The mPHP (Mobile Patient Health Platform) 9/19/12

A lot has been written by me and many others about PHRs and mobile PHRs. We usually speculate about what a PHR is and what it should do. The death of Google Health last year has not dampened the optimism for personal health records, nor should it. Also, last year Deloitte even concluded that mobile PHRs (mPHRs) are the "killer app" for patients, providers, and payers.

Blue Button just hit 1 million registrations, a number and success that is shocking. And I’ve e-mailed with two people just in the last week who are working on tools that leverage Blue Button data. Hopefully developers and vendors can provide better-tailored education based on Blue Button data. Raw data to patients doesn’t do much in terms of engagement or empowerment (a good post on that is here), but it’s the starting point.

I think most people agree that PHRs, or really more appropriately personal health platforms (PHPs), are the bare minimum for patients in terms of data access, and that they are really just a starting point for creating value-add services (scheduling, refills, reminders, emailing providers, integrate monitoring devices, enable form completion, virtual visits, care plans, and on and on) for patients. A more appropriate term would be personal health platform (PHP), something that doesn’t conjure up screenshots from a clinical system. A true PHP would require personal health data (labs, visit summaries, problem lists, meds, self-monitored data) as input but create an experience for patients that looks nothing like a data dump or a medical record.

In light of Blue Button’s recent success and my fascination with the various ways vendors are going about creating and marketing PHPs, I wanted to cover PHPs in more depth, though I’m certainly not an expert in the area and readily acknowledge that engaging patients, consumers, and employees at scale with health data is years off at best. From my knowledge of PHRs/PHPs/portals, my naive segmentation of PHPs based on distribution works something like this.

Employer-based. The biggest player I know of here is Dossia. It definitely has a platform approach with an API for developers and tools for employers, providers, and benefits reps. Employers desperately need to curb healthcare costs, but PHPs are one of many services that employers can choose from now. PHP vendors will need to add value-add services to actually curb costs, not just provide access to data.

Provider-based. It’s nice to own your data –just ask Epic. Epic’s MyChart is now the most popular PHR out there. It  enables both web and mobile access. On another note, I was unaware that Epic had another patient-based (freestanding) PHR called Lucy that pulls in MyChart data as CCD documents. A lot of the EMR vendors have (or are planning to build) a PHR solution. Providers also offer portals (MEDSEEK, GetWell@Home, and a bunch of others), many of which integrate health record data. Access to med record data helps providers meet Meaningful Use, and add-on service people want — like med refills and appointment setting — are easier for providers than employers. Portals and provider-sponsored PHPs, based on add-on services, can cut costs for providers, so they have a reason to implement them. Whether providers actually implement them in a way that they see cost cutting remains to be seen. Also, according to survey after survey, providers are the most trusted brand in healthcare.

Payer-based. Most big payers now offer access to basic medical information based on claims data. My understanding is that this is a subset of PHR data, but it’s convenient for patients and can be a differentiator for payers, if the speculation is correct and consumers are going to be more active participants in choosing payers. I think the more valuable offering from payers is in helping members find cheap drugs and cheap procedures to keep out-of-pocket costs low. I could be wrong on this, though, with recent payer pilots of LostIt! and Fitbit. It will be interesting to see how these wellness programs draw in new members and improve the health of existing members.

Consumer-based. This is where it starts to get interesting. The biggest drawback here is that most of these services require consumers to enter information, which I don’t think anybody is going to do. If we can get to the point where clinical data is more freely flows — or data liberación in the words of Todd Park — these services might start to gain more traction. In this area I think of Microsoft HealthVault, which has gone beyond direct-to-consumer and is now integrating with provider organizations like Mayo. HealthVault offers mobile PHR access via third party apps (here and here). One of the main advantages of these PHRs is that patients own the data and control who has access to it.

I actually think the most interesting offerings in this area are not really integrated into clinical data at all. These include services like Fitbit and LoseIt!, which I mentioned above, as well as the many other health and fitness services like MapMyRun, Nike+, Runkeeper, MyFitnessPal, Withings, and Wahoo. These services were created based on value-add services, not clinical data, making development and design a lot easier overall. They also have more user feedback and have more mature products than the standalone PHRs/PHPs. I’m anxious to see these services integrate with clinical data from provider systems, which I think will create a much more valuable service.

Data models / frameworks. I wasn’t really sure where to put Indivo, but I felt like I had to include it. Indivo is an open source personal health platform. I’m don’t know what organizations or vendors are using it.

The most recent numbers I’ve read are about 10% of the US population has a PHR.

With so many different points of distribution, it will be interesting to see if all these PHPs play nice together. I’ve used HealthVault, Google Health (before it died), Kaiser’s portal (I think it’s a custom version of MyChart), and several of the fitness-type apps (Runkeeper, LoseIt!, MyFitnessPal, Nike+, MapMyRun). Kaiser I liked mostly for setting appointments and dumping vaccine records. HealthVault and Google I could never get into because they always seemed like so much work. I use Nike+ regularly for running, but I think it’s a real stretch to call that a PHP.

What do you use and do you like it?

TGphoto
Travis Good is an MD/MBA involved with health IT startups. More about me.

  • Christopher Wasden

    you should check out the new Withings app that is now providing integration with multiple devices to show four dimensions of PHR. In addition, iTriage has emerged as a viable PHR as well and has 7 million downloads and millions of active users.

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