Portals Are for Cattle, Personal Health Records (PHR) Should Be for People

There seems to be confusion around the term Portal and Personal Health Records (PHR) in healthcare.  Let me explain.

Portal displays or communicates with a practice or network

Portal is a hospital's attempt to improve customer service.  A typical portal allows you can log on to your hospital, see your records, schedule a visit, or possibly message your in network provider.  Compared to the days of fax and phone it’s clearly a step forward.  And it works as long as this is the only place you go for care.  However, unlike cattle, most people don’t tend to stay inside hospital fences.  People wander from hospital to hospital, clinic to clinic, sometimes going to a doctor in network and sometimes going to one out of network. Portal is limited tool for a single hospital or network.

PHRs are something else entirely.  Fundamentally, they are owned by patients.  The record collects all care, irrespective of the health system.  It is not a tool for marketing, tethering you the patient to a particular set of providers, but rather an organized way to tell others about you.  Ideally, a PHR would leave room for patient self report.  Healthcare systems seem to forget that most of health occurs at home.  Hospital records leave no room for patient self report.  Personally I feel how patients feel about themselves day to day, whether their happy or depressed, has far more to do with their health and outcome then whether they took their medicine or lost weight.  A true PHR would collect information across the continuum- from hospital to home, across all providers.

An ideal PHR would gather all information for the patient
and put it into the cloud

Without an effective digital tool, many patient’s literally resort to a shoebox for their PHR. Particularly for those with a chronic disease, there is a clear need.  So why hasn’t the market provided one?  Attempts have been made.  Both Google (Google Health) and Microsoft (HealthVault) literally spent hundreds of millions of dollars in what were largely failed efforts.  In part, this was do to a failed business model based on…. advertising.  Hospitals initially looked to leverage Microsoft’s HealthVault, but got stuck in their old ways of thinking by reverting to “portal” built on top of HealthVault.  For all their outward mission based altruism, in the end hospitals are businesses.  They have a hard time thinking beyond I win/you lose mentality and tend to look for market differentiators rather than collaborative strategies to deliver better care at a lower cost.  Too bad.  Can you imagine the first hospital to offer a true PHR?  Sure it would help their competitor by collecting records for the patient, but do you really think it would work equally well across providers.  The first hospital would do well by doing good.

With the new federal mandates it’s time to stop spending on fences (portals), and start thinking about continuum (PHR).  Grabbing patients via insurance plans or Accountable Care Networks will only go so far.  To actually improve care at a lower cost a true PHR, a patient owned record managed by a hospital would provide huge value for all stakeholders.  At the very least, we should stop referring to portals as PHRs, something they’re not.