Physicians Looking for Info on Dossia Initiative

It looks like some of our earlier critiques of the recently announced plan to implement a nation-wide PHR for employees of five major corporations is starting to catch on.  Carmela Coyle, of the American Hospital Association, points out that the founders have yet to discuss logistics like how the system will be used by providers - a pretty glaring omission, we think.  Coyle questions whether providers will access the information via the web or if patients will "literally carry the information around themselves."  That's likely to work well.  We've spoken with physicians who can't get patients to bring the pre-mailed medical history sheets along with them; what's the probability they'll remember to bring their flash drive with them?

Another point being addressed by is the accuracy of patient controlled information.  According to internist and vice president for the American College of Physicians, Michael Barr, physicians "will always have a question of whether that information is complete information" because patients are allowed to change/exclude certain information:

[J.D.] Kleinke [Chair and CEO of Omnimedix Institute] said patients can request that changes be made on incorrect information, but they cannot change or tamper with what is in the health record. However, patients can choose to exclude certain medical details, such as a prescription or drunken-driving incident, from their PHR, according to [Intel spokesperson Jennifer] Gresson.

That will likely concern physicians already worried about malpractice suits.  The prospect of being sued for a drug interaction they didn't know about isn't going to help make this a popular program amongst doctors.  Interestingly, in view of Dr. Barr's comments, the ACP has officially endorsed Dossia, as has the American Academy of Family Physicians.

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[Miles Hochstein]

William,

I read your comments on Omnimedix' Dossia project (here and from December 11 2006) with interest and would like to offer a few responses. I hope they are a useful contribution to the discussion. http://calyxllc.typepad.com/it_for_healthcare/

Omnimedix Institute understands and shares physician concerns about the completeness of medical information provided by patients. Electronic Health Records and a Personal Health Record are quite different kinds of systems. Personal Health Records contain patient controlled data and are only as useful as the bond of trust between a physician and patient. It is that relationship of trust that physicians rely upon today when they ask patients to bring their pill bottles to the office visit, to report on their adherence to medication regimens, to report on their past medical history and to describe their current symptoms. A Personal Health Record enables patients to do all of these routine activities with greater accuracy and convenience. How the physician chooses to respond to patient supplied information will remain, as always, an important professional medical decision, the kind of decision that physicians make every day already today when the patient attempts to recall such information from memory.

Because Dossia enabled PHRs are likely to provide more information and more accurate information than patient memory and hand scrawled pieces of paper we believe that they have the potential to reduce the likelihood of error, confusion and perhaps even litigation.

While I don't speak for the AAP or the AAFP, we believe that considerations such as these explain in part why these physician groups view PHRs as a net plus for patients and physicians, and are part of why these organizations have endorsed the Dossia project.

In your earlier post of December 11, 2006
http://calyxllc.typepad.com/it_for_healthcare/2006/12/more_dossia_inf.html
you ask some interesting questions and I've attempted to answer them below.

Question "The main question - posed here and elsewhere - is how the physicians are expected to interact with the system. What if your doctor hasn't gone digital? "

Responses:

* An important goal of Omnimedix Institute is not to adversely impact physician work flow. We envision Dossia enabled PHR users may initially choose to provide data to physicians on paper or by other means, data that physicians might not otherwise receive, and data that is more accurate than physicians are able to receive from patients now.

* The ability of physicians to function as data suppliers to patients holding Dossia enabled PHRs will indeed depend on physician use of information technology. For some physicians the opportunity to populate a patient PHR may provide an incentive to move in that direction.

Question: "How does Dossia get the appropriate information into your file?"

Response:

* Omnimedix Institute is building data relationships with already existing aggregators of patient data and will import that data, with the larger goal of fostering a larger ecosystem of PHR applications.

Question: " Whatever else it may be, it clearly is not a comprehensive EHR and is no substitute for one."

Response:

* We agree. Dossa enabled PHRs will not be EHRs. That's a different product, a different market and a different need. PHRs can be configured to import information from EHRs, and physicians can choose to include data from a PHR in an EHR, but the two kinds of systems are very different.

Question: "Is it expected to drive adoption among doctors providing care to these employees?"

Response:

* Because this is a PHR we are focused on patient adoption. How physicians will respond to the opportunity to use data from a patient PHR, and the extent to which they will wish to supply data to a PHR are important empirical questions.

Question: "Does the combined healthcare buying power of these five - and soon to be more, reportedly - companies give them the leverage to demand that doctors adopt compatible EHR systems or lose their employees' business?:

Response

* Intel Chairman Craig Barrett and senior leadership for the Dossia Founder's group have publicly stated that they prefer the carrot to the stick, and we at Omnimedix certainly think that is the right approach. We think that a more complete, fully independent and private patient controlled PHR will present physicians with an attractive opportunity to improve communication with patients and to improve their knowledge of where and how a patient has been been treated in the past.

I understand your skepticism. It is good to be skeptical. We at Omnimedix Institute believe that patient owned and controlled PHRs have a valuable contribution to make to health care quality, but as with any innovation that has the potential to affect the delivery and quality of care it is important to watch how the implementation process works in the real world.

Miles Hochstein
Program Director
Omnimedix Institute
www.omnimedix.org