While HITECH doesn’t specifically set aside funds for PHRs, it includes expanded provisions for protecting patient health data, prohibiting its sale without consumer consent, and requiring physicians to provide patients an accounting of disclosures made through EHRs. All of those provisions are designed to empower and protect the consumer, and should create new demand for security and identity management tools aimed at the healthcare market.
Google and Microsoft are obviously betting on privacy issues being addressed. Joining established PHR providers like WebMD and Dossia, Microsoft entered the market back in 2007 with its HealthVault product. The product is aimed not at the consumer but at the healthcare community; respected hospitals like Cleveland Clinic have partnered with Microsoft to offer HealthVault solutions to patients. Dody says, "With HealthVault, Microsoft is really building a connected platform, signing up healthcare providers and HIT vendors to promote interoperability."
Google launched Google Health in 2008. It provides a free interface for patients to build online health profiles, share health records with providers, and import medical records from their list of "Google Health Partners." Given its consumer-forward approach, Google’s challenge now is to push for interoperability and expand partnerships with hospitals, clinics and other healthcare players.
But playing in the HIT world means facing a different regulatory environment than most high-tech vendors are accustomed to. For its part, Google disagrees that it is affected by the HITECH provision expanding HIPAA rules to business associates of covered entities. As Google Health’s Privacy page states, "Unlike a doctor or health plan, Google Health is not regulated by the Health Insurance Portability and Accountability Act (HIPAA) … This is because Google does not store data on behalf of healthcare providers. Instead, our primary relationship is with you, the user." Expect HHS to push back on that position as more consumers adopt PHRs.
Another area where consumers are taking control of the conversation around medical care is through use of social media tools. Sites like PatientsLikeMe and CarePages enable patients to compare symptoms, learn about treatment alternatives, and get support and empathy from others with the same diagnosis. James Heywood, co-founder and chairman of PatientsLikeMe, says transparency is a major factor in the success of the site, which has 10 percent of newly diagnosed ALS and multiple sclerosis patients joining each month.
"The fact is that people will share private information on a site where someone is honest with them about how it will be used," Heywood adds. He believes that such sites raise the bar on transparency expectations for other HIT providers.
While not specifically carved out under HITECH, the use of mobile devices to deliver real-time point of care information to physicians is sure to benefit from increased funding of HIT. As mobile devices get more powerful, applications are proliferating to provide on-site clinical decision support to medical professionals.
"There is a merging of medical applications, mobile technology and innovative home-based biometric devices which will facilitate care taking place outside the traditional healthcare setting," says John Moore, managing partner with Chilmark Research, a healthcare-centric industry analyst firm. "A typical doctor’s visit is 10 minutes long; the challenge is how vendors can present rich information within that time frame."
Companies like Epocrates and Skyscape provide decision support tools and drug updates, journal summaries, clinical trial results and other up-to-the-minute information to iPhones, Palms and Blackberries. One such application from Epocrates enables doctors to input physical characteristics of a pill (color, shape, imprint) described by a patient who can’t remember the name of a medication; within a few keystrokes, the doctor can pull up a list of matches, read the monographs and show images of the pills to the patient to confirm the prescription.
Of course, the ultimate measure of success for HITECH will not be in the number of EHRs and PHRs in use by 2012, or by the number of mobile decision support tools available on a Smartphone. Those are easier, but ultimately less important, to measure. "HHS is paying for utilization, but what it should be paying for is the value that comes from utilization," Heywood says. Improvements in quality of healthcare, the efficiency of how it’s delivered and the health of the overall population are really the only HITECH measures that matter.
Companies mentioned in this article