Personal Controlled Health Record Infrastructure Conference 2006

Agenda

Summary

PCHRI 2006, the Harvard Medical School Meeting on Personally Controlled Health Record Infrastructure, got off to an amusing start when Kenneth Mandl, M.D., M.P.H., a codirector of one of the CDC’s two Centers of Excellence in Public Health Informatics and an organizer of the conference, began by showing a clip from the TV show Seinfeld in which Elaine visits her doctor and finds she has been labeled “difficult” in her chart. Her repeated attempts to rectify this injustice and get treated for an annoying rash inevitably end in frustration.

The clip, Mandl said, was to “remind everyone why we’re here”: to improve care. But getting to that point — via the reduced medical errors and lowered costs that promise to result from patient-driven e-charts — will require working through many challenges, several of which were illuminated in the morning’s keynote address by John Halamka, M.D., M.S., the chief information officer of both the CareGroup Health System and Harvard Medical School.

In his role as chairman of the Healthcare Information Technology Standards Panel (HITSP), a public-private partnership that includes 206 member organizations under the sponsorship of the American National Standards Institute, Halamka oversees the coordination widely divergent health IT standards as part of a series of ongoing federal healthcare initiatives. Though he detailed numerous challenges at every level — from technical specifications, to how to create a self-sustaining model, to problems with perception on the part of both healthcare professionals and patients — he managed to set an optimistic tone that endured throughout the two-day conference. Barriers can be overcome, he concluded, as long as stakeholders strive not for compromise, in which “everyone is basically unhappy,” but rather for harmonization, which he defined as “everyone is basically achieving ‘good enough.’”

The afternoon began with a panel discussion on PCHRs in clinical care. Jeff Margolis, the CEO of the TriZetto corporation, which provides technology to 330 health plans in the United States, favorably compared highly portable, customer-controlled PHRs with electronic medical records, which are less sharable, and electronic health records, which are more costly to implement. Syed Tirmizi, M.D., and Ginger Price of the Veteran’s Health Administration then discussed that organization’s MyHealtheVet , a gateway to veterans’ health benefits and services that includes Web links, a personal health journal, and online prescription refills. Among the insights Tirmizi and Price provided are that veterans expect a Web site that works when they’re healthy as well as when they’re ill; that anticipates their needs rather than just reacting to them; and that works in a nonhospital environments, such as home care.

The final speaker of the panel, Ken Mandl, discussed various PHR models and asked, “Why do we all of a sudden care about this so much?”

“One reason,” he concluded, “is we have the technology that will allow this to happen. The other is that primary care is not what it used to be. I think we should recognize explicitly that part of what we’re doing is curating a patient’s information in place of the old country doc, who used to do that for a family for their whole lives.”