Google Health's Demise Shows Limitations of PHR Market

by Kate Ackerman, iHealthBeat Managing Editor

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Since the early 2000s, personal health records have been touted as a way to improve care coordination and empower patients. Despite the buzz around PHRs, adoption rates have remained relatively low. A 2010 survey from the California HealthCare Foundation found that only 7% of U.S. residents are using a PHR. CHCF publishes iHealthBeat.

Google's announcement last month that it will discontinue its PHR platform, Google Health, on Jan. 1, 2012, has put a new spotlight on the PHR market. In a blog post explaining its decision, the company said that Google Health -- which it launched in 2008 -- "is not having the broad impact that we hoped it would."

The departure by such a major company from the PHR market has raised some concerns about the future of similar PHR platforms. However, experts in the field say that the demise of Google Health will not have much of an effect on the market.

Erica Drazen -- managing partner of Emerging Practices, the applied research arm of CSC's Global Healthcare Sector -- said, "I don't think [Google's departure] will affect [the market] too much. I mean it was nice to have a couple of major players, hot companies in the market, but you know they weren't what people were using."

She noted that CHCF's survey on PHRs found that of those people who are using PHRs, only 6% used tools sponsored by private companies, such as Google or Microsoft. Consumers are more likely to use PHRs from their health care providers or health plans.

Still, Google's unsuccessful go at PHRs highlights some of the key barriers to PHR adoption and, ultimately, the realization of the benefits associated with using such tools.

Barriers to Adoption of a 'True' PHR

A new report from CSC notes that "despite the renewed buzz and some well-publicized initiatives, the reality is that we are still no closer to a true personal health record than we were five or 10 years ago." According to the report, a true PHR must be comprehensive, interactive, patient-controlled and secure.

Drazen -- an author of the report -- said that of those four characteristics, comprehensive is the hardest to achieve, given the silos of data in health care. She explained, "If you get the information from a health plan, it contains everything they paid for, but it doesn't necessarily give you the clinical results." She added that for PHRs that are tethered to a health system's electronic health record, "they only contain the information from the providers that share that EHR. ... So if you go to a specialist [who is] not using that EHR, you're not going to get that information into the record."

Meanwhile, for the patient-controlled systems, Drazen notes that "in theory the patient could enter all the information they had access to, but that would be a huge, huge burden."

John Moore, managing partner at Chilmark Research, said in an email to iHealthBeat that it still is "far too difficult to collect one's personal health information," adding that "use of EHRs by physicians, while increasing, is still low, especially among ambulatory practices where most care takes place."

Michael Critelli -- CEO of Dossia, an employer consortium that offers a PHR platform -- said that another barrier is that many PHR platforms are not patient centered. He said, "Doctors, hospitals [and] insurance companies prefer to have a controlled tethered record and to assert dominance over the information as opposed to putting it in the patients' hands." Critelli stressed the importance of adopting a model where "patient ownership means the ability to aggregate information in a portal and in a record management system that the patient totally controls."

Critelli added that for PHRs to be successful, the tools must be beneficial to patients, as well as health care providers and payers. Citing the new Dossia Health Manager, he said that "there's a lot of data available to Dossia that is of value to clinicians or to insurance companies and pharmacies that we can aggregate and they can't. So over time, we want to create an environment of mutual benefit." 

Where's the Value for Patients?

In a recent post on The Health Care Blog, Missy Krasner -- founding member and former product marketing manager of Google Health and senior adviser to former National Coordinator for Health IT David Brailer -- wrote, "Because health care is not a true market-based commodity in this country, patients end up being lousy health care consumers. Unlike the banking, airline and retail industries, this makes it much harder to convince a broad array of consumers to engage in a service that helps them organize, manage and share their medical records online."

Drazen said, "One of the interesting things when we talk about accountable care [is that] everybody's accountable except for patients. So people have to find ways to engage patients, remind patients, prompt patients [and] follow up on patients they haven't seen," adding that "the PHR really is the vehicle for doing that."

Moore noted that "the maturity of PHR solution capabilities is still too low to provide sufficient value to the consumer [or] patient." He added that current PHRs do not offer enough value to offset patients' privacy and security concerns.

Drazen said that PHRs are "much more valuable for chronic care patients than for patients that come in every once in a while." Still, she said that patients do want access to test results, the ability to schedule appointments online and the ability to email their providers, noting that it is important to incorporate such features into PHRs.

Moore said that providing "the transaction tools that make it easier for healthy consumers to interact with the health care system" will help build the value proposition for PHR tools.

Critelli said he disagreed with the assertion that most healthy patients do not see the value in maintaining a PHR. However, he said, "I do believe that financial incentives that drive healthy behaviors through the use of a personal health record will enhance the value of [prevention and wellness] programs employers already are paying for."  

Critelli said that another key to consumer buy-in is to ensure that PHRs are easy to use. He said that enrollment and sign on must be simple, data must be automatically populated and the Web tool must navigate and look like other websites consumers are familiar with.

Will Meaningful Use Be a Game Changer?

As the meaningful use incentive program drives more physicians and hospitals to adopt EHRs, more data will be electronic, thus alleviating a key barrier to PHR use.

Moore said, "Widespread use of EHRs will lead to more personal health information being available in a structured digital construct, which will make it easier for consumers to get their [personal health information], share it with others and drive transactions."

Further, Stage 2 and Stage 3 of the meaningful use program will require more patient interaction. Proposed criteria include providing electronic hospital discharge information, providing online patient-specific educational resources and allowing patients to access to a Web-based portal to review their information. 

Critelli said that Stage 2 of the program "will be an extremely important catalyst because it will cement in the whole process of making the patient at the center of the personal health record as opposed to a peripheral player as it is today."

Drazen said that while proposed criteria for Stage 2 "does require more patient interaction," the "proposed goals are pretty low." Still, she predicts that the requirements "will get people thinking about it."

According to Moore, "The big question mark though, is will consumers even care and indeed adopt and use a PHR?" He said, "Frankly, as a society we need to drop the term EHR and PHR altogether and start calling it CHR for Collaborative Health Record to remove the artificial distinctions of PHR and EHR [because] it really is about getting the consumer and clinician to collaborate around one longitudinal record to drive future improvements in health care delivery to improve quality of care and hopefully rein in costs."

Jeff Donnell
Before we condemn the PHR category based on Google's exit, let's not forget that Google measures success differently from the rest of us mere mortals. Google makes billions based on aggregating eyeballs and capturing clicks, and they are quick to abandon products that fail to support their unique business model - who can blame them? However, those of us who have labored in this space for years doing the pick and shovel work required to build a category are now experiencing exponential growth as patient engagement moves from an academic concept to concrete action. Factors including meaningful use, a focus on disease management and palliative care, ACO migration and consumer desire to better control the costs they are increasingly bearing are all contributing to an environment where PHRs can not only survive, but thrive. As the president of a portable, untethered (or as we prefer to call it, unshackled) PHR and patient portal organization, I can report real progress and success.
Kim Slocum
The lesson to be learned from the demise of Google's PHR is that this technology won't be widely adopted until we have truly interoperable EHRs in place. What patients want is see their medical (as opposed to their claims) data, and to be able to communicate with their providers about that information. I'll hazard a guess that most of the country's existing PHR uses are in integrated networks that have invested in sufficient provider-focused EHR applications to make a consumer-centric tool practical (e.g. Kaiser/Geisinger and similar systems). If we really want consumer tools, let's get the priorities right. Automate providers through EHRs and (hopefully) HIEs, and the PHR "problem" will largely solve itself.

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