PHRs: Where We've Been, Where We're Going (Text Version)

Slide presentation from the AHRQ 2009 conference.


On September 14, 2009, John Moore made this presentation at the 2009 Annual Conference. Select to access the PowerPoint® presentation (6.5 MB) (Plugin Software Help).

Slide 1

PHRs: Where We've Been, Where We're Going

Where We've Been, Where We're Going

By: John Moore, Managing Partner


Slide 2

Three Take-Aways

  • Healthcare in Transition & the Move Online
    • Implications
  • PHRs Today
    • Adoption/Drivers
    • Challenges
    • Successes
  • PHRs Tomorrow
    • Platforms
    • MHealth
    • Death of PHRs


Slide 3

Macro Trends Reshaping Healthcare

  • Growing Consumerism in Healthcare
    • Employee Accountability & Cost Sharing
      • Out of Pocket Expense Yr'00: $200B, Yr'07: $267B
    • Disintermediation of Care
      • Retail Clinics, eVisits, MedTourism, Virtual Labs
  • Information Liberation
    • Traditional: PubMed, Mayo, WebMD
    • Crowd-sourced: Wiki(s), Blogs, Twitter,
  • Stimulus Bill & Healthcare Reform
    • Unprecedented $$$ to Digitize Healthcare
    • Comparative Effectiveness


Slide 4

While Consumers Increasingly Go Online for Health Info.


Source: Pew Research 2006
74% of all adults are online

Now One of the Top Activities on the Net


Slide 5

Few Manage Health Records on Net

  • Yes 30%
  • No 56%
  • Don't Know 14%
  • Paper 76%
  • Web-based 11%
  • Basic Desktop App 10%
  • Specific App 4%

Source: Forrester Research Q2'08 Survey.n= 5,242
Today, Meager 3.3% iManage PHI


Slide 6

Three Dominate PHR Models

  • Direct to Consumer => Manage Records
    • Consumer has Full Control
      • Consumer self-populates, disconnect
    • Small ISVs with Little Market Influence
      • CapMed, Medikeeper, PassportMD
  • Payer/Employer Sponsored => Lower MLRs
    • Consumer has Limited Control
      • Trust issues, portability
    • Focus on HRAs, Health & Wellness, Disease Mgmt
      • Incentives common to drive adoption
  • Provider Sponsored => Customer Retention
    • Consumer has Limited Control
      • Little portability, modest tools, incomplete longitudinal record
    • Present Labs, Meds, Discharge
      • Facilitate transactional processes


Slide 7

PHR Adoption is Widely Dispersed

EntityTypeNo. of UsersPHR PlatformFeatures
Kaiser-PermanenteProvider3.0M+MyChartEMR portal w/email & transaction services
Portability w/HealthVault
Veteran's AdminProvider650KRYO (VistA)EMR portal, Not portable
WebMDISV500KWebMDClient defined, claims-based HRA & alerts Rarely portable
AetnaPayer~780KActiveHealthFocus on HRA, DM, aggressive build-out Portability w/HealthVault
United Health GrpPayer~200KHealthAtoZClaims-based, part of new OptumHealth Div.
 Portability w/HealthVault
Cleveland ClinicProvider100KMyChartSimilar to KP
Portability w/Google
BIDMCProvider40KRYOAging portal w/email
Portability w/Google & HealthVault
All OthersMix2.5MCountlessHighly variable, most simple templates Little portability


Slide 8

PHRs: What Are They Good For?

  • EMC
    • Adoption: Over 50% of Employees
    • Benefit: Lower MLRs = Lower Healthcare Costs
      • NET: $50M in 4 years
  • Kaiser-Permanente
    • Adoption: Over 50% of Members with Internet Access
    • Benefit: Cost Savings via Fewer Office Visits
  • Indiana University
    • Adoption: Over 40% of Entering Class
    • Benefit: Lower Admin Costs, Student Engagement

All Depends on Who You Ask!


Slide 9

Top 3 Challenges to Adoption

  • Data
    • Getting it, Cleansing it,
      Sharing it
  • Trust
    • Privacy & Security
    • Providence
  • Value
    • Personal
    • Actionable
    • Relevant

Consumer Engagement Begins Here


Slide 10

"Health Clouds" on the Horizon

Data Source(s)HighVirtually any pertinent data source
ControlHighStrong consumer control of data
InteroperabilityHighAdoption of Open Systems and standards
PortabilityMediumStill under development
ToolsVery GoodMultiple tools/widgets, communications???
PersonalizationHighFarther down the road
AdoptionHighPerceived value?


Slide 11

Health is Mobile!

  • Explosive Growth in Use
    • Over 1B AppStore Downloads
    • IPhone Rep. 0.7% of All Internet Traffic
  • Over 30K Apps
    • Nearly 1.5K are Health Focused
  • Every Major Mobile OS Now has App Market
  • And Still Only mHealth1.0


Slide 12

Evolution Accelerates PHR Adoption

A graph showing 4 stages to the PHR Adoption is shown.

  • Gen 1: Isolated
  • Gen 2: Online & Connected
  • Gen 3: Data Aggregation. (Health Clouds Form)
  • Gen 4: Personal, Actionable & Mobile


Slide 13

Generation 4: "Convergence" Personal, Actionable, Connected

Value: About Me, By Me, With Me, For Me


Slide 14

What to Watch

  • Traction of Platform Plays
    • Data Sources (agreements)
      • E.g., Cleveland-Google, KP-MS
      • New HIPAA Extensions
    • Consumer Adoption
      • Sub-group types
    • Developer Adoption
      • Popular apps/services
  • Employer Successes
    • Demonstrable ROI
  • All Things mHealth
    • Smartphones change equation
      • Biometrics play key role


Slide 15

Looking Into the Future.

  • Biometric Devices Become a Critical Data Source
  • HIEs will Serve Citizens as Well
  • Data Liquidity & Quality will
    Prove Challenging
  • Meaningful Use Requirement May Backfire

Biggest Challenge: Sourcing Quality Data


Slide 16

Final Thoughts.

  • Time to Ditch PHR Term
    • Consumers NOT Interested in
      Digital File Cabinet
  • Personal Health Platforms
    (PHP) are Future
    • Personal, Actionable Data
  • Education Critical
    • What's in it for me?
  • Without Consumer Engagement,
    HIT Adoption may be DOA
    • Stimulus Funding is Not Enough to Move Needle


Slide 17

The First Wealth is Health -Ralph Waldo Emerson

The Best Way to Predict the Future is to Create it
Peter Drucker

Current as of December 2009
Internet Citation: PHRs: Where We've Been, Where We're Going (Text Version). December 2009. Agency for Healthcare Research and Quality, Rockville, MD.