The Partners Healthcare pseudo-analyst firm, CITL has just released a monster report on the potential value of PHRs. At 144 pages, it is imposing, but don’t let the page count fool you as the Executive Summary will serve just fine for the majority of readers. Report was sponsored by Google, ICW, Kaiser-Permanente and Microsoft.
Did a summary review of the report and walk away with the following impressions.
What I Liked:
Some interesting financial models on the potential benefits of fairly common transactional activities (e.g., appointment scheduling, Rx refills, eVsits, medication mgmt, etc.) that PHR usage supports. Look for these in the next PowerPoint presentation from a PHR vendor or other like pundit like myself.
Good overview on what a PHR is and potential value to providers and payers.
Excellent literature review & references.
What I had Trouble With:
For the cost/benefit analysis, CITL proposed a scenario of 80% user adoption within 10 years that will generate $19B in annual savings. 80% adoption? $19B is savings? What are they smoking over there? PHR adoption today sits at 3-6% nationwide and with the current state of broader HIT adoption, will remain low until we get some data liquidity – an extremely tough nut to crack. Even if we get good data liquidity as represented in such examples as Kaiser where they have done a fabulous job rolling-out their PHR to customers, adoption is still only at 30% by the end of 2008. Simply put, we are unlikely to ever see 80%, unless of course there is a complete overhaul of the US healthcare system. But, hey, if we scale it back to 40% adoption, will that equate to $9.5B in savings? That is still a very respectable number and 40% is obtainable.
While report appears comprehensive a deeper look reveals a pretty big hole, no analysis on value proposition for employers. The employer market is one of the biggest markets for PHRs and was completely ignored in this report. This omission calls the complete report into question.
Report has an odd perspective that almost always references the “patient” and not the “consumer”. Get a clue folks, it is becoming a consumer-driven market (whether healthcare providers like it or not) and the reference to patients is outdated and frankly, paternal.
Another oddity was the reference to four distinct PHR architectures; provider-tethered, payer-tethered, third party and interoperable PHRs. What tripped me up here was the reference to interoperable PHRs which I initially, and wrongly assumed to mean those PHRs in the market today that use common standards such as CCR & CCD. No, couldn’t have been more wrong – they do not see those PHRs or even the platforms from Google, Microsoft and Dossia as interoperable. Huh? For CITL, interoperable PHRs, for which they lay the biggest beneficiaries of wide-spread adoption upon are in fact RHIOs. So how did they get there (all the big benefit numbers) when time and again we are seeing RHIOs fail left and right and most still are living hand-to-mouth from government grants? And why leave third party PHRs that support standards out of the interoperable category? A serious misstep here.
Wrap-up:
Good to see some of the major players in the market support a study of this magnitude. Also good to see some serious attention paid to the potential benefits of PHRs. It is just unfortunate that the net result is a report with some fairly large omissions, questionable assumptions and subsequently some grossly inflated benefit projections. Reminds me of the all too common market reports I would read during the dot-com days. Big projections, outstanding growth, huge numbers, everyone on the bandwagon that ultimately went over the cliff of reality.
Yes, there are (or can be) some major benefits from the adoption and use of PHRs but those benefits need to be tempered with a healthcare system that has a multitude of issues to address and frankly a consumer that rarely does anything with regard to their health until they need to.
A broader view needs to be taken, something that Microsoft has already hit upon, and in some respects consumers downloading health & fitness apps off the iPhone AppStore are already doing. It’s about whole health & wellness management, not episodic healthcare management. That is where the long-term growth, adoption and value is, not in the limited payer/provider perspective represented in this report.
Maybe it’s time we get rid of the PHR acronym and indeed take a broader view that supports what the consumer ultimately wants.
Addendum:
Rich Elmore has a more positive vew of the report with a some report figures thrown in which you will find over on his blog.
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