An emerging company called Kinsights this week launched an online pediatric personal health record for parents to keep track of their children's medical histories.
I initially rolled my eyes. "Untethered" PHRs—controlled by patients and not directly connected to an institutional EHR—have been an unmitigated failure to date.
As I noted in a February 2013 commentary, they generally don't fit physician workflow, and physicians generally don't trust information patients enter. Plus, few patients will even take the time to enter their own data. "It's like Quicken in the days before online banking let people download all their transactions. You need the interoperability first," I said.
Further, I wondered why, given the history of patient indifference toward PHRs failures, the White House Office of Science and Technology Policy would back San Francisco-based Kinsights, as it reportedly has. I know some in Washington are bullish on PHRs, and they might have a hope of making it if they follow the Blue Button Plus protocol, which adds structure like the Continuity of Care Document standard to the plain unstructured text of the original Blue Button developed at the Department of Veterans Affairs.
Stage 2 of Meaningful Use requires providers to give 50 percent of patients electronic access to their individual medical records, and, perhaps more importantly, 5 percent of patients actually have to view, download and/or transmit information back to their doctors or hospitals. The latter provision certainly can be met with a PHR, as long as the PHR follows standards, which the Kinsights product seems to do. (And, no, as others have reported, Kinsights is not a "competing health records provider" to Practice Fusion, CareCloud or any other provider EHR, but it should interface with them.)
Until Stage 2 actually starts, we won't know whether Meaningful Use will help untethered PHRs succeed, but I'm keeping an open mind.
Kinsights, formerly known as WeSprout, was part of San Francisco-based digital health accelerator Rock Health's first class of supported companies in 2011. As you may recall, I trashed Rock Health and Silicon Valley rather mercilessly in a column two years ago.
Among my criticisms, I said Rock Health and others breathing the rarified Northern California air were coming up with slick, hip apps seemingly meant to appeal to younger people. "It’s a demographic that includes many without health insurance, and even those who are insured can’t always be counted on to take care of their own health. Those that do probably are more interested in fitness apps than in actual healthcare. That’s good, but that’s not where the bulk of the country’s $2.5 trillion in annual healthcare costs come from. The frail elderly and people with chronic diseases are the expensive patients," I wrote.
Well, there is no demographic younger than children, but the children's health market is a different animal.
The target audience for Kinsights is not the patients themselves, but their parents, and I'd be willing to bet that parents are more vigilant about the health of their children than they are about their own health. Children get sick more often than young adults, too, and thus consume a lot of health services. (The 0-18 age group was responsible for 13.3% of U.S. health expenditures in 2004, according to CMS, the latest year for which an age breakdown is available.)
Plus, pediatricians already rely on the parents to get up-to-date information about the kids they care for, and seem more open about accepting consumer-entered data than physicians who care for adults might be.
Beyond PHRs, I think direct-to-consumer products in healthcare—not fitness, which really is a different market—cannot succeed in the current environment. "You have to go to those who pay the bills, namely insurers and employers," the February column said.
Kinsights actually is giving its PHR away for free. The company makes its money through advertising on its online parenting communities and forums. Kinsights isn't the first to offer a free PHR as an extra service to its core business—WebMD immediately springs to mind. It won't be the end of the world for the company if the PHR fails, but I actually believe a pediatric PHR stands a chance of success.