it will hopefully be automated.You can see the whole report here: Majority of market now adopting value-driven healthcare, Leavitt says.
This is somewhat of a shift in priorities from the original vision laid out by Kolodner's predecessor, David Brailer. The original Framework for Strategic Action created in 2004 had PHRs as the third goal, behind EHRs and HIEs.
I've written before about my belief that PHRs can't be the driver of HIT. EHR penetration is so low at present, and hospital systems are so hard to connect to, that there isn't enough electronic data available yet to make PHRs interesting to consumers (please see You can't get blood (or data) out of a stone and Hi, I'm from Wal-Mart and I'm here to help....).
Further, by framing this goal as having "most Americans" rather than "most physicians" on an EHR by 2014, ONC is going after the highest hanging fruit. According to the National Ambulatory Care Survey, 90% of outpatient visits happen in small practices, yet, according to the CDC, penetration of "good" EHRs is only around 9% generally, and much much lower in small practices.
I hope I'm proven wrong, because the point is to get it done in any way that works. Maybe we can get consumers to pound the table for PHRs. And maybe that pounding will get physicians to feel the urgency to get EHRs in order to meet their patients' demands for data to populate these PHRs. And maybe substantial federal dollars focused in this way can create a market.
With all due respect to Dr. Kolodner and his tremendous efforts and vision, I think it will be an enormous challenge to have most Americans on an EHR by 2014 even if we funded EHRs directly. Getting to that goal indirectly through demand generated by PHRs will be even more challenging.