Posted September 14, 2009 by Jason Rothstein (with Lygeia Ricciardi)
If current statistics are reliable, PHRs have decidedly not reached a tipping point. While the marketplace has introduced PHR products at a rapid pace (with perhaps 50 active products with considerable use today, according to Chilmark Research, actual adoption rates remain low overall. But the appearance of a product like this at the pharmacy counter definitely suggests that consumers increasingly make the connection between their digital and medical lives and want technology to solve real life problems.
Although in subsequent research, I found that these cards can connect to a limited online system for providing minimal extension of functionality and backing up data, the USB PHR card clearly does not embody the platform approach and emphasis on information definition, acquisition, and creation by consumers that Project HealthDesign researchers, policy analysts, and others have envisioned. Although it is for sale directly to consumers for their use, because it contains only traditional medical information about an individual and has such limited functionality, it is in some ways less a PHR than a variant of an electronic health record (EHR) for use by healthcare providers that happens to be carried by consumers in their pockets or purses, rather than shared electronically via a network.
Having said that, one can understand why this approach may appeal to some: these cards fit in a wallet, include only the information a consumer explicitly wants to share, don’t require navigating connections among different entities, and even have a certain ‘show-off’ factor that doesn’t involve revealing any private information. (“Hey, Charlie… look at this card!”) It would be a stretch (or at least, premature) to say that this product’s existence suggests that a more complex, networked approach to PHRs is headed in the wrong direction. But it does reinforce the notion that what appeals to researchers may not appeal equally to the public, and that convenience often trumps innovation, at least in the early days of technology adoption.
I have to confess that one of the first questions that leapt to mind upon seeing these cards was whether or not they were eligible medical expenses (purchasable with pre-tax dollars set aside for medical expenses through Flexible Spending Accounts or Health Savings Accounts). I was disappointed (but not surprised) to discover that they were not. But this opens up a whole other side to the policy questions surrounding PHRs and other related technologies. A cursory look at IRS rules suggests that as of this writing, the rules aren’t written with personal health software and some related technologies in mind (though of course, many other rules haven’t yet caught up to PHRs either). But shouldn’t they be? If PHRs and other personal medical software provide the benefits we believe they will, shouldn’t we make the case to treat all such tools as medical expenses like any other?
Part of the answer may be that many PHR services are now free… but it’s a chicken and egg kind of dilemma. At some point, many PHRs will probably move to a paid model, particularly for value-add services like ODL-tracking or enhanced storage and communication capabilities. Making the case that these costs belong in the same category as other medical expenses would help lend legitimacy to the category and further encourage consumer adoption.
There has been a lot of analysis of PHRs from a technology perspective, patient care perspective, and a regulatory perspective. But perhaps PHRs would benefit from a little more marketplace perspective. We tend to think that the main competition to PHRs is simply the status quo; it turns out we’re also fighting with Snickers bars for shelf space.