Tech Talk: Personal Health Records: A Failed Revolution

June 7, 2010
Jonathan Bertman, MD

MDNG Primary Care, May 2010, Volume 11, Issue 5

The recent announcement that Revolution Health was discontinuing its PHR service should not have surprise anybody who has been paying attention to this market. Patients have been apathetic at best to this technology, and physicians have wisely steered clear out of concerns over time, reimbursement, and liability issues.

My kids might not believe this, but I’ve never been a particular fan of the phrase “I told you so.” Probably because it’s used mostly by people who are more concerned with thumping their own chests than with imparting any valuable wisdom that could be gained from the fact that they were actually proven right over the course of time. But in the wake of the recent announcement that Revolution Health is “discontinuing (its PHR) service," and the continued struggles of Microsoft and Google to launch their own PHR products, all I can say is... sorry... I told you so.

Back in the spring of 2008, when Revolution Health, along with Microsoft and Google, was ramping up its efforts to jump into the PHR game, I greeted the news with a gigantic raised eyebrow. While much of the media were fawning over the new services, I was, as it turns out, justifiably skeptical.

Part of the problem is that consumers (aka, our patients) have simply not shown much interest in using PHRs. Google and Microsoft may point to surveys that say 78% of US adults want PHRs, and even 26% are willing to pay for them, but wanting them and spending the time it takes to actually create them are two entirely different things. If you don’t believe me, just ask the folks over at Revolution Health, whose “revolution” has gone belly up thanks to the disinterest of the public at large.

In fairness, Microsoft has made strides recently toward making HealthVault more accessible and user-friendly, but even this progress doesn’t address my biggest concern with the current state of PHRs: the real cost in time, energy, and legal risk to physicians who would be responsible for knowing what’s inside the patient’s PHR.

My feelings today remain as strong on the subject as they were two years ago. It’s not that I don’t see a future for people having and keeping their own health records; I just refuse to be a part of it until a reasonable compensation plan is determined that makes it worth my time, energy, and medico-legal liability.

My fear is that physicians who know of the existence of a patient’s PHR will be liable if information appears within it that the physician didn’t recognize and/or act on. Let’s say, for example, the PHR notes a complaint of chest pressure (perhaps related to congestion from a recent cold), or some history of a potential cardiac issue that the patient has never spent time discussing during an actual visit. Simply put, the physician will end up screwed if that patient happens to have a heart attack at some point in the future. Of course, the patient is screwed too, but a malpractice lawyer will make this appear to be the physician’s fault‑‑ something that could have been avoided had the physician followed up or adequately addressed the information “clearly provided within the PHR.”

Without adequate compensation for this very real risk, let alone reasonable compensation for whatever time is spent evaluating the issue, physicians will be placed in a very precarious position where PHRs are concerned. Don’t forget we’re already forced to squeeze in more patients in less time just to pay our ever-expanding overhead. Imagine if we now have to start reviewing PHRs in the course of our day? Insurance companies will do what they have done time and time again: consider it “standard care” and say this is part of what they already pay through reimbursements of E&M codes. Spending the appropriate amount of time to adequately review and understand a patient’s PHR requires adequate compensation beyond current office visit codes.

So, while I firmly believe that healthcare will someday certainly include PHRs, for the time being, physicians should adamantly refuse to be cajoled or drawn into being involved with any part of them without a clear understanding of how our time and energy will be compensated. If we do start working with PHRs before the system is fixed, I may be forced to utter another “I told you so” somewhere down the line.

Trust me, that would bring me no pleasure.