I do think a "centralized" data repository is a bad idea, but I don't think it is where this thing is going:

ATMs and PHRs

It really doesn't have to be scary.  The misinformed reaction of Consumer Reports highlights the danger of a banding together of citizens in a cause that has wrong information.

Rob

Augusta, GA

For other writings, check out

http://robsoddblog.blogspot.com/

I agree that we should avoid the centralized approach, but if you look at the typical RHIO model (like that in Indianapolis), there is no centralized data warehouse, just a web of connectivity between hospitals, physicians, pharmacies, and other ancillaries.  I doubt that the culture in the US would permit such a centralized database (we are generally distrustful of government, as opposed to the Europeans who view the government as a good thing in general).

As far as federal funding, the decisions by CMS usually lead the way for changes by the private payors.  DOQ-IT is wholey funded by CMS and is working to get IT adoption and improvment that would benefit all payors, not just Medicare.  I think the savings would be enough that CMS may be willing to underwrite the lion's share of the NHIN.  That has been my impression up to this point.  Maybe I am wrong.

Rob

Augusta, GA

For other writings, check out

http://robsoddblog.blogspot.com/

I think consumers ought to be concerned about privacy and make a stink, if nothing else but to keep software vendors and regulators on their toes. For example, while strong encryption (e.g., 256-bit AES) is adequate to protect patient records now, technology increase in power all the time and at some point in the future it will be able to hack them with brute force. This means encryption methods must continually evolve. Identity theft through social engineering and “inside threats” are also worthy of concern. But the potential gains from use of HIT, imo, outweigh immediate dangers, especially <i>if</i> the HIT tools are useful in helping radically improve care and control costs.

Unfortunately, this is a big IF.

The potential gains from the exchange of data between physicians are obvious, as well as the use of a good EMR/EHR to improve record-keeping and help avoid errors and omissions, as well as a good CPOE to validate prescriptions, etc.

And ideal PHR would:

• Give patients easy access to their health records
• Offer a convenient way for patients to enter information into their EHR for use by their providers, or to another care giver in case of an emergency
• Enable patients to authorize and restrict access to particular practitioners for specific pieces of information in their EHR
• Provide interactive patient education to help them better understand medical conditions and medications
• Help them carry out home-monitoring and self-testing can improve control of chronic conditions, such as such as cholesterol results and blood pressure readings.

This, however, requires going well beyond they typical PHR on the market.

But the biggest potential benefits of HIT, I argue, are barely being discussed: Providing diagnostic and evidence-based treatment decision-support, plan of care coordination and execution management, automated outcomes research, knowledge management, and integrated biosurveillance. These HIT tools would help transform the practice of medicine.

My concern is that we’ll spend tons of money on basic data transmission tools enabling modest gains (at best) in efficiency and effectiveness, and then say we’ve done enough. I know we have to start somewhere, and basic EHR/EMR/PHR/CPOE tools is a good beginning, but we should procede with a clear view of the picture and convincing “business case” to guide our efforts lest we get complacent or distracted.

To see a vision of what is possible in the near future, if we have our priorities straight, take a look at this series of scenarios, starting with this one.

Steve Beller, Ph.D.
http://curinghealthcare.blogspot.com

Most PHR solutions are focused on institutional needs, rather than those of the patient.

Of the list that was published in this thread (easy access, on-going self care, restricted access, etc) there are some solutions that are indeed patient-need focused.

Take a look at our PHR, for instance - HealthFrame (www.HealthFrame.com) and think from a patient's perspective:

- Patient controls content (ability to import electronic content if desired)

- Patient can filter/customize what is exported to providers' systems (electronically and in the form of physical reports)

- Patient can create custom graphs to track self-monitored data (cholesterol, blood glucose, weight, etc) - even overlaying correlated data in a single graph

- Patient can export to iPod Notes (visibile in the iPod screen and navigable via iPod wheel), USB, etc

Bottom line is that there are patient aware solutions out there that can interoperate with provider systems over secure web transmission, under the control of the patient.

We need RHIOs to be configured to support web-service enabled communications with truly patient-controlled systems - which btw we support too...