This document summarizes a presentation on personal health record (PCHR) platforms. It discusses how PCHRs have evolved from static portals into applications platforms that give patients access to and control over their health data. Examples of PCHR platforms like Indivo are presented, as well as how they can integrate with electronic health records through standards like SMART. The presentation argues that PCHRs can promote patient engagement, data sharing, and the development of new healthcare applications if they are designed as open platforms like the iPhone.

1. Indivo X Users Meeting
2012
Kenneth D. Mandl, MD, MPH
Boston Children’s Hospital Informatics Program
(www.chip.org)
Harvard Medical School Center for Biomedical Informatics

2.  The Personal Health Platform
 How it diffused
 Why Google Health died on the vine
 The cure for personal health platforms

3.  Portals:
 A static view into the EHR
 PCHRs:
 Apps platform, and a patient copy of the data

4. New England Journal of Medicine

5. Ecosystem
NEJM

6. The Verbs of PCHR
Subscribe

9. New Approaches
to Data Liquidity

10. The Verbs of PCHR
Share

11. 81.4%
34.1%

12. VA Survey
 79% of Veterans are willing to share personal health
information with those outside their health system
 62% with a spouse or partner
 23% with a child
 15% with another family member
 25% with a non-VA health care provider
12

13. The Verbs of PCHR
Add an App

14. “We cannot overstate how
important PHRs are to
the efficient functioning
of a low-cost, high quality
health-care system . . . .
We think that the INDIVO
system, or something like
it is a good place to
start.”
--Clayton Christensen
Harvard Business School

17. http://commonhealth.wbur.org/2011/07/killed-google-
health
• Trust
issues
• No app
developers
• No data
Keeping EHRs Error-Free: the Value
of Patient Engagement

18. The App Store for Health
ONC Funded Research Project under the
“SHARP” program

19. Clinical use case
Med-tastic is a well-funded NewCo which has developed
an elegant medication list application that has
physician and consumer facing functionality. Patients
can annotate medication lists for accuracy.
To work, Med-tastic needs
 Prescribing history
 Dispensed medication history
 Allergies
 Problem list diagnoses

20. Healthcare IT: Why Can’t
 Innovators widely share what they create?
 Systems innovate faster to support
fundamental health care improvement and cost
reform?
 Providers readily request features and
?
applications?

21. We imagine EMRs as an iPhone-like
platform where Medtastic could
create and widely distribute an app
across many disparate EMRs and
PHRs

22. EHR as an “iPhone-like” Platform
 There is a common application programming
interface that enables
 Software developers to build SUSTITUTABLE
applications
Push innovation to the edges
Nimbly evolve functionality
Avoid vendor lock
Shrink switching costs
 Enable disruption

23. An esign less
d D Cand
ire c
n sp v e M se )
I a
D licen
from (cc

24. 1 Design + 1 Developer + 1 Week
1 De
velo
per
1 We in
ek

25. 1 SMART App in 3 SMART Systems

26. SMART
BP Centiles App
Running on Cerner
26

27. Medication adherence
JAMIA 2011

28. 28

30. Brief Tangent
 I2b2
 NIH Funded
 Pulled into use at 61 Academic Medical Centers
 ETL
 Involved in QueryHealth

31. “Side Car Strategy”
 The data need to come out for analytics
 Once they are out . . .

32. i2b2

33. Portal-PCHR Hybrid
 SMART Platform Apps
 Have access to EHR data in a vendor agnostic fashion
(from an Epic system, a Cerner system, or an
complementary system with data warehoused from the
EHR)
 So, one can readily create a patient facing portal,
which is an apps platform

34. Portal-PCHR Hybrid
SMART SMART
Clinician APPS APPS Patient
-Facing EHR Connect Indivo -Facing
Apps or App Apps
The best of both worlds:
•A local portal, with lots of data from the EHR
•A personal health platform with patient control,
sharing, and apps

35. www.indivohealth.org
www.i2b2.org
www.smartplatforms.org