Personal health records high on HIMSS agenda

Personal health records, patient identification, interoperability and, of course, quality were high on the agenda at the annual Health Information and Management Systems Society (HIMSS), in the recovering US city of New Orleans, Neil Versel writes.

An Accenture study released at the start of last week’s meeting suggested that two-thirds of Americans consider electronic health records “at least slightly important” in their choice of physician, and a slim majority might even be willing to pay for an EHR. This survey did not address the privacy and security issues that other consumer research has shown to be a potential roadblock to widespread EHR usage.

That omission didn’t stop hordes of companies from suggesting that their products were more than slightly important to hospitals, doctors, nurses and the like, however, as nearly 900 exhibitors took advantage of the larger expo hall that New Orleans affords over last year’s venue in San Diego to showcase their wares on a grand scale.

The city of New Orleans has bounced back reasonably enough from Hurricane Katrina in August 2005 to host the gathering of more than 24,000, though flight cancellations due to wintry weather in the north-eastern and mid-western United States prevented many would-be attendees from making the trip.

Those who made it to the Crescent City heard Microsoft chief executive Steve Ballmer leading off the conference with a keynote address which mostly stated the obvious—that healthcare data rest on islands that are not connected to other stores of information and that individual patients have a growing interest in managing their own healthcare with online tools.

One subset of consumer health information, namely personal health records (PHRs), took a high profile at HIMSS. “We must empower consumers to manage and maintain their health,” explains Dr Holly Miller, co-ordinator of clinical internet strategy for the Cleveland Clinic.

The problem, however, is that there is no uniform definition of a PHR. In fact, several constituencies are developing their own standards for various forms of PHR, with no guarantee the groups will reconcile the divergent approaches.

While the Cleveland Clinic and other large organisations offer PHRs to patients via web portals, those records tend to be “tethered” to the institution’s internal EMR. Recently, some major companies, including Intel, BP America and Wal-Mart Stores, announced plans to build a data warehouse in which to store “portable” PHRs on behalf of their US employees.

The firms, who insist that people will be able to keep the records even if they change jobs, expect to develop a new standard for PHRs as part of the project, which they have named Dossia.

Meanwhile, an association of US health insurance companies are working on their own flavour of PHR, based on data derived from billing claims, pharmacy records and laboratory reports. “The vast majority of the data [today] exists in the payer’s hands,” says John Capobianco, president of care-management software vendor MEDecision, a company that helps health insurers mine claims data to create the beginnings of an EHR.

Again, as Microsoft’s Ballmer pointed out, these efforts are developing largely in isolation, creating the potential for additional silo-ing of information unless various parties find ways to create interoperability.

However slow the progress might be, those efforts actually are advancing. In February, standards-setting boards Health Level Seven (HL7) and ASTM International approved a format known as the Continuity of Care Document for exchange of patient demographic information and medication and allergy lists. And last week, HL7 completed its “functional model” for EHR systems, a key steppingstone toward making an EHR a patient’s legal medical record.

Some of these standards are in use this week at the Interoperability Showcase, a live demonstration of a health information exchange between dozens of vendors and healthcare organisations on the HIMSS show floor. The showcase is part of the global Integrating the Healthcare Enterprise programme, which has a strong European contingent.

Exhibition highlights

* Microsoft acquired health search engine Medstory, perhaps as a pre-emptive strike against the possibility that Google soon will debut a long-anticipated healthcare portal. Google rumours grew stronger in January when the company agreed to develop a physician search engine for an e-prescribing project in the US.

Speculation may increase with late news on Tuesday that an advisory board to the US Department of Health and Human Services is holding its March meeting not in Washington but rather in Mountain View, California, the Silicon Valley town which just happens to be Google’s home base.

* McKesson added a web-based nursing portal to its Horizon Clinicals suite, based on research showing that nurses account for 600,000 of the 3.7 million monthly log-ins to McKesson’s existing physician portal.

* Siemens have begun talks with Harvard-affiliated Partners HealthCare about a possible joint development of clinical services for the Siemens Soarian service-oriented architecture.

* Portuguese EMR developer Alert Life Sciences Computing entered the US market by announcing a deal with the Florida-based operator four hospitals. This news comes just two weeks after Alert contracted with an Indonesian company to distribute its products in Asia.

* Misys Healthcare Systems, the US subsidiary of London-based Misys plc, have integrated a mobile electronic charge-capture system from MedAptus with Misys inpatient and outpatient clinical and administrative software.

* Participants in a pre-conference symposium for physicians mentioned secure authentication of patient identification as a major hurdle to achieving interoperability health information. Several companies, including Sun Microsystems and US software developer Medseek, launched products aimed at creating accurate master patient indices.