Thursday, June 26, 2008

Of HIEs and PHRs......

Yesterday we announced the launch of our second HIE, this one in greater Newburyport. My blog energy on that launch went to my entry on WBUR's Commonhealth site: Realizing the Dream of 21st Century Health Care.

David Harlow wonders aloud in HealthBlawg whether the GoogleHealth and Microsoft HealthVault PHRs may obviate the need for the type of HIE infrastructure that we're putting in place in our pilot communities. The answer, I think, is, maybe, someday, but it's going to be a long time before there's enough electronic information for patients to reap, and therein lies the biggest obstacle to PHR's getting a greater foothold among consumers.

For example, in Massachusetts today, if a patient gets all of their care at Beth Israel Deaconness Medical Center, and their insurance from Blue Cross, all of their clinical and claims information will be easily uploaded into a GoogleHealth account -- that's pretty cool. Most patients are like me, however. I don't get my care at BIDMC, nor am I member of Blue Cross, so at the moment I'm plumb out of luck -- I would have to gather, scan, and upload all of my medical records and claims into my GoogleHealth account, and then keep it current myself any time I get more care. Which means I won't do it.

There's certainly hope, and GoogleHealth and HealthVault are solid, well thought-out products that deserve to be taken seriously. Indeed, MAeHC is likely to be working with one or both of them in the near future. But considering that real EHR use is somewhere between 4-13% in the US according to the best study to date on the topic (published in last month's New England Journal of Medicine), I don't see how a PHR-driven strategy will get us there any faster than an HIE-driven one.


Sean Nolan said...

Micky, you make a great point here. Getting to real data liquidity is going to take a broad combination of efforts over many years -- and regional networks such as what you've done in Newburyport have a critical role to play. Even in a mature market, they really serve two different needs -- one personal, the other clinical -- and I see no reason they wouldn't coexist happily forever.

Ideally --- it would be great to discuss how we could get WellportSM connected with HealthVault, so that patients could take the regional benefit they're now receiving and leverage it when they travel or perhaps move to a new area.

In any case, very cool stuff and congratulations to you and the MAeHC on taking real steps to make things better for the world.


Sean Nolan
Microsoft Health Solutions

Johnnysmooth said...

Micky, yes, it will take time to achieve the ho;y grail of data liquidity that will enable such services as Googel Health, Dossia and HealthVault to be truly useful. And yes, there may be a role for organizations such as yours in the meantime to assist in getting physicians to use EMR systems. In fact, initiatives such as the one your organization is supporting (hosted EMR with secure messaging services) may be the best role for HIE/RHIOs.

Longer term, however, the NHIN will most likely reside within the context of the major platform/ecosystem plays. I've actually written quite a bit on the subject over at

Drop by some time and provide a comment - would welcome your input.