Healthcare Reform: It's the MHR Stupid!

Electronic health records are all the rage in healthcare circles these days and you are likely to see all of the following acronyms used: EMR (electronic medical records), EHR (electronic health record), PHR (personal health record). The healthcare industry uses more acronyms to cause confusion than any other industry I know. The legal and tech industries can't hold a candle to healthcare.

Here's the point, the only electronic health record that matters is the MHR (my health record). Why? Because I am the patient stupid and I don't trust the mostly backward looking healthcare industry to do the right thing with my medical data. I am now on a mission. I will refuse to see a provider that cannot update MHR's  (OK emergencies excluded). It looks like I won't be going to see a provider any time soon because as far as I can tell none of them can update MHR's today (sure a few support EHR's but I don't control those records and they live in individual provider silos).

Truth be told an MHR is really a PHR and mine is currently stored on Google Health (Microsoft and others have similar initiatives). All my medications currently automatically update my record thanks to the interfaces between the leading pharmacies and Google Health. There is nothing from a technical perspective that would prevent a provider from updating this record with lab tests, interventions, etc. once I have authorized it.

If the healthcare industry is going to start competing to create "patient value" around a medical condition as Michael Porter suggests in Redefining Health Care (see this post) then a complete MHR that holds all relevant patient data is a requirement, period end of story. The healthcare industry is going to launch the mother of all resistance battles to prevent this from happening. The industry is currently gearing up for the battle because of fears that such an initiative is imminent (and it is). 

The first argument will be there are no standards and we can't move forward until we have standards in place. To  understand why this argument is bogus read Clay Shirky's article located here. Once this argument is refuted the next battleground will be a move by providers, health plans (more likely), and perhaps the government to OWN the electronic health record. This effort should be resisted by consumers (i.e. all of us) at all costs. Why? There are number of reasons including not the least of which are privacy and confidentiality, but none of those are controlling from my perspective.

The reason that we the consumers need to own our MHR's is because we are the most important stakeholder AND we are the ones BEST positioned to ensure interoperability and a complete record. Huh? You heard it right and here's why. We are never going to get the kind of interoperability needed to compete on patient value between all the systems, from all the players, that need to touch the record and we don't have to. All the systems, from all the players ONLY need to "talk" to one system, the system that holds my MHR (the system of record). I give the required authorization and any provider that needs to reads/updates my record. Problem solved and the patient is in control.

Each healthcare consumer can select whatever system they choose to hold their MHR, but only one. Once we have this in place we can get about the business of implementing many of the suggestions that Porter makes in his seminal work. Until then we are going to "fiddle while Rome burns."

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Comments

[Deborah Leyva]

You've made some excellent points. It really is (or should be) the patient who is most interested in the quality of their health and how their healthcare is delivered.

As an RN, I believe that the patient needs to be the one who chooses their own healthcare options. But in order to do that, they need to understand what is wrong, what can be done about it, what are the choices, and what are the risks and benefits for each choice. Once they have the right information they can make an informed decision - one which they have the right to, and should make.

With a PHR (or MHR as you so aptly called it), more information is at a their disposal. They can see the history and ongoing "evolution" of their health conditions. As more information is obtained - and understood - better decisions can be made.

Thanks for sharing.

[Ravi Sohal]

The Heath 2.0 "movement" echoes your thoughts. When patients/consumers own their own records they become much more comprehensive and portable. I analyze and track my spending through my bank account/Quicken. I'd like to do the same with my lab tests, prescriptions, and visits...

[MarkData]

Yes, interesting points. We live in a real world where for an EMR or MHR solution to be efficient, effective, socially appropriate, and politically acceptable it must be generally applicable across the population. Those of us who understand your points are among the small segment of this population that are sufficiently motivated and competent to both care about and care for their own EMR. What most patients care about is getting well when they have a problem - they have no understanding of concepts like data ownership, interoperability, and their data management responsibilities in that new world. Designing a solution is first a societal matter and involves overhauling fundamental health processes, only when these societal and process solutions are shaping up should we add technology.