Where have all the PHRs gone?

In Search of the Dream PHR

In the pre ARRA era, which I believe was right about the time the dinosaurs died off, there were Personal Health Records (PHRs) everywhere. Web-based, thumb drives, smart, dumb, tethered to EHRs, and on and on. They were everywhere and existed in every possible permutation of hardware and software. Everybody was developing them. It was the Next Big Thing. It got so ridiculous that even I was designing one. I’m not kidding and one day I must dust it off and try and sell it to somebody.

We all knew that everyone needed a PHR, there was no doubt about that. Even CCHIT saw the writing on the wall and developed a certification program for PHRs. It was the 11th commandment: “Thou shalt maintain all personal relevant clinical history in a HIPPA compliant device”. The trouble was no one wanted to use a PHR. I guess a few did. Most folks just don’t like to get that up close and personal with their health records. They pay other people to do that. Maybe if Apple developed one and it plugged directly into our nervous systems we would use them. I’m not even sure if that would tip the balance.

Several years ago I gave a presentation on my “dream PHR” to an audience of HIT stakeholders that included a former Surgeon General of the United States. I asked who had a PHR and no one raised their hand. I didn’t use one either. Now don’t get me wrong, I like PHRs. There is a real need for this type of interface with our medical records. We just haven’t found the right tool. It reminds me of the story about the man who only had one tool, a hammer, and he roamed the world looking for nails. Or the man who always wore shoes and so he thought the earth was covered with leather. There is a mismatch between current PHRs and the perceived benefits of using them. I guess that is one of the reasons that Google threw in the towel on their PHR, Google Health.

The arrival of the CMS EHR Incentive Programs delivered a blow to PHRs. Stage 1 meaningful use  incentives did nothing to promote the use of PHRs and overnight they became the stepchild of HIT. I’m sure something will come to fruition but I don’t know what it will be. Maybe Stage 2 or Stage 3 will support and incentivize PHR use in some way.

My “dream PHR” continues to evolve. What I want now is a elegant interface which gives me a real time dynamic look into my record located somewhere in the stratosphere. I don’t want to have to do anything. Please don’t ask me to input anything or make more than 2 or 3 decisions. Make it simple, intuitive, powerful, and available on the internet and I will use it. Maybe.

Jim Tate is a nationally recognized expert on the CMS EHR Incentive Program, certified technology and meaningful use and author of The Incentive Roadmap® The Meaningful Use of Certified Technology: Stage 1.