Very helpful – I honestly have never thought about the DM model being applied to PHRs and the difference in thinking that requires. I can see how that’s a use case, in addition to the one I’ve been interested in primarily, which is the PHR changing the model altogther. Thanks for the mind expansion and participating in the conversation with me,

Ted

Generally, we should expect that there will be many unanticipated ways in which patients and their caregivers will wind up using PHRs.

More specifically, the DM model is only one example of a perhaps unanticipated but potentially highly useful application of PHRs.

In the case of the BMJ reported study, the authors implicitly assume that patient awareness and involvement are somehow critical factors in evaluating PHR success. I’m questioning this assumption.

And…I question the assumption generally, but even more specifically for the population in the study. What’s the big aha in reporting that a low health literacy audience doesn’t remember receiving information about PHRs in the mail? Duh.

This low health literacy/safety net population intuitively seems ideal for a DM type program. They likely are high cost/high risk, and could benefit from a 3rd party (DM company, health plan, physician, caregiver) coordinating care on their behalf. In this scenario, you need the patient’s permission to create a PHR on their behalf, but much of the “involvement” can be energized by a 3rd party care coordinator.

We can learn from the lessons of the disease management communty that this is not necessarily true. Here’s the logic:
* 5% of a population typically accounts for 60% of costs
* For the past decade, health plans and DM companies have been focusing on this population. The basic idea is to identify high cost/risk patients and to intervene before unnecessary care and costs are incurred.
* While patient ENGAGEMENT is of course highly desirable, the prerequisite is patient PERMISSION to enroll them in a DM program
* Creating and using PHRs and personal health applications for this high cost/high risk group is a natural extension of the existing DM model. While conventional wisdom thinks of personal health information gathered “BY” the patient, in this case PHI is gathered “FOR” the patient by 3rd parties (health plan, DM company, care provider)