Over the Counter PHRs?

Posted September 14, 2009 by Jason Rothstein (with Lygeia Ricciardi) 

Imagine my surprise the other day when I dropped by my local pharmacy and found—among the mints, candy bars, lip balm, and other impulse purchase items— a $20 USB-based wallet card designed for consumers to hold a variety of their own personal health record data: emergency information, physician numbers, medications, test results, diagnostic scans, and even living wills. Though this simple tool doesn’t measure up to the personal health record (PHR) vision articulated by Project HealthDesign: the PHR as tool for action that enables consumers to understand and significantly contribute to their own health and associated records—the discovery nonetheless prompts a few questions. Has the personal health record (PHR) concept reached some sort of tipping point? Are those of us who think and write about PHRs perhaps over-thinking what will capture consumers’ imaginations? Are PHRs just another medical commodity?

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. 

Comments

[Lori]

Interesting blog post. As someone who is also writing about PHRs, I've read about a lot of people "crafting" their own PHR data and putting it on a thumb drive, especially if they are traveling to another country. While I prefer my HealthVault account, I could see the advantages of a portable back-up of some sort for those trips to countries in which getting online access might be tricky. Privacy is the other hot button, so perhaps consumers who are really worried about privacy will adopt this sort of option, and then, as they build confidence, migrate over.

[Jason Rothstein]

Thanks for commenting. I suppose another question to ask is what PHRs that conform to a platform approach might learn from the appeal of this product. Perhaps as a value add, vendors like HealthVault could offer the option to create one's own emergency 'thumb-record' to carry when traveling. Or perhaps they could use a check-out register level marketing approach to broaden the audience they reach. (Conceivably, with the right APIs in place, this would be an opportunity for third-party vendors too.) All food for thought.

[twitter.com/john_chilmark]

Couple of problems with USB-drive based PHRs: First, no IT person in their right mind would ever allow someone to come in off the street and insert a USB into the computer/network for fear of virus. Have actually heard of some hospital IT folks actually plugging all USB ports on computers in ER. Secondly, consumer is still left with populating the PHR and once they go through that effort, will they keep it updated?

There is a very small and limited opportunity for these products, maybe best left to those who travel.

But there is a silver lining. Consumers simply seeing these products on the shelves of the local pharmacy will bring awareness to the market, awareness that has been sorely lacking to date.

[Lygeia Ricciardi]

Hi John --

Thanks for your comment. I agree that this particular PHR model is not ideal for several reasons, but I also think it may work for some people with particular needs. And I do think there is value for the industry in the sheer "marketing" point -- raising awareness that you, the patient, could use IT tools to access info about and ideally better manage your health.

In my own personal experience, a few years ago I used a regular USB to port my dental x-rays from the UK to my dentist in the US, which is a small, 2 doctor practice. While some large practices might have objected, my local dentist was curious but more than willing to let me crawl around on the floor, plug in the drive, and show the him the images -- which saved me from doing duplicate x-rays.