Tag Archives: PHR

“Consumer” or “Patient” – Roles We Play

I have been involved in many conversations and listened to numerous presentations that use the words “consumer” and “patient” interchangeably, often in the same sentence!  While I will readily admit that we can get hung up on words at the expense of getting anything done, I think that the inaccuracy in our use of language can actually impede progress.    Such is the case, I suggest, with regard to the words “consumer” and “patient”.

While the debate as to whether the individual who is the subject of care is a “patient” or “consumer” may be heated, both sides of the argument seem to be focused on classifying the individual as either a “patient” or a “consumer”.  I contend that “patient” and “consumer” refer to roles that we play and that we can shift between these roles depending upon the situation.  I define these roles as follows:

  • In the consumer role an individual will make choices of about the services that they need, when they need them and from whom they receive them. In this role, the consumer may engage service providers outside the traditional healthcare system such as a consumer health portal or consult with other individuals in on-line communities of interest.
  • In the patient role an individual has made choices regarding the healthcare services that they wish to receive and are engaged with one or more healthcare providers for these services. Just as banks and courier companies are using ICT to streamline operations and engage their customers in ways and at times that are most convenient to these customers so too can healthcare providers use ICT to engage their patients.

Numerous surveys and studies confirm that Internet users have a strong interest in searching for information related to health and medicine and interacting with others who suffer from the same disease or condition.  Yet, despite this strong interest in using the Internet for health related purposes, many so-called “personal health record” applications have floundered.  Examining these successes and failure reveals a pattern of behavior that is best explained by categorizing the role in which the individual operated when using these applications as either “patient” or “consumer”.   Applications that are designed for the role in which the individual is operating are more likely to garner an active and engaged audience.

I think it is time to better define what we mean by the words “patient” and “consumer” and to be more careful about how we use these words.  The distinction is critically important to understanding how best to use IT to help people manager their health.



Doctors Will Prescribe Mobile Apps

A recent article in Healthcare IT News examines the results of a survey conducted by research2guidance.  The results of this survey suggests that  “in five years the major distribution channel will be doctors prescribing or suggesting applications to patients as a component of treatment.

Respondents to the research2guidance survey felt the most effective mobile app distribution channels today are:

  • App stores – 53%
  • Healthcare websites – 49%
  • Doctors – 34%
  • Hospitals – 31%
  • Pharmacies – 16%

This mix will change dramatically in 5 years according to respondents, with healthcare providers growing importance as follows:

  • Hospitals – 68%
  • Doctors – 65%
  • Healthcare websites – 56%

The survey results support Mark’s and my contention that physicians are a key gateway for many eHealth applications, particularly those that interact with patients.   For example, we believe that the most successful PHR applications will be those that are recommended by the physician.  Since many of these applications will use personal health data collected and managed by the physician, EMR software will play a critical role in the eHealth ecosystem.



Healthvault strategy revisited

A post on a Microsoft Developer network blog points out that “In reality, there is no change in strategy – HealthVault is part of Microsoft overall business, but was never intended to ‘make a profit’ on it as a standalone product in the United States”. Rather, the post goes on to say:

HealthVault is an important  part, together with Amalga of Microsoft  end-to-end strategy for connecting care across the healthcare ecosystem. Together with other Microsoft solutions and partner solutions, it enables  integration of multiple sources of information and knowledge across the continuum of care … HealthVault in the US is Microsoft  “model home” for innovation in the ecosystem.

This view is consistent with Healthvault presentations that I have attended over the past few years.  Microsoft representatives were very clear that they did not see making a profit on Healthvault in the US.   I still find it interesting that they believe that they can generate a profit offering Healtvault in publicly funded healthcare systems but not in the home of “user pay” healthcare.  Or, perhaps I am just being cynical 🙂


US PHR Roundtable

Interested in personal health records (PHRs)?  So is the US Congress.  Section 13424 of the HITECH Act directs the Office of the National Coordinator (ONC) for Health IT to conduct a study and make recommendations related to the application of privacy and security requirements to “non-HIPAA Covered Entities”, with a focus on PHR vendors and related service providers.

To collect information related to the mandated study, the ONC is hosting a PHR Roundtable on December 3rd, 2010. According to the ONC website for this event, the Roundtable will “address the current state and evolving nature of PHRs and related technologies (including mobile technologies and social networking), consumer and industry expectations and attitudes toward privacy and security practices, and the pros and cons of different approaches to the requirements that should apply to non-CE PHRs and related technologies.”

The roundtable will include “four panels of prominent researchers, legal scholars, and representatives of consumer, patient, and industry organizations.”  These panels will include:

  • PHRs: Origins, Developments, Privacy and Security Practices
  • PHRs and Related Technologies: New Forms, New Audiences, and New Challenges
  • Privacy and Security of Identifiable Health Information in PHRs and Related Technologies: Expectations and Concerns
  • Perspectives on Privacy and Security Requirements for PHRs and Related Technologies

The ONC will begin accepting public comment at the beginning of November.



AMA Updates PHR Policies

At its annual House of Delegates (HOD) meeting last week, the American Medical Association (AMA) amended its current policy regarding Personal Health Records to address concerns about the use of patient supplied data in a PHR:

  • “If the patient is allowed to make annotations to his or her EMR …. the annotation should be indicated as authored by the patient with sourcing information …. A permanent record of all allowed annotations and communications relevant to the ongoing medical care of the patient should be maintained as part of the patient’s record.”
  • “Physicians retain the right to determine which information they do and/or do not import from a PHR into their EHR/EMR and to set parameters based on the clinical relevance of data contained within personal health records.”
  • “Any data imported into a physician’s EMR/EHR from a patient’s personal health record (PHR) must preserve the source information of the original data and be further identified as to the PHR from which it was imported as additional source information to preserve an accurate audit trail.”

In addition, the AMA adopted a new policy to address the physician’s use of information contained in a PHR.  Specifically, this policy includes the following elements:

  • “To the extent that the physician chooses to review a PHR, the physician retains the right to exercise professional judgment in determining the clinical relevance of information contained within a PHR.
  • “The physician is responsible only for the use of PHR data that the physician has actively chosen to incorporate into the patient-physician relationship; conversely, the physician bears no responsibility for PHR data that the physician has not actively and specifically incorporated into the patient’s active medical care.”
  • “All data contained within a PHR must have accurate and verifiable attributions as to the originating source of the data.”

According to an article posted June 18th on ModernHealthcare.com, the delegates decided that “it was too early to call on Congress to pass legislation regulating still-evolving and little-used personal health records.”

The CMA has been quite active in promoting various technologies to digitize healthcare including, not surprisingly, EMRs.  It will be interested to see if they follow their American cousins and approve resolutions related to PHR use.


Australia moves to Personally Controlled Electronic Health Records

Last fall I wrote about a possible dramatic shift in eHealth strategy in Australia.  Today,the Australian Minister for Health and Ageing, Nicola Roxon, announced a $466.7M (AU$) investment in “a secure system of personally controlled electronic health records” that are accessible over the Internet.  Patients will be able to “present for treatment anywhere in the country, and give permission for health professionals to access their relevant history at the touch of a button“.

There are increasing calls across Canada a open and public review of Canada’s eHealth strategy which is heavily oriented on a centralized system of electronic health records.   The Australians had embarked on a similar approach which they have abandoned in favour personally controlled health records.  Perhaps it is time for Canada to at least consider a similar approach.


“…About Your PHR”: A Response

A little over a month ago a post, written by Michael Martineau and Michael Power, was published on this blog (as well as Dot Indicia and ITWorldCanada) entitled “Dear McGill University Health Centre … About Your PHR”.  Shortly after it appeared, the authors were contacted by Philippe Panzini, Chief Technology Officer at MEDICAL.MD EHR INC., the company which developed and operates  unani.  Mr. Panzini  responded with the following letter and we think it merits publication – if only to indicate that the company does indeed take privacy and security very seriously. We weren’t expecting this and Mr. Panzini is to be commended not only for the letter but also the indicated actions.

Dear sirs,

We, Medical.MD EHR INC, would like to extend to you our appreciation for taking the time to look at Unani in detail, and to write this informative letter. As you may know, we are the developers and distributors of Unani as well as the website managers for http://www.unani.ca.

We have put great care into the conception of Unani, and we will continue to do so for the entire lifespan of this service. The core concept of Unani being a PHR designed with the needs of the public in mind, our priorities are entirely governed by the goal of meeting our users’ expectations.

We took note of the comments raised in your letter, which was posted on March 24 and 26, 2010 on various websites, and further to such letter, we have decided to implement certain changes in our next releases of Unani, which should be available to the public starting a few days from now. In particular, we will take additional steps to ensure that our Privacy Policy is easily accessible to any person visiting our website.

With respect to our hosting services, we have entered into written agreements with reputable IT suppliers, which contain confidentiality provisions and provisions to ensure that the information collected via Unani is used solely for performing the hosting contracts.

In particular, we have entered into an agreement with a Canadian IT supplier to host and support Unani by the end of this year, in the Province of Québec and in the rest of Canada.
The information relating to Canadian users will be collected and held on servers located in Canada.

Unani will continue to operate as a world-wide service provider, using various hosting facilities throughout the world, in accordance with the applicable legislation. Before releasing our users’ information to any foreign suppliers, we will ensure that such information will receive an equivalent protection as that granted under Canadian privacy laws.

Until the services of our Canadian IT supplier are made available later this year, all accounts of Unani users, regardless of their geographical origin, will be hosted by a well-known, reputable  IT facility located in the Republic of Ireland. Once the Canadian hosting platform is available, all existing and future accounts belonging to Canadian residents will be hosted by the Canadian service, on Canadian territory. The migration of the existing Canadian residents’ accounts will be done transparently, and no trace will remain on the foreign hosting service.

In addition, we would like to share with you the following details regarding Unani:

  • Through a very simple, two-click procedure, our users can delete their account, and all of their data, without any backup copy being kept by us. Deleted accounts are no-longer recognized by our system.
  • Unless otherwise indicated in our Privacy Policy, we do not hold any information about our users that has not been provided to us by our users themselves.
  • To further improve on the confidentiality of data storage, we keep in separate databases the users’ demographic information, from their medical data. Both databases being encrypted.
  • We regularly retain the services of an independent security firm to audit our source code and to conduct database penetration tests.

We hope you will find these precisions satisfactory, and we invite you to maintain your interest in Unani. This project has only begun, and we are planning the release of many exciting features for our users in the course of the upcoming months.

For any additional enquiries, please do not hesitate to contact our Privacy Officer at the following address :
Medical.MD EHR Inc. 1035 Laurier Avenue West, Suite 100, Montreal, QC  H2V 2L1, Canada

Kind regards

Philippe Panzini
Chief Technology Officer