Personal health records: Does President Bush's vision for EHRs include Google?

The nationwide network of EHRs that the feds are building will include variousPHRs on the market, and possibly those from Google and Microsoft.

A PHR is the patient’s version of an electronic health record maintained by a doctor or hospital. Some PHRs are, in fact, online extensions of an EHR, allowing patients to view selected bits of health data that are packaged in a layman-friendly way. Other PHRs are separate online systems offered by health insurers, employers, and non-healthcare businesses like Google and Microsoft. While patients ostensibly control these PHRs, they can give doctors and hospitals permission to view them.

These stand-alone PHRs also may interface with the IT systems of physicians, hospitals, insurers, and the like, again, with the patient’s permission. That linkage allows data like medication lists and lab results stored in an EHR to automatically flow into the PHR, sparing the patient some record-keeping. Plus, the patient can share his constantly updated PHR with other providers. Google is giving this kind of connectivity a test run by interfacing its PHR-called Google Health-to the EHR of the Cleveland Clinic. Microsoft is conducting a similar experiment with its HealthVault PHR and the Mayo Clinic.

So what’s this got to do with the feds?  Plenty. The Bush administration wants most Americans to have an EHR by 2014, and it wants these EHRs connected to each other in a nationwide health information network, or NHIN. The US Department of Health and Human Services intends to build this system from components such as regional health information organizations, or RHIOs. Also called health information exchanges, RHIOs are data-sharing networks formed by doctors, hospitals, insurers, and employers in a city or state.

Last month, an HHS official announced that the NHIN would be expanded in 2008 to include federal agencies such as the Departments of Defense and Veterans Affairs, large integrated delivery systems, and PHRs created by “entrepreneurial organizations.” One news organization erroneously suggested that the HHS already had agreements in the works with Google and Microsoft, but later made a retraction.

However, the Google and Microsoft PHRs are in the running as future NHIN components, says medical informaticist David Loonsk, director of interoperability and standards for the Office of the National Coordinator for Health Information Technology, which is spearheading the HHS effort to digitize medicine. PHRs are important for the NHIN, he says, because giving patients access to their health records “puts them front and center in understanding and managing their care,” says Loonsk. A PHR, he notes, can be used by multiple healthcare providers and “support new services for prevention and quality and efficiency of care.”

This year, HHS is giving the NHIN a trial run. So far, it’s signed up nine RHIOs to exchange health data with each other as well as the Department of Defense, the VA, and the Social Security Administration in a demonstration project. In the next few weeks, HHS will announce five to 10 additional project participants, which could include integrated health systems, “entrepreneurial” PHRs, and more RHIOs, according to Loonsk. The NHIN could go into operation as early as 2009, although on a limited basis, he adds.

PHRs like those operated by Google and Microsoft worry some privacy advocatebecause they do not fall under the privacy and security requirements of HIPAA.Not to worry, says Loonsk. He anticipates that NHIN participants will agree onsecurity safeguards “that may exceed HIPAA.”