Health IT, Startups

What’s the key to solving the PHR conundrum?

As the healthcare landscape continues to shift, with more drugstores using alliances to reshape themselves as healthcare providers, personal health record startups such as PHR Plus may succeed where others have stumbled.

A personal health record is a good idea in theory but historically has been beset by many challenges in practice.

From the need to keep the information accurate and up-to-date to a to the conviction by many investors that PHR vendors lack an effective business model to generate revenue, there are myriad challenges to overcome. Bad headlines have also given PHRs an aura of doom — think of the failure of Google Health and smaller companies such as Cognovant.

However, a shifting healthcare landscape where drugstore retailers are providing more healthcare services, demonstrated by CVS Health’s push to acquire Aetna and the new partnership between Walgreens and health system NewYork-Presbyterian, could provide a more logical framework for PHR adoption. Further, a new generation of digital health companies integrating blockchain — the software used to support Bitcoin trading — to better secure sensitive patient health data and using APIs to support automation in order to sidestep the issue of patients updating their own records could create more confidence in PHRs.

Aside from the pharmacy- payer/provider collaborations, another development on the consumer side could indicate a renewed interest in this digital health subsector —Apple’s acquisition of PHR vendor Gliimpse last year. In a recent interview with CNBC, Apple COO Jeff Williams suggested that Apple was working towards a way to integrate data from electronic health records onto its smartwatches, noting that everyone should be able to have their health information.

“We think the right place for the health information to exist is with the person on their device,” he said. “And we believe from a privacy standpoint, that where that information gets shared should be — should be completely up to the individual…And so we view that as the future.”

Another notable tech brand in the PHR business is Microsoft HealthVault. Although it is frequently derided, the Microsoft unit hasn’t given up the ghost yet.

As the industry moves to build a new generation of PHRs, it’s worth looking at why previous PHR efforts have failed.

Chilmark Research’s obituary on Google Health concluded that buy-in is needed from physicians and consumers but neither of these stakeholders believed large consumer technology companies could be trusted with sensitive patient information. The comments on that report were just as damning with some observing that the lack of value proposition was a stumbling block. If doctors doubt the veracity of information entered by patients, it would undermine their support of the system.

For Cognovant, the problem was it couldn’t generate enough interest to raise a Series A. Its model was married to the widespread adoption of Meaningful Use Stage 2, which required providers to engage patients in their own care. The requirement was delayed and that impacted the company’s business model.

Compared with the U.S., personal health records are far more common and widely used in India and across Europe. Abhishek Sharma is an investor with Nexus Venture Partners, which targets investments in the U.S. and India. He noted in an email that what makes PHRs so compelling and challenging is that they are designed to enable us to decentralize data ownership as opposed to the current system of centralized, fragmented data protected guarded by gatekeepers such as hospitals and electronic health record vendors. PHRs rely on users keeping them up to date. More often than not, they are misplaced or lost and so become episodic rather than chronological. No real progress has been made in interoperability, which also undermines PHR adoption.

“In the U.S., lack of EHR interoperability and data lying in disparate systems have hindered building a longitudinal medical history of patients,” Sharma said. “Patient portals are trying to be pseudo-PHRs but are limiting for the same reasons.”

Mesa, Arizona-based health IT startup PHR Plus may succeed where others have stumbled. The company’s CEO and Cofounder, Kyle Anderson, believes that starting point for PHR Plus personal health record data is with patient portals, and the company appears to be taking a more practical and realistic approach to PHRs compared with predecessors.

These records are not intended to be a mirror image of electronic health records but include the kind of critical information a healthcare professional needs to treat patients effectively. Food allergies, prescription medications, pre-existing conditions, vaccines are the kinds of data a physician could use to avoid mistreating a patient and putting their health in jeopardy. It is also the kind of basic information that most people could accept would be useful to have when they need it.

Anderson said the business can sync data in real time from Epic MyChart, Cerner’s patient portal, athenahealth, and others through an API.

“If I’m going to a doctor at Sanford Health, the VA, and the Mayo Clinic, all of those records can sync into one PHR Plus account,” he explained. “We are compatible with over 60 percent of the hospital system patient portals, but right now this is the only way we get data from hospitals.”

Anderson noted that aside from hospitals, other critical partners for PHR Plus in the future include retail pharmacies and some pharma companies. He is also excited about the future of his company, especially in light of the unexpected move by CVS Health to acquire Aetna. 

“If that deal goes through it could create a huge need for our platform. The mega company would have a financial incentive to keep individuals healthy AND coming back to their pharmacy —these are both needs we can help them address,” he declared.

Anderson also sees the relevance for PHRs with corporate wellness programs. The company is not only working with employers and insurance companies directly but it is also building a partnership/reseller channel with other technology and service companies that target the employer and insurance sectors.

As we have tried to find product-market fit, we decided we really need to be part of a wellness program. We can use this info to help people live a healthier lifestyle,” Anderson said.

Australian insurance company, OnePath, a subsidiary of the Australia and New Zealand Banking Group, is a pilot partner for PHR Plus and is working with the vendor to create new insurance products for its members.

Usability and navigation have been important concerns for the company as it has worked with focus groups for different demographics and rightfully so. If electronic medical record vendors had made more concerted efforts to work with physicians to make them as user-friendly as possible from the beginning, perhaps clinicians would find it easier to work with them.

Looking ahead to next year, Anderson said his business is gearing up to launch an updated version of its product, which will include targeted educational content in the form of healthy recipes and condition-specific articles. People with a heart condition, for example, would receive heart-healthy recipes and tips to exercise on the go. PHR Plus is working with ConnectWell and the University of California, Berkeley School of Public Health to develop this content.

Not everyone is convinced about the usefulness of PHRs.

Dr. Bob Kocher, a partner with venture capital firm Venrock, is one of them but he highlighted some of the critical ingredients that could make personal health records work.

“What matters is getting the important pieces of data and having an index of all the places where data exists so it can be gathered if it is needed someday,” said Kocher in an email. “It is not hard to have an index of where your data exists — what is hard and very contentious is having some company aggregate [it] and then charge you for all of your data.”

Another skeptical VC — Stephen Kraus, a partner with Bessemer Venture Partners — noted that it would be useful to add a health education content component to a personal health record.

In a phone interview, he said that aligning content and advertising to a specific patient profile seems like a good idea to generate advertising revenue from healthcare organizations that want to market to certain patient profiles. With advances in blockchain technology the ability to protect personal health record data becomes more manageable, he believes.

Despite the potential, PHR vendors face an uphill challenge. They have to create a secure system with equal appeal to patients and physicians and a business model that generates revenue and can scale easily.

It’s no mean task.

Illustration: sam_ding, Getty Images

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