1. Interoperability Still the Barrier to Patient Portal Implementations October 23, 2013

2. The Drivers Patients increasingly are requesting access to their PHR through patient portals; and U.S. residents increasingly are becoming a more mobile-driven society.

3. Two Realities Available EHR systems lack interoperability and cannot communicate with one another, therefore failing to reach the goal of creating seamless, universal and secure access to individual health information. The patient, does not own his or her health information, as this data is stored within the IT protocols of the EHR system, proprietary to providers, hospitals and health systems.

4. History The American Recovery and Reinvestment Act (ARRA) in 2009 to stimulate EHR deployment $19 billion in incentives as part of the Health Information Technology for Economic and Clinical Health (HITECH) Act to incentivize installation and Meaningful Use Proprietary platforms still cannot share information with other providers or hospitals

5. “Despite significant consumer interest and anticipated benefits, overall adoption of personal health records (PHRs) remains relatively low” (Nazi, 2013)

6. Kaiser Permanente Experience Free service available to all Kaiser Permanente members In 2011, more than 74 million sign-ons resulting in: – 29.7 million lab results viewed online – 12.2 million emails sent to providers – 10 million prescriptions refilled – 2.7 million appointments scheduled 90% of patients with chronic conditions agreed the website enables them to more effectively manage their conditions Mobile-optimized website has received more than 9.7 million visit sessions since January 2013, accounting for 16% of total traffic

7. The Kaiser Downside No exchange of data with external care providers No mobile access outside of coverage area

8. How Do We Get Better Results? The Goal of Meaningful Use Stage 3 is the creation of a truly mobile PHR, including: Transition of care information Setting up appointments Getting reminders Updating allergy and reaction data Sharing information with others at will

9. This vision for true mobile access is attainable with the understanding that patients are first consumers who require technical concessions to solve interoperability challenges.

10. Technical Details Common Data structure: this level of interoperability requires that PHRs must support the same communication platforms, content encoding, messaging, and encrypting for images as all other health information systems.

11. Current Barriers Multiple data locations Human behavior – Recognition by BOTH patients and providers of the patient role in personal wellness – Education for better understanding of the need for consolidating all information Provider attitude – Learn to willfully share ALL clinical information with patients – Learn different approaches to sharing, based on patient factors – Learn to document data sharing dialogs to improve communication in the future

12. BYOD Redux Consequences: – Most devices aren’t secure and can be lost or stolen easily – “Sketchy” apps downloaded and installed – All personal data on personal devices could be wiped out in the case of a breach – Cost ‘savings’ can easily turn into major losses due to fines and penalties

13. BYOD Hazards Apps that access and store your device’s contents elsewhere: – The Flashlight app takes virtually all the device's data – Charging stations set up in airports do the same thing. Most secure mobile device? The Blackberry…

14. References ‘Ethical hacker' calls BYOD a nightmare Google Health shutdown spurs debate over PHR viability Kaiser PHR sees 4 million sign on, most active portal to date Moving Beyond the Limitations of Fragmented Solutions - Empowering Patients with Integrated, Mobile On- Demand Access to the Health Information Continuum PHR progress still hangs in limbo