Consumers Not Ready for Do-It-Yourself PHRs, Experts Say

by George Lauer, iHealthbeat Features Editor

Revolution Health's exodus doesn't necessarily mean the PHR market is moribund, but it probably does mean the world isn't ready yet for a do-it-yourself version for consumers, industry observers say.

Revolution Health, started by AOL co-founder Steve Case in 2005, launched its personal health record a couple years after the company's start. The product attracted much fanfare, and predictions abounded that PHRs would empower patients and change the system by giving people tools and information to actively manage their health. Last week, Revolution Health told account holders the PHR service will shut down at the end of February.

"I think this shows the direct-to-consumer market for PHRs just doesn't work," said John Moore, founder of Chilmark Research, a research and analysis company specializing in health IT. "It's too much work for consumers -- you can't expect them to collect, input and keep track of all that data," Moore said.

Matthew Holt -- a leader in the Health 2.0 community, which advocates putting as much IT power as possible in patients' hands -- goes one step further:

"PHRs don't exist," Holt said. "Especially stand-alone data stores, which you enter your own data into and get nothing out of."

Future for Populated PHRs

Moore, Holt and other industry insiders say there is a future for consumer-controlled health records, but only if they're populated with data automatically.

"There's no question that systems like Kaiser's and other company-driven health records that give consumers some control make sense and will continue to be created and refined," Moore said. "And I think there is a future for Google Health and HealthVault because they are actively looking at ways to get data into these documents."

Moore added, "But I think the idea that patients themselves will take charge of this data is just not going to happen. You have to be pretty compulsive to keep that up and then when you have it all collected and arranged, there's nothing you can do with it."

Holt agrees, saying eventually the distinction between EHRs and PHRs will dissolve and leave nothing but data and applications to manipulate that data.

"We're moving to a general data utility layer into which data about you is transferred from systems that have it (e.g. lab results, drugs you're on, information about office visits -- often from claims data)," Holt wrote in an e-mail. "Then applications will accept data from that data utility layer and do something useful with it."

Holt points to a new PHR model, Keas, as a good example.

Started by former Google Health leader Adam Bosworth, Keas collects data from several sources -- including labs, physicians and even other online sites such as Google Health and Microsoft's HealthVault -- and translates that data into action plans for patients.

"This type of approach is the future of the PHR," Holt said. "There is no PHR and no EMR -- there's just data and applications."

Revolution's Evolution

Revolution Health's departure from the PHR market is directly related to its merger with Waterfront Media last fall. Revolution became part of Waterfront's Everyday Health Network, which boasts more than two dozen online health sites.

Last week, a few days before Revolution Health PHR users were urged to get their information off the Web site, Everyday Health announced an initial public offering, which the company hopes will raise $100 million.

Marjorie Martin, general manager of Everyday Health, said the decision to scrap Revolution Health's PHR was part of the company's strategic move toward more "high-end, decision-making tools."

"One of the nice things about working online is you understand relatively quickly what's working and what isn't," Martin said. "The personal health record is a very nice tool and a good application, but it's not being used very much." Asked how many Revolution Health PHR accounts were active, Martin said, "I'm not sure exactly, but it's in the hundreds."

Martin said the Revolution PHR decision was "part of a continuation of looking at our portfolio of sites to see where we want to go. A lot of energy is now going into our high-end decision-making tools like our video symptom checker."

Everyday Health plans to retain the architecture for a PHR, but not in the current Revolution Health format.

"We decided to sunset this version with the idea that we may bring it back some time in the future," Martin said.

Martin acknowledged that times weren't ripe for a consumer-driven PHR and that the Revolution Health PHR perhaps was not ripe enough for the times.

"We haven't hit the sweet spot of consumer need yet," Martin said. "I think that time will come, but we're not there yet. And the other part of it is the responsibility to keep this going in its present format -- we're not sure we want to do that. We probably haven't developed as fluid a product as consumers would like."
Steve Parker
Your article is very nice & informative, I also agree with all the discussion.
Steve Wilkins
Are we really surprised that yet another health care "outsider" has failed to revolutionize health care IT? Anyone remember Healtheon? Health care is a very different industry whether we like it or not. I would have to agree with Kim regarding the fact that people would be much more accepting of a PHR that is integrated into their physician office practice. Look at Kasier, Geisinger, Group Health, or Palo Alto Medical Foundation. The operative term here is integrated. Unless the physician actually uses the information in the PHR to mange the patient and the patient recognizes that value, the patient will quickly see no point in looking at the PHR or keeping it updated. Steve Wilkins San Jose, CA Author Mind the Gap
jeffrey delson
It seems to me that a fully formed and functional PHR/EHR that would work in all but very restricted situations, like a specific hospital, is very much wishful thinking and a very long way off at the least. I believe there could be another way to get started. Instead of expecting health care providers of all types to input the data, we could spend some time teaching our patients how to maintain basic charts themselves. For many patients this would not be such a challenge and would have the extra benefit of involving them in their own care. I think the challenge on our end is to understand the type of content we need to see in these records and how could it be streamlined in order for it to be useful to us and to our patients. Jeff Delson, MD
Steven Baldwin
It's worth noting that RevolutionHealth was a fairly uninspired effort. PHR's that actually bring domain knowledge to the table like DiabetesMine, PatientsLikeMe and SugarStats don't seem to be having the same problem. Who knew Health 2.0 wouldn't be as easy as a good domain name, a forum, and some health-ish blogging tools?
Jeff Brandt
There has to be an incentive to get patient to use PHRs or portals. In Argentina, The medical informatics department was shocked to the amount of elderly users of their Portal. They figured out that they were using it because it was much quicker to get an appointment via the portal. Another incentive is chronic disease management. More interoperability of patients health data is one of the keys factor of ease of use the other is Physician buy-in of PHR usage. Our healthcare system need to change to a system of Health, then patients will see the benefits of monitoring their own health via a PHR. Jeff Brandt

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