phrs, where we've been, where we're going

04/11/23 Copyright: Chilmark ResearchFor internal use only, not for distribution

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PHRs:

Where We’ve Been, Where We’re Going

By: John Moore, Managing [email protected]

mailto:[email protected]


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Three Take-Aways

Healthcare in Transition & the Move Online Implications

PHRs Today Adoption/Drivers Challenges Successes

PHRs Tomorrow Platforms mHealth Death of PHRs


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Macro Trends Reshaping Healthcare

Growing Consumerism in Healthcare Employee Accountability & Cost Sharing

Out of Pocket Expense Yr’00: $200B, Yr’07: $267B Disintermediation of Care

Retail Clinics, eVisits, MedTourism, Virtual Labs Information Liberation

Traditional: PubMed, Mayo, WebMD Crowd-sourced: Wiki(s), Blogs, Twitter,

Communities Stimulus Bill & Healthcare Reform

Unprecedented $$$ to Digitize Healthcare Comparative Effectiveness


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While Consumers Increasingly Go Online for Health Info…

0% 20% 40% 60% 80% 100%

60+

40-59

18-39

Male Female

Source: Pew Research 200674% of all adults are online

Now One of the Top Activities on the Net


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Few Manage Health Records on Net

Yes30%

No56%

Don’t Know14%

Paper75%

Web-based11%

Specific App4%Desktop App

10%

Source: Forrester Research Q2’08 Surveyn= 5,242

Today, Meager 3.3% iManage PHI


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Three Dominate PHR Models

Direct to Consumer => Manage Records Consumer has Full Control

Consumer self-populates, disconnect Small ISVs with Little Market Influence

CapMed, Medikeeper, PassportMD Payer/Employer Sponsored => Lower MLRs

Consumer has Limited Control Trust issues, portability

Focus on HRAs, Health & Wellness, Disease Mgmt Incentives common to drive adoption

Provider Sponsored => Customer Retention Consumer has Limited Control

Little portability, modest tools, incomplete longitudinal record Present Labs, Meds, Discharge

Facilitate transactional processes


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PHR Adoption is Widely Dispersed

Entity Type No. of Users

PHR Platform

Features

Kaiser-Permanente

Provider 3.0M+ MyChart EMR portal w/email & transaction servicesPortability w/HealthVault

Veteran’s Admin Provider 650K RYO (VistA) EMR portal, Not portable

WebMD ISV 500K WebMD Client defined, claims-based HRA & alerts Rarely portable

Aetna Payer ~780K ActiveHealth Focus on HRA, DM, aggressive build-out Portability

w/HealthVault

United Health Grp Payer ~200K HealthAtoZ Claims-based, part of new OptumHealth Div. Portability w/HealthVault

Cleveland Clinic Provider 100K MyChart Similar to KPPortability w/Google

BIDMC Provider 40K RYO Aging portal w/email Portability w/Google & HealthVault

All Others Mix 2.5M Countless Highly variable, most simple templates Little portability


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PHRs: What Are They Good For?

EMC Adoption: Over 50% of Employees Benefit: Lower MLRs = Lower Healthcare Costs

NET: $50M in 4 years

Kaiser-Permanente Adoption: Over 50% of Members with Internet Access Benefit: Cost Savings via Fewer Office Visits

Indiana University Adoption: Over 40% of Entering Class Benefit: Lower Admin Costs, Student Engagement

All Depends on Who You Ask!


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Top 3 Challenges to Adoption

Data Getting it, Cleansing it,

Sharing it Trust

Privacy & Security Providence

Value Personal Actionable Relevant

Consumer Engagement Begins Here


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“Health Clouds” on the HorizonDat

a Sou

rces

Secure Repository

App

licat

ions

Attributes Potential NotesData Source(s) High Virtually any pertinent data source

Control High Strong consumer control of data

Interoperability High Adoption of Open Systems and standards

Portability Medium Still under development

Tools Very Good Multiple tools/widgets, communications???

Personalization High Farther down the road

Adoption High Perceived value?


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Health is Mobile!

Explosive Growth in Use Over 1B AppStore

Downloads iPhone Rep. 0.7% of

All Internet Traffic Over 30K Apps

Nearly 1.5K are Health Focused

Every Major Mobile OS Now has App Market

And Still Only mHealth1.0

QuickTime™ and a

decompressor

are needed to see this picture.


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Evolution Accelerates PHR Adoption

2008

Gen 3: Data Aggregation (Health Clouds Form)

Gen 4: Personal, Actionable & Mobile

Gen 2: Online & Connected

2011

Gen 1: Isolated

20031992 Time

Use

r V

alu

e P

rop

osi

tion

Adoption

2000(Online)

20

1992

40

80

Users(Millions)

Low

High


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Generation 4: “Convergence”Personal, Actionable, Connected

Value: About Me, By Me, With Me, For Me


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What to Watch

Traction of Platform Plays Data Sources (agreements)

E.g., Cleveland-Google, KP-MS New HIPAA Extensions

Consumer Adoption Sub-group types

Developer Adoption Popular apps/services

Employer Successes Demonstrable ROI

All Things mHealth Smartphones change equation

Biometrics play key role

QuickTime™ and a decompressorare needed to see this picture.


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Looking Into the Future…

Biometric Devices Become a Critical Data Source

HIEs will Serve Citizens as Well Data Liquidity & Quality will

Prove Challenging Meaningful Use Requirement

May Backfire

Biggest Challenge: Sourcing Quality Data


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Final Thoughts…

Time to Ditch PHR Term Consumers NOT Interested in

Digital File Cabinet Personal Health Platforms

(PHP) are Future Personal, Actionable Data

Education Critical What’s in it for me?

Without Consumer Engagement, HIT Adoption may be DOA Stimulus Funding is Not Enough to Move Needle


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The First Wealth is Health-Ralph Waldo Emerson

The Best Way to Predict the Future is to Create it

- Peter Drucker

phrs, where we've been, where we're going

Health & Medicine