apractis.com Blog

It is so typical that in a broken industry the entrance of large internet/software companies into an arena creates such buzz and confusion. If one reads the opinions of people from different perspectives this is either a threat to PHR companies, a boon to PHR companies, a threat to the EMR, an enabler, a repudiation of the whole privacy arena, an enabler of it, etc.

Maybe it is better to just ask ourselves why we continue to be looking at health information as so unique in all its attributes. Those of us who have been in the “PHR” arena either as developers, users, partners, promoters, speakers, etc really struggle with the fact that it is not necessarily a “thing” that everyone agrees exists or can define. I think we can all agree what a phone fundamentally does, who uses it and why. As more features and capabilities are added, and smartphones are the term for some, we still do understand that the thing “helps you call, respond and talk in real time to people” and that “if you type in a number it will ring” If it does email, then you know what email does also.

Health records are either something totally different than any other type of information, or share many other attributes and have some that are distinct. For the majority of people who look at health records as documents, reports and “page views” of content about an individual, the storing, sharing and creation of them is really not terribly different than legal, financial ,real estate or other files. However the differences might be viewed more in the complexity of how they are generated, the level of integrity of pieces of information in them because they reflect “results” that came from some other source, the different points in time and place that pieces of a document originated, and whether the author is the validator or even knows how the document will be used by anyone else in the future.

But until one can develop any consistent concept for a large proportion of human beings what a personal health record really is, maybe it is better to just realize that microsoft and google are already in the business of health records. Doctors send email to each other, faxes are received thru telecom companies, phone calls about consultations are made on sprint phones, medical searches are done from within web browsers in EMR’s on the open web, powerpoint can be used to create a case demonstration, etc, etc. People store some documents in their google account, they keep reports from doctors in Word on their PC or elsewhere, and some people use third party document storage services for all sorts of things. We might be better off if we primarily just looked at Health records as one other element of personal records, and just focus on what specific attributes are somewhat, largely, completely or not at all different than other types of information.

On the other hand, if one views person-centered health information as subserving a context (the person and their behaviors and conditions) that can be tied to other similar contexts, then the ability to advance medical knowledge based on the open leveraging of this in the search and communication process would be a natural step along the path of human biological understanding. If that is the case, then microsoft and/or google are merely formalizing what is already occurring to some degree.

Since the healthcare technology privacy industry is far more legally and technologically self serving, not having emanated from what busy clinicians and consumers think privacy needs to mean, any excited discussion about the impact of these moves on privacy is of questionable value. The more important question is this….if entities begin to align themselves with the workflow, collaboration and business models about person-centric health information, will that finally help eliminate this “industry centric” focus on what an EMR or PHR or HIPAA is, and enable a more natural, “user or physician/consumer” centric perspective on the relative meaning and value of the different attributes of these records, how they are created, managed, shared, secured, etc

Maybe this is an opportunity to really open up the dialogue and end up with something called a PHR that ends up having some common meaning to a critical mass of people. And maybe it will result in nothing like a PHR at all, just another set of practical processes to facilitate sharing, retrieval, documentation, etc that are not so distinct from the rest of our daily workflow

Here is a link to an interesting blog in ecare management on a personal health information network 
Just my thoughts

AJB