[MUSIC] Hello, I'm Nicholas Genes and this lecture will focus on the failure of personal health records. Try to imagine the most important piece of medical data about you. Is it an allergy you have to a specific drug? Is it a medical condition that can manifest in certain ways that doctors are going to need to know about? Is there something crucial that you just need to communicate to people that are taking care of you? And then imagine a certain situation where you can't communicate. How can we get that information into the hands of the people that are making decisions about your health? This is a scenario that has driven a lot of medical investments or health IT investments over many years. And yet I think it has led to some dead-ends in personal health records. We'll explain. John Halamka is an interesting figure. He was an early leader in health IT. He is emergency physician and works at Harvard as their CIO, their Chief Information Officer. And he describes a news case scenario called Unconscious in the Emergency Department. And this is a scenario that has driven a lot of healthcare investment to help IT investment and led to some platforms and decisions that we'll talk about. But believe it or not this scenario doesn't happen that often and while there are sometimes key items that need to be conveyed to providers in the emergency department and that the patient is unable to, that can create a lot of risk. Believe it or not, a very low tech solution that has existed for decades is simply a bracelet, a bracelet that conveys key medical diagnoses or key allergies that doctors will have to know about. There has been the thought over many years that perhaps we could do better than a bracelet. Perhaps we could have a system where doctors could access data and learn about past visits, past medical history, past medications that a patient might be on. Or even risk factors that they have so that if they do show up unconscious in the emergency department a doctor can save a lot of time, and save a lot of redundancy, and protect the patient by accessing this information. And various forms of, various solutions have been proposed. One of the most bold and interesting solutions came out more than ten years ago and it was an implantable chip. Imagine just sliding something under your arm that can be accessed by a doctor with a special wand so they could interrogate this piece of technology that's in your arm and learn about your past history. And so even if you can't advocate for yourself, even if you are unconscious, a doctor could know everything that's relevant about you before making any big medical decisions. This didn't take off, and we can imagine many reasons why. It's probably a little painful. After you implant the chip it becomes cumbersome to actually update the information that's in there. And if a doctor has access to this chip, to read all kinds of data from you, that doesn't prevent other people from gaining access too. And it actually posed something about security risk. Other solutions include smart cards, just having a card on you with a chip that is understandably a lot easier to update. In fact you can present this card at clinics. A lot of patients have told me over the years that they really resent having to fill out the same information at clinics over and over again. The smart card could reduce a lot of that redundancy and if you showed up unconscious in the emergency department, a doctor could check your wallet, see the smart card, and check that data and then know all there is to know about you medically. So that was a proposed solution and that gained a lot more traction than the implantable chips. And then finally there were cloud based solutions like Google Health or Microsoft Health Vault. And these systems didn't have a chip but they had passwords where you could authenticate log in and then see your data. And you can imagine if a patient could do this, then they could share their data with a provider or pharmacist. And this data could be kept up to date, and then during the unconscious in an emergency department scenario, someone would be able to log in and view crucial data to make informed healthcare decisions. Google Health also didn't catch on. And a lot of these patient health record systems failed to succeed or failed to gain enough traction to make it worth continuing these systems. Why is that? Why did these technologies fail? Well it turns out first and foremost the unconscious in the Scenario is surprisingly uncommon. And the bracelet works well enough for the majority of scenarios where some important information needs to be conveyed. Smart cards there are security risks here too, they can get lost or stolen and they have to interface with every clinic, otherwise they simply lose their relevancy. So if you have one clinic that can read your smart card but then you have to go see a specialist at another clinic and that specialist recommends a new medication, but that smart card can't read that new medication then suddenly your smart card is obsolete or is out of date and it doesn't carry the latest information about you. And finally these cloud based solutions like Google Health required a lot of the patient. The patient would have to often update the information themselves, upload all their past medical history, upload documents, upload medication lists and dose. That is a hassle and there wasn't a lot of incentive for clinics and healthcare institutions and even pharmacies to integrate with these siloed repositories. Google Health famously refused to be a business associate of healthcare institutions, so they couldn't be part of a HIPAA compliant chain of health data. And so a lot of healthcare organizations were really reluctant to share data with Google because if there was a hack or a breach, the healthcare institution would be liable and Google would not be. In the meantime, and this is a timeframe throughout most of the 2000's. As these patient health record repositories were trying to take off and failing, electronic Health Record patient portals were under development. And starting in 2009 their use was incentivized by the Federal government, so that really spurred vendors of electronic health records to ramp up their development of patient portals. And patient portals are actually good enough for the vast majority of functions that patients are interested in. They give on demand access to crucial aspects of the chart. They're updated automatically, often after every visit. And they facilitate a lot of key functions that are important to patients. Patients can update their, can refill their prescriptions. They can send messages to their provider. They can even sometimes schedule appointments. These are all functions that of course, an implantable chip could not do and that's why I think patient portals have caught on and patient health records as we understood them in the last decade, failed to catch on. Thank you. [MUSIC]
