Since we launched the the Center for Information Therapy (IxCenter) eight years ago, we have focused on three core objectives:

1. Advancing the practice of information therapy (Ix).
2. Building the science around Ix.
3. Embedding Ix into everyday care delivery.

The rationale for this approach has always been straightforward. We needed to make enough progress on the first two objectives in order to both advance the field and make the third objective possible.

We have begun to witness substantial signs of progress. Indeed, we brought Ix practice and science to a level that facilitated our 2009 efforts to embed Ix into the meaningful use (MU) definition. The MU framework is associated with tens of billions of dollars in incentives to be paid out to providers under the HITECH provisions of the Recovery Act. In collaboration with others — particularly those organizations active in the Consumer Partnership for eHealth — the draft definition of the MU requirements include several core elements of Ix (i.e., patient-specific education resources, after-care summaries, prevention/follow-up reminders, self-management tools, etc.).

(As background, the health information technology (HIT) provisions (also known as HITECH) of the recovery act/stimulus bill (American Recovery & Reinvestment Act of 2009) established tens of billions of dollars of incentives for Medicare and Medicaid providers who not only adopt electronic health records (EHRs), but become “meaningful users” of them. This distinction was critically important because it is common wisdom that simply adopting HIT systems will have little impact if those tools are not deployed in such a way that they help clinicians and patients manage information effectively and communicate better.)

David Blumenthal, who directs the Office of the National Coordinator (ONC) for HIT, and other senior ONC staff have made a strong commitment to ensuring the patient-facing aspects of meaningful use remain a high priority as HITECH implementation progresses. Although the incentives will be administered by the Centers for Medicare & Medicaid Services (CMS), ONC will be responsible for supporting the extension centers and HIT research center that will support providers’ HIT adoption.

In a testament to the critical role that the IxAction Alliance and the IxCenter have played in advancing consumer-facing HIT applications, ONC has asked me to join their staff to ensure the successful translation of MU requirements into HIT implementation. This is a tremendous opportunity to fulfill the IxCenter’s mission of embedding Ix into everyday care delivery expectations, and therefore, an opportunity I had to embrace.

Implications for the IxCenter and the IxAction Alliance

In addressing my departure and the current challenging business environment, the IxCenter Board of Directors has considered multiple possible scenarios for sustaining the momentum of Ix progress. The Board decided that the best course is to close the IxCenter itself and to position the IxAction Alliance for continued growth and impact by integration of the Alliance into another not-for-profit organization. After careful consideration, the IxCenter Board has decided to transfer management of the Alliance and donate the IxCenter’s core intellectual property to the eHealth Initiative (eHI), a multi-stakeholder organization of more than 170 members. The IxCenter will cease operations on 11/30/09.

Through this transition, we believe strongly that the IxAction Alliance can continue to be an engine of progress, stimulating innovation and diffusing best practices. IxAction has evolved in the last few years into a community of shared learning — a cross between an innovation network and a learning collaborative.

We are also very pleased that the transition to eHI will create alignment with an excellent organization and a larger immediate constituency. eHI’s mission is to drive improvement in the quality, safety and efficiency of health care through information and information technology. Through its own strategic planning process, eHI has recently placed greater emphasis on consumer engagement and patient-centered care. IxAction will continue to drive forward with the same mission and have the opportunity to extend its reach, including a wider array of providers, state-based organizations, and other health care leaders.

“By combining the strengths of eHI and the Alliance, we will emerge as a stronger advocate for patient-centered care and HIT. Working together, we can make a significant and meaningful impact on health care. In the coming weeks, we will work closely with leaders and members of the Ix Action Alliance to ensure a smooth transition” said Jennifer Covich, Interim Chief Executive Officer.

The substantial intellectual assets that the IxCenter has amassed in the last eight years—most notably the several dozen IxInsights reports, IxResearch Briefings, and other IxAction resources—will transition with the Alliance to their new home. There, they will be maintained and nurtured, and eHI will build upon this work as it brings its wealth of knowledge and expertise to the task of managing the Alliance. IxAction’s output will continue to provide enormous value to organizations within the Alliance and externally—including helping to inform the work that ONC does in MU implementation.

There will be no interruption in support for the IxAction Alliance. Members will continue to benefit through the leadership provided by eHealth Initiative. The web portal, briefings, reports and IxAction events will continue to be available. Staff who are also transitioning from from the IxCenter will join in the future support for the efforts and  activities of the Ix Action Alliance.

Organizations who have questions or comments about the transition should contact Cindy Throop at cindy.throop@ehealthinitiative.org or Jennifer Covich at Jennifer.Covich@ehealthinitiative.org. We welcome all your suggestions and ideas.

Looking Back
The IxCenter and the IxAction Alliance have accomplished a great deal.

• We have stimulated innovation and diffused best practices on an ongoing basis among dozens of progressive organizations across the country.
• We have produced a rich set of resources in the form of dozens of white papers, webinars, IxInsights reports, research briefings, conference presentations, and many other documents.
• Through the efforts of the Alliance’s Ix Payer Workgroup, we have made great strides in building an infrastructure for widespread Ix adoption: Inclusion of Ix criteria in URAC disease management standards, NBCH eValue8 RFI, and Healthy People 2020 objectives.
• We have played an instrumental role in ensuring that Ix is a part of the draft definition of HIT meaningful use, and have an opportunity now for that work to continue as a federal government priority with tens of billions of dollars in provider incentives behind it.

At the request of Neil Calman, I had the opportunity to speak in Albany last week at the New York State AHEC (Area Health Education Center) System Advisory Board meeting on “Health Care Reform & the Health Information Technology Workforce.” The trip was well worthwhile for many reasons, certainly not the least of which being the chance to soak up more wisdom from Neil Calman, MD, CEO of IxAction Alliance member, the Institute for Family Health (IFH).

Neil — a member of the Health Information Technology (HIT) Policy Committee advising HHS on the implementation of HIT provisions in the American Recovery & Reinvestment Act — set up the discussion about the all-important definition of “meaningful use” of electronic health records (which will determine whether physicians are rewarded with incentives for HIT adoption). As others have stated, Neil made clear that “It’s not about the technology.” Rather, he said, “It’s about the handshake between HIT and health care reform.”

Neil then proceeded to give a great example from his own delivery system of the difference between HIT implementation and meaningful use of HIT. When IFH implemented its EHR in 2002, it experienced no improvement in the rate at which its older patients got a pneumonia vaccination. However, IFH added an electronic reminder system to its EHR in November 2003, which produced an immediate and sustained spike in vaccination rates that continues to hover around 80%.

Neil discussed other examples of meaningful use and highlighted that what it’s really about is changing the way clinicians practice. Although many clinicians bemoan the transition from handwritten, paper progress notes to electronic notes available for the patient to review, Neil emphasized that this modern form of documentation can produce important improvements in care delivery. This transparency (an important goal by itself) does much more than just create an environment of participatory medicine for its own sake.

Neil pointed out, “When you change what you write in progress notes,” to make them appropriate for your patients’ consumption, “you drill down further to the real reason” for sub-optimal care. In the past when a patient wasn’t taking a new medicine, an IFH clinician may have just written in the progress notes, “Patient non-compliant.” But such a statement obviously begs the question: Why? So the doctor now will ask, and the answer often provides important direction for improved care delivery: “Patient took first 2 pills and they made him sick.” Now, the clinician and patient know what they need to discuss in order to improve adherence to a medication regimen.

That’s what meaningful use is all about. Taking apart HIT, we’re not just changing the T (technology), but actually fundamentally changing the I (information) in order to improve H (health).

In the couple of years since I’ve gotten to know him, I’ve often found myself leaving a room with Neil Calman — saying to myself, “Wow! That really captures the issue in front of us.” Or, sometimes it’s “If only we could clone Neil — or simply replicate his leadership — we could eliminate most of our country’s health care problems.” Neil is a primary care physician who is CEO and Co-Founder of IxAction Alliance member, the Institute for Family Health, a network of 17 federally qualified health centers in New York.

In Friday’s post on this blog, I mentioned the questions he posed for meaningful health information exchange that move the ball forward substantially. In the past, I’ve cited other wisdom from Neil, such as:

• HIT vendors’ responsibility to teach people how to use HIT products meaningfully
• The connection in HIT evolution between quality and equality
• His proclamation that training his own clinicians on effective HIT use was about helping them to become (in his words) “information therapists”
• (And from the same blog post) HIT implementation with his safety-net population was approached with the goal of building trust with their patients

At last week’s HIT Policy Committee meeting, Neil made another comment that triggered a light bulb flickering on over my head. As concerns over the implications of HIT meaningful use definitions on provider liability swirled, Neil raised a fascinating point. We are getting close to an understanding around a new “standard of care in the community” related to the meaningful use of electronic health records (EHRs). Neil suggested that soon “if an error in care that could have been prevented” by a meaningfully used EHR, there is in effect a new standard of care to which all providers will be held accountable.

The literature has demonstrated that little relationship exists between actual malpractice and legal action. This is true in both directions. Many horrible and preventable medical errors never are punished while many lawsuits are settled where negligence may not be the issue.

What the literature tells us is that most medical malpractice lawsuits arise because of poor advance communication resulting in a mismatch between patient and clinician expectations. Effective information therapy (Ix) that leads to informed choice in advance of medical and surgical procedures can dramatically reduce the likelihood of malpractice suits being filed.

More importantly, by meaningfully using HIT to deliver Ix, clinicians can dramatically reduce the likelihood of committing medical errors or having consumers unprepared for the clinical realities that confront them. And that’s a standard of care for our community.

David Blumenthal, who heads the Office of the National Coordinator (ONC) for Health Information Technology (HIT), spoke at a Center for American Progress briefing this morning on, “Aligning Health IT and Health Reform: Achieving an Information-Driven Health Care System.”

Blumenthal reiterated that the HIT provisions (HITECH) of the American Recovery & Reinvestment Act (ARRA) were not about the narrow objective of HIT adoption, but much more so about the bigger goals of “health reform, health improvement, effiiciency improvement, getting more value…” He added, importantly, that this wasn’t just about their interactions with providers, “but also to help people stay away from the health care system and live healthier lives.”

Blumenthal commented that the ambitious HITECH timetable creates enormous time pressure on ONC, but it also “gives us a discipline; it focuses us on the most important things… What is meaningful use and how do we get to it?”

ONC’s first draft definition made important strides (though there is still room for improvement), particularly in terms of strategies for better engaging consumers and families. The HIT Policy Committee advising ONC will issue its next iteration of the meaningful use definition at its meeting tomorrow.

At the second meeting of HHS’s HIT Policy Committee today, the committee’s Meaningful Use (MU) Workgroup offered a proposal that represents some important strides forward. From an overarching perspective, we can see progress in the fact that engaging patients and families is now one of the primary four or five goals for how “meaningful use” of HIT can transform health care.

The HHS Office of the National Coordinator (ONC) for HIT distributed a matrix along with the presentation by MU workgroup co-chairs Paul Tang and Farzad Mostashari. One of the five health outcomes policy priorities is “Engage patients and families,” and the associated care goal is “Provide patients and faimiles with access to data, knowledge, and tools to make informed decisions and to manage their health.”

Interestingly, when Mostashari presented the “achievable vision for 2015,” the slide advocated for “All patients have access to their own health information.” But Mostashari said, “All patients have access to the information they need to have.” I think the latter describes a broader set of information needs and would do more to meet the health outcomes policy priority.

For the 2011 objectives, Tang stated that the MU Workgroup’s “goal is to capture in coded format and to report health information and to use that information to track key clinical conditions.” By 2013, the goal becomes “guide and support care processes and care coordination,” leaving “achieve and improve perofrmance ans support care proceses and on key health system outcomes” by 2015.

The 2011 objectives under engage patients and families:

• Provide patients with electronic copy of — or access to — clinical information (including lab results, problem list, medication lists, allergies) per patient preference (e.g., through PHR) for outpatient (OP) and inpatient (IP) care
• Provide access to patient-specific educational resources (OP/IP)
• Provide clinical summaries for patients for each encounter (OP/IP)

For 2013:

• Offer secure patient-provider messaging capability (OP)
• Provide access to patient-specific educational resources in common primary languages (OP/IP)
• Record patient preferences (e.g., preferred communication media, advance directive, health care proxies, treatment options) (OP/IP)
• Documentation of family medical history (OP/IP)
• Upload data from home monitoring devoices (OP)

For 2015:

• Access for all patients to PHR populated in real time with data from EHR (OP/IP)
• Patients have access to self-management tools (OP)
• Electronic reporting on experience of care (OP/IP)

Many of these elements derive from the document that the Consumer Partnership for eHealth developed (a process in which the IxCenter was involved), though there are some areas where some improvements in the ONC document would go a long way toward driving better care. Some of these points were made during the meeting by HIT Policy Committee member Christine Bechtel, which I voiced support for during the public comment period, and I also added some of my own (or expanded on themes raised by Christine) there and here.

• Certainly, some of the elements should be moved up — earlier in the timeline (e.g., secure messaging, patient access to self-management tools & decision support, and electronic reporting on experience of care).
• The access to electronic information needs to be “timely” (a word that should be added); timely applies both to the speed at which it is made available and the ability to get information targeted to the consumer’s particular moment in care.
• Incorporation of data generated by the consumers themselves beyond just what can be uploaded from electronic monitoring devices (per the 2013 criterion).
• There should be more attention to consumer information tools (beyond just narrowly definted personal health records) and more clarity around the kinds of tools that consumers need — not just self-management tools but also decision support tools and tools that facilitate effective & efficient communication to improve the infrastructure for participatory medicine.

Finally, although clinical summaries are mentioned in this section, there are more ways in which improving care coordination (one of the other key five goals identified by the committee along with: engaging patients and families; improve quality, safety, efficiency, and reduce health disparities; improve population & public health; and ensure adequate privacy & security protections for personal health information). Specifically, the stated care goal for “improve care coordination” is “exchange meaningful clinical information among professional health care team.” Given that, for many of the measures proposed in the care coordination section, there is substantial research to support exchanging clinical information with patients and families improves care, reduces readmissions, etc., there should be an explicit inclusion of patients & families in that exchange.

If you also would like to share your comments with ONC, instructions for doing so are here.

For the past several months, the Center for Information Therapy (IxCenter) has been working alongside other consumer advocates to guide the HHS definition of “meaningful use” of EHRs to include consumer access to meaningful information. Part of that collaboration has been with the Consumer Partnership for eHealth (CPeH), which has brought together many organizations dedicated to advancing a patient-centered care delivery system. We also believe it’s important to build a meaningful use definition off of robust definitions of patient-centered care, such as that proposed recently by Don Berwick.

With the decisions on meaningful use now being hammered out by the Office of the National Coordinator (ONC) for HIT with input from the HIT Policy Committee (with detailed guidance from a meaningful use workgroup), CPeH has developed a consumer pathway to meaningful use to help inform the discussions.

Here’s an overview of our recommendations:

• To ensure care is comprehensive, coordinated, personalized and planned:
  • By 2011:
    • Care summary is generated and shared with the patient and other authorized providers and family caregivers after every visit or
      discharge.
    • Reminders about preventive services, medications, necessary/routine tests, and follow-up care are sent to patients via their preferred medium
  • By 2013:
    • Prompts and key information (patient preferences, health goals, functional status, preferred language, advance directives and social situation) are used to individualize and customize care
    • Patient generated data is incorporated into the clinical context for individualized care
    • Connections are made to community resources
• To ensure patients and their caregivers are partners, making informed, shared decisions:
  • By 2011:
    • Patients have electronic access to the lab results, medication lists and problem lists
    • Care summary (see above)
    • Patients are connected to resources that help them understand their medical information in the context of their specific health needs
    • Providers make available shared decision making tools to promote partnership in care and treatment decisions
  • By 2013:
    • Patients have real-time electronic access to their medical record along with linkages to tools that make the information meaningful and useful to them
    • Patients have access to evidence-based decision support tools that enable informed choices tailored to their preferences
• To ensure transitions between settings of care are smooth, safe, effective and efficient:
  • By 2011:
    • Care summary (see above)
  • By 2013:
    • Referrals are made to online patient coaching and/or other self-care management tools
• To ensure patients can get care when, where, and how they need it:
  • By 2011:
    • Patients are able to use secure messaging or email for more timely and beneficial communication with their providers
    • Personal health records (PHRs) or other consumer tools are populated by providers and are easily portable
  • By 2013:
    • Patients are able to use online scheduling for more convenient access to their care providers
    • Providers use remote monitoring to manage patients with chronic illnesses in the least restrictive way
    • Electronic tools provided by the health care team are accessible to people with visual, hearing, mobility, cognitive, and other impairments (and in multiple languages)
• To ensure patients and their caregivers are participants in continuous quality improvement:
  • By 2011:
    • Information about patients’ experience of care is collected electronically and used to improve
    • Quality data are electronically generated, aggregated and publicly reported in ways that are meaningful for consumer use
    • Information about race, ethnicity, primary language, and gender is collected and used in ongoing efforts to reduce disparities
  • By 2013:
    • Data regarding cost and the clinical quality of care are electronically collected and publicly reported for consumer use
    • Outcomes measures are reported stratified by race, ethnicity, primary language, and gender to spur disparities reduction

We firmly believe that effective, meaningful use of HIT can help create a platform for a better, more efficient health care delivery system, but only if we design it to meet consumers’ needs and preferences at the right time, in the right setting, and in the right way. The elements above will take us a long way in getting there.

For those interested in the detailed recommendations from CPeH, please contact me directly or leave a note in the comments section.

Nancy Shute has a nice piece in yesterday’s Charlotte Observer that summarizes “6 ways electronic medical records might make diagnosis easier and more convenient, and care safer.” An excellent writer, Nancy has done a good job of boiling down all the grandiose discussions on EHR functionality into tangible, “what have you done for me lately?” functions. This consumer orientation to EHR functionality is badly needed as we define “meaningful use.”

With every one of them, however, by attaching information therapy (Ix) to the technological function, we could substantially expand the utility of that application. So, I’d like to propose amendments to Nancy’s six high-impact apps.

1. “Skip trips to the doctor.” Yes, secure e-mail with your clinicians is a huge convenience factor, and attaching an information prescription about what to do next (or when it really would be time to come into the office) would provide additional value to the patient.
2. “Track Mom’s medical chart even if you’re in Albuquerque or Altoona.” As long as you can actually interpret what’s in the online record, that’s fine. But what if the medical jargon raises more questions than it answers. If the chart via the portal contains links to content that contextualizes the data points, you’ll feel a lot more comfortable staying in Albuquerque or Altoona.
3. “Get lab test results without having to play phone tag with the doctor’s office.” By hyper-linking the lab test results to brief explanations of what each acronym means, what the “normal” ranges are, and what it means if your values are “abnormal,” the lab values will have much more meaning.
4. “Never again drag X-rays to a specialist.” Very few lay people can interpret radiology images, so attaching the radiology report (translated into plain language) to the digital files will empower consumers.
5. “Find out if your prescriptions could have dangerous interactions, before you start taking them.” But then what? Provide some guidance to the consumer about alternatives or what questions to ask your doctor, pharmacist or other health care professional.
6. “Use your cell phone to tap into your health records.” Put everything together from above, and the more ubiquitous cell phone really will ring!

As we move forward in defining what we want out of “meaningfully used” EHRs, let’s take a page from Nancy’s book and boil these functions down into what they actually mean for the day-to-day lives of consumers. But let’s also go the extra step of making the most of the electronic opportunities that present themselves by connecting data points to content that helps all consumers use these tools most effectively.

There’s a lot of buzz out there in the blogosphere about the next steps on health information technology (HIT) standards. Certainly, the recommendations of HHS’s new HIT Standards Committee to its new HIT Policy Committee clearly will inform how HHS implements the HIT provisions of the American Recovery & Reinvestment Act (ARRA).

Many of the decisions will need to be made quickly, which is part of why John Halamka (Vice-Chair of the Standards Committee) put some of his thoughts on the Web this morning, as did Mark Leavitt, Chair of the Certification Commission for HIT (CCHIT).  Leavitt was specifically defending CCHIT’s structure in the face of a recent Washington Post article and other comments made on The Health Care Blog, among other places.

I certainly wouldn’t pretend to have all the technical answers for the HIT Standards Committee. The Center for Information Therapy firmly believes that we need to advance the discussion productively, as I believe virtually all of those engaging in online dialog are trying to do.

Among the most critical issues that has not been adequately addressed is the relationship of standards-setting to the ultimate impact on consumers’ access to meaningful, useful electronic information to help them manage their health. An Issue Brief I wrote a few years ago for the California HealthCare Foundation is just as relevant today (maybe more so given the stakes involved in 2009!), so I’d highly recommend it to those interested in improving health care delivery.

The basic premise of the CHCF Issue Brief, “Lost in Translation: Consumer Health Information in an Interoperable World,” is:

“…Availability of information does not necessarily translate into understanding or taking appropriate actions. While momentum builds for a National Health Information Network infrastructure, it remains unclear what role patients will play in the interconnected world of providers.

“…As clinical information becomes more directly available to consumers through the Internet or through other electronic communications from providers, a mechanism for meaningful, consistent translation to engage consumers is lagging…”

I urge all those working hard to drive forward meaningful use of HIT to consider the issues raised in this CHCF Issue Brief and ensure that HIT implementation leads to more effective and efficient care for everyone.

The HIT Policy Committee — formed as a result of the HIT provisions of the American Recovery & Reinvestment Act (ARRA) — held its first meeting in Washington yesterday. David Blumenthal, the recently installed National Coordinator for HIT, convened the session, noting that he was in a bit of an “awkward position as chair of this committee and the principal recipient of its advice.”

Blumenthal set the stage with a few important points. First, he made it clear that “The focus is not on information technology, but on how to make the health system better.”

Second, Blumenthal emphasized that the ARRA HIT provisions were a downpayment on President Obama’s broader goals around comprehensive health care reform: “The President has made clear two main goals: Coverage and delivery system reform. We can’t make coverage gains without making the health system better” and more efficient.

Third,  he made it clear that the ARRA HIT provisions needed to result in three things: “Improving population health, improving individual health, and health system efficiency.”

As he turned the discussion toward the more nuts and bolts issues, Blumenthal talked especially about the issue of defining “meaningful use,” which he said is “in some ways a revolutionary concept.” The timeframe for coming up with this definition is extremely tight and one of the top priorities for his office (ONC) — along with certification and infrastructure building and support.

The meaningful use discussion that followed involved substantial emphasis on the need for meaningful use of HIT to facilitate patient-centered care delivery — which, several committee members stated, inherently means addressing consumers’ privacy and security concerns. Several comments highlighted the need for meaningful EHRs to put patients at the center of the delivery system by promoting patient access to care and consumer ownership of usable information. Importantly, since that is true for all consumers, this patient-centered HIT also needs to focus on reducing health disparities.

Neil Calman also made the excellent point that, “Vendors have to be responsible beyond just the production of the product. Vendors need to support and lead through the process of adoption. They need to teach people how to use the products meaningfully. That will go a long way to making sure that the products are meaningfully used.”

Of course, all of this is in the context of the statute’s alarmingly tight timetable for rule making. In order to help the committee provide substantive input on time, it came to agreement on the establishment of three working groups:

• Meaningful use
• HIT adoption
• Information sharing/exchange

Although other workgroups were discussed, the committee agreed that issues of patient-centeredness and privacy/security should not be independent workgroups; rather, they should be central issues of each group’s deliberations.  HIT adoption will first focus on certification and then move to a broader set of issues around assuring effective and efficient HIT adoption, including infrastructure and workforce training.

Although the committee and ONC have an enormous set of tasks to accomplish in a short period of time, most everyone I’ve talked to agrees that the first meeting was quite successful. And, for me, it was a great feeling to come to the public comment period and not feel compelled to highlight the need for consumer orientation of HIT implementation because so many committee members had driven that point home already.

Several articles published in today’s New England Journal of Medicine are worthwhile reads (all of which, I believe, are free full text).

• News flash (not!): We have a long road ahead. A new study out of Harvard updates the dreary state of electronic health record (EHR) adoption by U.S. hospitals. Just 7.6% of surveyed hospitals have a basic system and a measly 1.5% have a comprehensive EHR system throughout the hospital.
• Incoming HHS National Coordinator for Health Information Technology David Blumenthal, MD, MPP, makes some important points about how the HIT provisions in the stimulus bill were designed to generate “improvements in health and health care” and not just increase EHR adoption. Aside from the financial incentives (and  down the road, penalties) for providers and the important infrastructure created, Blumenthal highlights the critical importance of the “federal government’s skill in defining two critical terms: ‘certified EHR’ and ‘meaningful use.’” He is right that tightening certification criteria and “motivating providers to take full advantage of EHRs” are prerequisites for HIT actually improving quality and efficiency. I’ve described this and the importance of stretching out “meaningful use” to meet the needs of consumers before.
• Paul Tang, MD (Palo Alto Medical Foundation), and Tom Lee, MD (Partners), have an excellent piece comparing the advantages of stand-alone personal health records (PHRs) with what they call “integrated PHRs.” The latter term describes electronic portals that allows patients to gain access to provider EHRs and, perhaps more importantly, communicate directly with their clinicians. One of the big question marks is how fast will the stand-alone version effectively integrate with clinician records to help support the kind of information-supported communication that facilitates participatory medicine.
• An interesting piece from Kenneth Mandl, MD, MPH, and Isaac S. Kohane, MD, PhD, from Children’s Hospital in Boston, makes the argument that HIT “components should be not only interoperable but also substitutable.” Thankfully, they describe in excellent detail the broad range of applications and examples that comprise those “components.” It’s an excellent list, though it could benefit from some more emphasis on content applications.