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The consumer benefits of PHRs are brought in to relieve against the limitations of EMRs and EHRs. These digital interfaces, which replace paper medical records for physicians and patients, do not facilitate patient engagement. They are incapable of patient updates, and as data repositories solely for one provider, they disallow interoperability. With the proliferation of all kinds of internet connected devices, such as Fitbits, scales, blood pressure cuffs, etc, patients have the ability to collect quite a bit of health data from the comfort of their own homes, and they are – 1 in 4 Americans own a wearable device. This kind of data allow providers to have better insight into a patient’s health, and make more informed decisions, hence why it would be important to have access to it through a PHR. The fragmentation of data across EHRs highlights the need for a personal, portable data repository that can be used across health providers, transferring control to the patient.
Health systems are constantly looking for better ways to engage their patient population, to not only ensure patients are more informed and empowered, but also feel connected to the health system. Patient portals are an attempted solution to theproblems of patient engagement, but the healthcare industry’s focus on this innovation rather than PHR implementation could explain why the latter has struggled to gain widespread adoption. Yet while portals increase patient access to data, their value for consumer engagement is primarily operational, not clinical. Patients are utilizing these portals for appointment scheduling, bill payment, prescription refills, and direct secure messaging. With no standard of operation, even these basic capabilities vary widely by provider and the web-based model of patient portals is inefficient and outmoded; limited to data originating from a single provider. Most importantly, patient portals fail to address the biggest demand of consumers who are looking for more than a storage space, that data effectively manage targeted health outcomes.
Currently, each time a consumer visits a nutritionist, a weight-loss coach, a primary care physician, etc., their health data goes to a different repository. The data then accumulates in these different care silos, fragmented and ineffective, thus the need for a PHR that aggregates data across multiple providers. Ideally, this data would be automatically populated into a patient’s PHR, providing a holistic picture of the patient’s health profile to any provider, thus facilitating targeted health outcomes.
If PHRs are so patently beneficial to consumers, then why have they struggled to gain a foothold in the industry? Beyond the obvious obstacles of private data exchange presented by Health Insurance Portability and Accountability Act (HIPAA), the difficulties to deploying PHRs are manifold. Perhaps the greatest obstacle is the lack of an immediate monetary incentive although long term benefits could be anywhere from $13 billion to $29 billion after a period of ten years, the widespread implementation of aggregation will have an initial negative net value. This is exacerbated by our current fee-for-service system where the medical record is primarily designed to do one thing: bill and account for transactions. The difficulty of pulling together data from different formats further complicates the process. While consumer-empowerment is gaining massive traction in the healthcare industry, the reality remains that for the widespread adoption of any health platform, clinicians must be the instigators.
Apple is uniquely positioned to give PHRs a stable foothold in the consumer market. They have a secure and established platform, trustworthy for the passage of encrypted data, and command a brand loyalty ubiquitous in the United States and elsewhere but can they inspire clinicians to shift to a patient-controlled infrastructure? If they cannot, is their new feature dead in the water? The jury is still out.
