Editor's Corner


Somehow, suddenly, PHRs have become the topic of the hour. Not only have only have employer and insurer groups launched major PHR efforts, and grantors begun funding multiple PHR pilots, but there's even a bill (H.R. 6289) circulating on the Hill which would give physicians $2 for each PHR they build. PHRs aren't just hot, they're a fashionable cause, up there with driving a hybrid car. Heck, I expect Bono to pop up on the scene any minute now.

I confess to being a bit puzzled by this. While nobody argues that EMRs can have a meaningful impact on care, it seems to me that the information contained in a typical PHR isn't detailed enough to merit this level of excitement. Sure, clinicians get some excellent information, including some basic historical details, allergies and outpatient encounter information. But PHRs still offer more of a snapshot than an oil painting.

Sure, PHRs offer enough detail there to, say, prevent doctors from giving a patient a drug to which they're highly allergic, or to alert them to the fact that Jane Smith might have presented with that cough a week ago. That's certainly good. But the really rich clinical information isn't there. And they're nothing the insurance industry and major employers couldn't accomplish by, say, handing out a low-maintenance flash drive or a smart card to every employee.

Instead, the employer group spearheaded by Intel and Wal-Mart is building a high-cost, massively-scaled data warehouse to house these records. Don't get me wrong, I recognize that the employers will be conducting significant data mining initiatives on these warehouses, but couldn't they do most of this using their existing claims databases?

Look a bit closer, ultimately, and the groups' agenda becomes easier to see. In reality, the focus here is clearly improved benefits administration, not better clinical management. The PHR proposed by America's Health Insurance Plans, for example, will include subscriber info, benefits information and, if I'm understanding them correctly, access to claims histories and administrative data. This is all good, but let's make sure no one oversells it as a major clinical advance. Normalizing a few core pieces of clinical data may be a step toward building a universal EMR, something virtually everyone would like to see, but it's a teeny, tiny step at best.

Now, I'm not suggesting that there's anything wrong, per se, with insurers or employers putting their interests first. And Lord knows saving money is good, if done intelligently; after all, we don't have infinite resources. I just wish employers and insurers had the frankness to admit that this is 99.9 percent an effort at getting their own internal houses in order.

If these groups muddy the water around real e-health initiatives, which do help providers avoid expensive complications, these industry groups are helping to keep the costs of care high. I hope someone can get that across to them sometime soon. - Anne

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