Personal Health Records--Who Are the Key PHR Providers and How Are They Handling Laboratory Results?

Several significant events have driven public andpossible source of revenue, few companies
industry interest in personal health records. Inindicate they are currently selling
2004, President George W. Bush outlined a plannon-user-identified health data to researchers or
for the implementation of an electronic healthpharmaceutical companies.
record that could be accessed by all Americans.4. Increased Service. Healthcare providers, in
Although numerous companies had been in thisgeneral, acknowledge that their personal health
market for several years, the announcementrecord systems are just part of the service and
provided impetus for growth in this area. In 2007a happy client will remain with the system. Google
and early 2008, computer giants Google andHealth indicates they aren't in the healthcare
Microsoft announced their intentions to enter intobusiness and part of their mission is to drive users
this market, Google with Google Health andto Google.
Microsoft with Microsoft HealthVault.5. Subcontracting and licensing. MedCommons is
In March of 2008, laboratory industry leaderfocusing on providing their services and platform
Quest Diagnostics announced a partnership withtechnology for other users and companies that
Google Health to provide uploading of laboratorymight want to deliver personal health records. It's
testing to Google's version of a personal healthnot clear if Microsoft HealthVault plans to enter
record (PHR).the market in this fashion, but many industry
The U.S. Department of Health and Humansources suggest it's likely.
Services cites six positive outcomes with theUltimately, what is clear from looking at a
implementation of widespread personal and/orcross-section of PHR providers is that there are a
electronic health records.number of approaches to dealing with laboratory
1. Improved healthcare qualityresults depending on the nature of the PHR.
2. Prevention of medical errorsGoogle Health has recently announced a
3. Reduction of healthcare costspartnership with Quest Diagnostics.
4. Increased administrative efficienciesThis is likely to be the first in a number of similar
5. Decreased paperworkrelationships with other laboratory corporations.
6. Expanded access to affordable healthcareThe real question, one that remains unaddressed
Although there are a number of potential barriersyet, is whether competing labs will create
to widespread implementation of personal healthpartnerships with Google Health and other PHRs
records, three are the most significant. They are:or whether it will become an exclusive and
1. Interoperability. The various systems need tocompetitive marketplace, where some PHRs will
be able to interact with each other and variousfind their services locked out of the market.
computer systems.Another potential question is whether or not a
2. Privacy and Security. The systems need tolaboratory, independent or affiliated with a
provide HIPAA-like compliance, but also haveparticular healthcare provider, is going to be able
security measures similar to the banking industryto provide data uploads to a myriad of different
and in compliance with a variety of industryPHRs. Although largely a technical issue, it's hard to
standards.see how a laboratory needing to provide results
3. Data Modification. In order for physicians to beto twenty or thirty different PHRs in addition to
able to act on medical information, they will needrequesting physicians and patients, is going to
to be confident of the veracity of the medicalmake laboratory medicine more efficient or
data. This will at least partly require that they becost-effective.
able to determine the sources and modificationsPHRs Gain Momentum
that have occurred to the information in personalIn his January 20, 2004, State of the Union
health records.Address, President George W. Bush outlined a plan
Although there are a number of companiesfor the implementation of an electronic health
currently in the marketplace offering personalrecord that could be accessed by all Americans.
health records, they fall into four broad categories.The system was to be in place by 2015.
1. Standalones. These companies are primarilyAccording to the White House Web site, patient
personal health record companies, such asparticipation would be voluntarily, and "these
LifeOnKey or FollowMe. In some cases theseelectronic health records will be designed to share
companies also specialize or have specialtyinformation privately and securely among and
subcategories, such as MiVia, which was designedbetween health care providers when authorized
for the migrant farmworker population, orby the patient."
LifeOnKey's Diabetes focus or Women's HealthTo achieve that goal, the following steps were
focus.taken:
2. Spin-Offs of Information Technology or1. Health Information Standards were adopted.
Software Companies. Most notable in thisUnder the direction of the Department of Health
category are Google Health and Microsoftand Human Services, in cooperation with other
HealthVault.Federal agencies and the private sector, voluntary
3. Healthcare Providers. Examples of this arestandards were to be identified and endorsed.
Partners HealthCare's Patient Gateway and the2. Health Care Information Technology
Group Health Cooperative's MyGroupHealth.Demonstration Project funding was increased to
4. Platform Providers. In some cases, the$100 million.
companies are focused less on being the patient3. Federal agencies were encouraged to adopt
consumer's personal health record, than inHealth Information Technology.
providing the platform and/or technology for4. A sub-cabinet level position of National Health
personal health records. MedCommons is anInformation Technology Coordinator was created.
example of this. Microsoft HealthVault may alsoThis falls under the Office of the National
fall into this category. FollowMe also is willing toCoordinator for Health Information Technology,
customize their product for other companies,part of the Department of Health and Human
which then provide their own branding.Services.
There are five ways personal health recordIt's important to note that the Bush
providers are generating revenue.Administration's proposal did not break new
1. Subscriptions. Typically, standalone PHRground. Numerous companies providing personal
providers charge nominal annual subscription rateshealth records (PHR), medical health records, and
ranging from about $25 to $50.electronic health records or some way of storing
2. Advertising. Google Health and Microsoftand delivering medical information electronically
HealthVault indicate they will generate income viawere in existence for several years prior to the
advertising. It's not yet clear how MicrosoftBush Administration's efforts.
intends to do this, but Google Health has indicatedThe announcement of launches into the health
that their product itself will not contain advertising,information technology (HIT) arena by Google and
but will have search boxes that connect to theMicrosoft has renewed media interest in the area,
traditional Google page, which does have targetedand may signal a renewed velocity and vigor to
advertising.the market.
3. Data mining. Although often mentioned as a