Is the PHR the Solution for Information Therapy?


More than a decade ago, Kaiser Permanente gave all its members a copy of the Healthwise Handbook and demonstrated that it reduced utilization. The goal of information therapy (Ix) is the right information being delivered to a patient at the right time. Last year the Center for Information Therapy, incubated by Healthwise, became formally independent. Its president, Joshua Seidman, suggests that Ix is going through three main stages.

First, information is given out, but no record is kept. Then tracking of the Ix is kept in the patient chart. In the third stage, patients go online to get information personalized for them, so organizations can "track whether the Ix was 'filled.'"

Ix, in part driven by the consumerism movement, is being touted as a way to improve the relatively low levels of compliance with basic health guidelines, such as patients with high cholesterol but not taking statins. Patients are more likely to react to information that's tightly integrated with information about their specific care. The personal health record (PHR) is an obvious venue for that information.

One organization that is wrapping information around the patient's view of their own data is the Cleveland Clinic. Some 25 percent of its primary care patients have registered to use its MyChart PHR. Patients can access information from the Clinic's Epic EMR, including messages from their physicians, lab results, and information written by its staff -- all specially selected for them by their physician. Click on a lab value, and it will open a separate window with information about the meaning of the test result. Additionally, gender-, age-, and disease-specific alerts are made available to patients in the PHR. Patients tell Holly Miller, M.D., MyChart's managing director, that "having this information at their fingertips makes them feel empowered."

But, of course, most patients don't get care at a Cleveland Clinic or a Group Health in Seattle, which has a similar system. Seidman thinks that the movement is also poised for take off among insurers and other providers. J.D. Kleinke, chairman of the Omnimedix Institute, suggests that "it won't be tomorrow" but that within three to five years a broad-based PHR will emerge that will be able to take information from multiple sources, and that the "PHR will become the place where the information silos break down. It will take the separate streams with your pharmacy data, your lab data, your medical data, combine it, and do some data mining." Kleinke foresees an e-mail alert sent to patient and doctor suggesting care programs, with information layered over that. "That will be the real killer app for the PHR, not some claims viewer." Given that hardly any Americans have a PHR as yet, that killer app is desperately needed.
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