1. K D S Consulting, LLC Strategic Sustainable Solutions The PHR Story Kim D.Slocum President September 14, 2009

2. Keep Paper Records 40.0% Neither 57.3% Already Use 2.7% SOURCE: Markle Foundation Survey—June 2008 Consumer Use of Electronic PHRs Remains Very Low

3. Very Interested 13.5% (31 Million) Somewhat Interested 33% (75 Million) Not Very Interested 26.2% (60 Million ) Not At All Interested 27.4% (62 Million) SOURCE: Markle Foundation Survey—June 2008 (106 Million) (122 Million) Consumer Interest In PHRs, Even When Offered At No Charge, Remains A “Mixed Bag” “Some Internet technology companies and health care organizations are inviting individuals to join free online electronic personal health record services. You could obtain, store, and update your health information on a secure web site. You could control which health care providers can see or update your PHR, and you could automatically receive valuable information from the Internet related to the medical and health conditions and interests you indicated in your PHR. How interested would you be in enrolling in such a free online PHR system?”

4. Why? Impact of health & computer literacy “Who do you trust?” The “Quicken” effect? Can the successful model be replicated widely?

5. Who is The “Average” Consumer? Mean household income of ~$60,000 (median is ~$50,000) High school graduate, maybe “some” college Current post-tax expenses equal 80% of pre- tax income (95% for median income) Minimal financial assets Reads at 6 th -8 th grade level Roughly 30%-50% chance of being “health illiterate,” “health innumerate” or both

6. Living With Chronic Condition No Chronic Conditions US Population Aged 65+ 29%15%17% Less Than High School Education 25%10%12% High School Diploma 31%34%33% Some College 27%26% College Degree Or More 18%29%28% Use Computer At Work, School, Home 52%75%71% Use Internet Or eMail 51%74%70% SOURCE: Pew Internet & American Life Project Chronic Disease Patients Are Older, Less Educated And Less Computer Literate Than The General Public

7. Source: Harris Interactive Strategic Health Perspectives 2007 The General Public Thinks Physicians Are The Most Trusted Source For Personal Health Records

8. Source: Harris Interactive, Strategic Health Perspectives 2007, 2008 “Strongly/Somewhat Agree” The General Public Believes Personal Health Records Are For Doctors and Patients, Not Plans

9. What Data Are Included? Insurers & employer-sponsored PHRs consist mostly of claims information Measures what care was delivered and how much it cost Of little use in managing clinical course of care (unless lab values and medication histories are included) Provider-based PHRs are often patient-centric shared views of an enterprise-specific EMR Measures why patient sought care Describes clinical outcomes These two data sets need to be combined—does this require NPI? Better developed interoperability standards? Fundamental philosophical changes in attitudes toward data sharing?

10. The “Quicken” Lesson Personal financial management software has existed since the early 1990’s “Cult status” during early years Rise of internet, on-line banking required to drive widespread popularity and use EHRs and HIEs are probably healthcare’s “parallel construction”

11. Integration Of PHRs With Electronic Health Record 76%: More than three-quarters of survey respondents believe that personal health records (PHRs) need to be integrated with an electronic medical record (EMRs) in order to have value in patient treatment. Source: HIMSS Analytics Vantage Point, May 2008

12. The “Kaisinger” Model Most PHR success stories involve integrated delivery system providing essentially 100% of medical services to their members Many of the economic barriers confronting other physicians, hospitals, and patients do not exist there Data integration issues far less pressing Kaiser Permanente based its system on an EHR containing nearly all relevant clinical information and included the ability for patients to do simple transactions with their physicians Is this success currently scaleable to other sorts of environments? Technology is not the only issue to be addressed

13. My Conclusions US health care desperately needs HIT to be either sustained or reformed The main task we face is deploying EHRs and building HIEs If these are accomplished, and patients are given access to their own data, the PHR problem largely solves itself In general, patients’ interests will be better served by EHRs and HIEs than by dedicated PHR products There will be a time to devote resources to “bespoke” PHRs, but not until “job one” is complete