A lot has changed between now and 2004, when health IT company VisionTree developed its first patient portal to be used for research data collection. In terms of providers, some early adopters had implemented patient access to electronic medical records, but nowhere near the half of U.S. providers who use them today.
VisionTree founder and CEO Martin Pellinat has witness the changes in health IT adoption over the last decade from the top seat at the company. He talked with MedCity News about how IT adoption has changed, what the future holds for EMR-related technologies, and how IT fits into the patient-centered care model.
Where does VisionTree fit into the greater scope of EMRs and Meaningful Use, and what does your technology allows hospitals and doctors to do?
Some of the technologies out there are very defined, like you’ve got an EMR which more than likely is software stored on a server, and then you have these patient engagement tools around wellness, etc. We kind of sit as a bridge between the two. We’re just two measures short of becoming a complete EHR and have quite a few modular Meaningful Use certifications.
We’re cloud-based and patient-centered, and we allow you to configure your system for connectivity across disparate systems. The patient can set permission through their portal to give access to different parts of their record for different providers. That is, we believe, where the future is headed, and that’s the kind of day-to-day implementation that we’re serving. We don’t market ourselves first and foremost as a PHR, but we’re really evolving into that because of all the discrete data we’re managing and collecting that’s patient-centered.
Beyond that, we have several registries that are using us, [...] we’ve got RTOG, which is the research arm of the NCI, using us for several national, multi-center research initiatives, and they’re all using our patient portal. So it’s kind of like the patient is being introduced to filling out discrete electronic data at different stages of their health history. We’re working right now with UCLA around a sports concussion program being introduced at the high school level.
Providers have come a long way in implementing EMRs, but I still sense some resistance. What are the big issues you’re seeing?
As simply an EMR, you may run into the obstacles of adoption where the doctor’s office, the cancer center or the hospital is still relying on paper. You’re handing the patient a clipboard of forms to fill out, and that stack of paper is unfortunately being handed to the patient every time they go into every new doctor’s office. So you have this dichotomy of, yeah the system is moving to EHRs, but patients are still filling out information on paper until its keyed in or it’s scanned in, and then the data isn’t minable or exchangeable.
Now that we’re seeing lots of applications that build onto EMRs, how are hospitals and doctors’ offices going to manage the implementation of all of this new technology? Will we see consolidation in the market?
You’re always going to have the large EMR solutions that have dominated an entire hospital system, but what they’re still not necessarily serving is a given community, which might consist of doctors that all refer to each other but might be using different EMRs. So the consolidation in that regard won’t happen until you’ve got some kind of solution, it would need to be web- or cloud-based, that could sit as a middleware layer between the systems and provide roles and permissions to send and receive data in a very clean way.
I think the future leans toward service-oriented architecture that’s modular with a web services approach that uses the internet to exchange data securely, and does it in a modular way through APIs. So any company that can take their technology, publish an API, do it in a modular way and use web services is going to be a connector in the ecosystem. I do think other technologies that are more siloed and don’t have APIs or don’t provide interoperability may go by the wayside and may be squashed through other forms of consolidation.
The PHR market has been a bit tricky. How has adoption changed over the past few years?
We do see it changing. In 10 years, we’re going to see that our society will be holding onto portable and personal health records because it’s just a natural part of the evolution. Today, a PHR is just as standalone as an EMR if it’s not interoperable and is not introduced to the patient at the time of care. We believe it’s the provider-patient relationship that’s going to foster adoption. So if the doctor has a system that has a web-based patient portal that’s also interoperable as a PHR, that would introduce the patient initially to the concept. One of our guiding principles is to be a trusted source where you don’t have to worry about your data being sold to advertising or to other companies for marketing or research. It starts with the doctor, engages the patient and then allows the patient to hold onto their record that they start to build themselves and share that data long-term.
Any other noteworthy trends you’re seeing in EMRs or PHRs?
What we’re seeing starting to happen is that the trend is going quickly toward integrating what had been data collection for research purposes and actually converting that to quality data – being able to collect patient-reported outcomes and integrating it into clinical care. (That) will start to be used for actual clinical decision-making and be used remotely, so you don’t necessarily have to be in touch with the patient as long as they’re engaged and communicating their information through the portal.