February 14, 2008 By Chad Vander Veen
Sometimes technology is as much a problem as it is a solution. In the health-care industry, electronic health records (EHRs) are causing plenty of headaches because of a lack of standards and disagreement on best practices. EHRs offer another opportunity to improve medicine, from neighborhood private practices to huge government organizations. But the promise comes with a curse familiar to other helpful technologies: People disagree about how exactly to implement electronic health records.
Interoperability and standards issues have stalled progress toward the goal of seamlessly integrated health IT. However, personal health records (PHRs) could fill some of the gap as the nation waits for Congress and the health-care industry to lead a unified effort.
PHRs are nothing more than digital versions of a file folder filled with a patient's health records, and are designed to let people be guardians of their own health information. Now, industry heavyweights such as Microsoft and Google are creating simplified services that might make it easier for citizens to collect and keep those records. Microsoft says its HealthVault PHR system already works with dozens of existing, stand-alone hospital EHRs, giving patients an online repository for electronic health information that is ready to use.
Developments such as HealthVault may spur quicker adoption of industrywide standards and best practices. In the meantime, they offer a Band-Aid for citizens frustrated with the health-care industry's inability to solve the problem on its own.
PHRs are, in effect, the antitheses of EHRs, which are systems that health-care providers build to electronically manage patient information. The U.S. Department of Veterans Affairs (VA), for example, has a huge and often-praised EHR system called VistA. The system manages the electronic health records of millions of veterans across hundreds of locations. Currently it's only compatible within the VA system, though work is being done to expand VistA's capabilities. It is the kind of health records management system the industry and patients desperately want to interoperate.
On the other hand, PHRs are software applications that allow individuals to store and share their own health information. A PHR can be as simple as a Microsoft Word document, or like HealthVault, a Web site for users to securely upload, store and share their health records.
The Internet has been abuzz lately with rumors of a Google PHR tool in the making. Although Google was contacted to discuss its rumored project called Google Health, company representatives offered only links to the official Google Blog. There are, however, interesting tidbits to be discovered here. In June 2007, Google announced the creation of the Google Health Advisory Council to help the company "better understand the problems consumers and providers face every day and offer feedback on product ideas and development" for managing health records.
The Google Blog also publishes a numerous entries written by high-level employees who hint at what Google Health might feature.
"We believe that patients should control and own their own health information, and should be able to do so easily," wrote Adam Bosworth, former vice president of engineering for Google. "Today it is much too difficult to get access to one's health records, for example, because of the substantial administrative obstacles people have to go through and the many places they have to go to collect it all. Compare this to financial information, which is much more available from the various institutions that help manage your financial 'health.' We believe our industry should help solve this problem."
According to an Aug. 14, 2007, New York Times article, Google has demonstrated a prototype of Google Health to a select number of health-care industry professionals. Since then, the company has offered few details regarding when, or if, the product will go live.
This Digital Communities white paper highlights discussions with IT officials in four counties that have adopted shared services models. Our aim was to learn about the obstacles these governments have faced when it comes to shared services and what it takes to overcome those roadblocks. We also spoke with several members of the IT industry who have thought long and hard about these issues. The paper offers some best practices for shared government-to-government services, but also points out challenges that government and industry still must overcome before this model gains widespread adoption.