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.

Vermont Flying Under the Radar

I don't know why this hasn't gotten much press in the health IT press, but on May 12 the Vermont Legislature approved a program to create a health IT fund that would pay for EHRs and health information exchange across the state. The program will be implemented by Vermont Information Technology Leaders (VITL), the statewide "RHIO". (The press release is here, and the actual legislation is here). The program will be financed by a claims assessment on health insurers (and self-insured employers), who will pay a quarterly fee of 0.199% claims paid (or 19.9 basis points or one-fifth of a penny per claim dollar). The assessment is expected to raise about $32M over the next seven years. The funds will be used to subsidize EHRs for primary care physicians, who will receive a 75% subsidy on an EHR purchase (up to $45K). Physicians will have to pony up the remaining 25% themselves. The fund will also pay for connecting these physicians on a statewide health information exchange.