Personal Health Records: Information Wants To Be Free

Talk to Colin Evans, the CEO of Dossia, a personal health records company founded by Wal Mart and several other large corporations, and you get the impression that employers have a different view of this technology than insurance companies and healthcare providers do. The big employers involved in Dossia--which also include AT&T, Applied Materials, BP America, Cardinal Health, Intel, Pitney Bowes, sanofi-aventis, and Abraxis Bioscience--want to help their employees get more engaged in their own healthcare, he notes. They know that employees often change doctors and may switch health plans. So they're trying to help employees build lifelong PHRs that are completely portable, even when they change jobs, and that are independent of which provider they use or which health plan they belong to.

In contrast, he says, most health plans, hospitals, and physician groups want to use PHRs, not only to improve patient outcomes, but also to keep their customers tied to them. So they don't want to enable patients to be able to take their PHRs with them when they go to a competitor. "If you give someone enough access to their health record, you're allowing your customer to become independent, which is not something any business wants to do."

Providing a PHR for "free" to build customer loyalty and to make it difficult for customers to leave is similar to what banks do by offering online banking services, Evans says. Banks don't charge customers directly for these services, but they make a profit by getting them to stay with a particular bank and deposit more money in it. The same, he says, is true of health plans and providers. Even Microsoft HealthVault and Google Health, which offer PHR platforms that are not tethered to any provider or plan, hope to make money by getting people to come to them for health information and, perhaps, buy something from one of their advertisers.

Providers and plans have been slow to play ball with Microsoft and Google, Evans notes. Among the few that are cooperating with the infotech giants are Kaiser Permanente, the Cleveland Clinic, the Mayo Clinic, Beth Israel Deaconess Medical Center in Boston, and New York Presbyterian Hospital. All of these organizations allow patients to upload PHR data to HealthVault and/or Google except for Mayo, which says it's moving in that direction.

A few insurance companies, including Aetna and Blue Cross Blue Shield of Massachusetts, also allow their members to move their PHRs to one of the untethered PHR platforms. Several pharmacy and lab chains are offering their customers the same service. Most electronic health record vendors offer patient portals that include some kind of PHR. But only a few of them enable patients to transfer any of that information to HealthVault, Google Health or Dossia.

So while Evans' case doesn't hold true across the board, there is truth in what he says. Hospitals, physician groups, and insurers do have a vested interest in restricting patients' access to their own medical records. Patients can view them, and even add to them or correct them, but they usually can't take their online records with them when they leave. Somewhere in this proprietary maze, information wants to be free, but most PHRs are not.