Health systems nationwide are in varying stages of implementing personal health record applications. The thought is that the technology can provide clinicians with a gold mine of data that will be helpful in improving both efficiency and care quality, while providing consumers with the tools necessary to take a more active role in their health care. Despite the benefits, resistance remains.
At a Project HealthDesign conference in Washington, D.C., last week, health system leaders discussed their efforts to ease concerns and ultimately make PHRs a staple of their health care systems.
Patients Conflicted
Holly Miller, vice president and chief medical information officer at University Hospitals and Health Systems, said consumers' main concerns about PHRs are privacy and security. However, she noted that surveys have found that consumers believe the benefits of PHRs "outweigh the privacy risks."
Beyond privacy and security, there are other barriers to consumers' adoption of PHRs. Miller noted that consumers don't want the responsibility of having to enter their health data online and that they worry about the lack of regulation of PHRs. Another concern is that PHRs are not interoperable with other electronic platforms, making them less useful.
In spite of these concerns, most consumers also see the benefit of online access to their health information. Miller cited a 2007 Wall Street Journal/Harris Interactive poll that found 91% of respondents said patients should have access to their electronic health records.
According to Miller, PHRs can give patients a sense of empowerment and control. She added, "Consumers are now facing external incentives and disincentives regarding their health," and PHRs can help consumers take on more accountability in their health care.
John Wald -- associate director of Clinical Informatics Research and Development at Partners HealthCare System -- said that patients who use Partners' EHR-connected patient portal, called Patient Gateway, "love it." He told iHealthBeat, "We've done online and phone surveys to assess the patient experience. For them, it is so much easier than using the telephone and it provides very easy access to information that previously they did not have."
"The most common complaints from patients relate to wanting more access," Wald said, adding, "So, we are addressing these complaints by working to roll out to more doctors, create more transparency, and certify on more platforms."
Health Care Providers Drag Their Feet
Patients aren't the only ones resisting PHR adoption. Over and over again, health system leaders hear physicians voice concerns that PHRs will increase their workload and lead to new legal liabilities.
Proponents of PHRs argue that the technology eventually will make doctors' lives easier by increasing efficiency and productivity. Still, even when physician colleagues offer an endorsement of the technology, most doctors need to see the benefits for themselves before they believe, Wald explained.
Further complicating things is the fact that the U.S. health care financial model essentially pays physicians for the number of health care services they perform, rather than rewarding them for preventive and efficient care. This makes it difficult for physicians to see the financial benefit of investing in PHR technology.
Anna-Lisa Silvestre, vice president of online services at Kaiser Permanente, said the key to convincing physicians to adopt PHR applications is to "frame it from a consumer perspective." In essence, health system leaders should explain to physicians that patients -- their customers -- want this technology. Silvestre added, "Persistence can't be overestimated."
Future of PHR Adoption
According to Wald, we are still "very early" on in the PHR adoption curve. He said, "Adoption will accelerate when 'the value is plain to see.' For example, if using a PHR is as simple and as risk-reducing as wearing a seat belt, then many many people will take advantage of that. We're not yet at that point for the general public."
However, Wald did note that "for some segments, especially those managing medical conditions who have multiple interactions with a variety of caregivers and professionals, PHR tools are already helping to improve coordination, reduce information gaps and help patients create more of a safety net for their care."