The Key to PHR Success Isn't What You Think

Kathryn Mackenzie, for HealthLeaders Media, November 4, 2008

I attended a town hall meeting recently featuring senior executives from Google and Microsoft, who talked about their respective efforts in the area of personal health records. I expected to hear the usual chatter about why the PHR is good and how it will revolutionize healthcare. While I did hear some of that, I also learned that even the two biggest players in the game know they still have a long way to go before the full potential of the PHR is achieved.

Gaining consumer trust seems to the biggest problem facing both Google Health and Microsoft HealthVault. Despite continued assurances about the security and safety of the information from both companies, it seems some of us aren't quite ready to put our lab results on the Web. Which is somewhat surprising considering all of the personal information most of us already put out there, says Alfred Spector, vice president of research and special initiatives at Google. "We bank online, we join social networking sites, information about you is out there. Both of us (Microsoft and Google) have brand reputations to protect. We have extensive privacy notices in place. What would we gain from not abiding by them?"

Spector says that while Google Health will not advertise based on patient data, resell it, data mine it, or repurpose it in an way, the company will use "generalized" information to offer consumers products they may find useful. Microsoft Health Vault has adopted a similar policy , says Peter Neupert, corporate vice president for the Health Solutions Group at Microsoft Corp.

Notice that Spector said "we" have brand reputations to protect and "we" have privacy notices in place and "we" will abide by them. There was a whole lot of "combined efforts" talk at the meeting, which caught me a little off guard considering how much has been made of the so-called health content war between HealthVault and Google Health. For example, I read a whole host of media reports last week saying Microsoft has pulled ahead in the race to be No. 1, thanks to its newly announced partnership with Connecticut-based health benefits provider Aetna (which, by the way, I found to be a particularly amusing announcement thanks to Aetna CEO Ronald Williams' less-than-flattering comments comments about Google and Microsoft almost exactly a year ago).

But, rather than focusing on competing for what Neupert says is basically a zero market share anyway (based on users), we should be focused on how to improve both products and, more importantly, get consumer buy-in. "Google, Microsoft, Epic, we should all be involved at this point. The more involvement the better; we can worry about competition later. Today, the issue is educating consumers about why this product is valuable to them," he says.

That value is clear and real, not just for the consumer, but for the entire industry, John Halamka, MD, CIO of Harvard Medical School and Beth Israel Deaconess Medical Center told me during a conversation I had with him last week. "Patients should be stewards of their own data. The PHR allows them to have complete control over the flow of that data. This is a very important step toward greater consumer awareness and responsibility," he says.

For the industry as a whole, it's also a good way to address the complex policy and security issues surrounding the dissemination of private medical information. "There are 50 different privacy policies, and they are called states. So if you want to exchange data, even if you have the standards, technology, and architecture, if you don't have policies that allow sharing or allow patient privacy preferences to be adjudicated, then it's tough," says Halamka, who is part of the Google Advisory Council.

Once Google and Microsoft embrace the same set of standards, which they seem set to do, then everybody from health benefits providers to hospitals to pharmacies and labs can send their data to either platform, and the patient decides where it goes from there. "In a perfect world, Google, Microsoft and other major services would develop a sort of 'plug-and-play' interoperability standard that will simplify the process for both patients and IT staff," he says.

The bottom line is that it's going to be the consumer who drives the ultimate success or failure of the PHR. Without their effort, trust, and buy-in, it won't matter how secure or technologically advanced any of the platforms become. That said, I'm thinking that since most of us have already migrated to the online world for a myriad of everyday transactions—travel reservations, shopping, bill paying, even dating—it's easy for me to imagine the management of my healthcare on that list.

Kathryn Mackenzie is technology editor of HealthLeaders magazine. She can be reached at
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