Tories may offer private record stores

Tags: Conservatives Google Google Health Government GP GPs Health Vault Microsoft

06 Jul 2009

Patients may be given the option to transfer their health records to Google or Microsoft personal health record platforms under a Conservative government.

According to newspaper reports, patients may be given the option of moving their medical notes to services provided by private companies, such as the US technology giants.

Both technology firms have been developing PHR systems. Microsoft HealthVault and Google Health are now in early stages in the US. Neither system has yet been launched in the UK.

The Times quotes Conservative sources as saying: “We are 100% certain there will not be an exclusive deal with one provider. We fully expect multiple providers that will almost certainly be free to users.”

Such systems would most likely be funded by allowing advertising to be incorporated into future patient records services.

The Conservatives are due later this month to publish a review of NHS IT policy, which has been carried out on its behalf by Dr Glyn Hayes, a past chair of the British Computer Society's health informatics forum.

They have already said they will replace the electronic patient record projects of the National Programme for IT in the NHS.

However, sources close to the review have warned that PHRs, though offering potential, remain largely unproven yet in the US or elsewhere. They stress that PHRs are a useful tool to supplement the complex detailed legal medical record maintained by doctors, but are not a replacement.

The Department of Health last shelved its ambitious development and implementation plans for the NHS’s own national PHR system, HealthSpace. Unlike other rival commercial systems HealthSpace is desigedn to be fully integrated with, and not separate to, the detailed medical legal records used by GPs and other health professionals.

The Conservative plan appears to be to enable people to choose from a range of private sector PHR providers, possibly including those operated by Bupa. Other candidates likely to be in the frame include primary care software firm EMIS, which is already provides patients with online access to their GP record.

According to the Times report the move to PHRs raises questions about the party’s links to Google. Steve Hilton, one of David Cameron’s closest advisers, is married to Rachel Whetstone, the company’s vicepresident of global communications and public affairs.

Five months ago, the party announced that Eric Schmidt, Google’s chief executive, was joining a Conservative business forum to advise on economic policy.

The Times quotes an un-named senior Tory source as saying: “We’re thinking about how in government the architecture of technology needs to change, with people ‘owning’ their own data, including their health records.”

The source added: “We are 100 per cent certain there will not be an exclusive deal with one provider. We fully expect multiple providers that will almost certainly be free to users.”

Jon Hoeksma

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Reader's Comments

What sort of advertising?

07 Jul 09 10:07

Responding to the Times extract quoting a Tory source

"The Times quotes Conservative sources as saying: “We are 100% certain there will not be an exclusive deal with one provider. We fully expect multiple providers that will almost certainly be free to users.”

Such systems would most likely be funded by allowing advertising to be incorporated into future patient records services."

This is the holy grail for vendors like Google and Microsoft. Being able to display personalised advertising within the context of a health condition means that the premium rates can be charged to advertisers.

For anyone already using gmail - you can see how advertising is directed based on the context of the contents of the email - further populating a Google or Microsoft PHR with a full health history would allow data mining to take place to target high cost advertising possibly to individuals who may be vulnerable. GeoLocation services would also allow localised advertising as users would have to login to use the system.

The question overall however is what sort of advertising would be allowed? The US is already quite liberal in terms of pharma and device advertisin. There is now a strong lobby within European Pharma working through Patients Groups to allow DTC (direct to consumer) advertising of prescribed drugs and the Tory position clearly responds to that.

For the Tory position to be credible therefore and not just an opportunistic lash against the 'NHS Computer' as Cameron dubs the Natioanl Programme, detail of what sort of advertising and the limits that would apply is required.

A response from Microsoft or Google to this post would be helpful although I doubt it will be forthcoming.

Health records on Google / Microsoft platform

jean@hcjean.demon.co.uk

07 Jul 09 12:07

Having spoken at a National Library of Medicine meeting recently in the US where both named companies spoke on their offerrings for PEHR, grave concern in my mind was raised by two commercial presentations from Microsoft Health and Google, Research and Special Initiatives. Balancing corporate statements with genuine health domain sensitivity appeared to become challenging at times for the two speakers!

The Microsoft HealthVault record is controlled by the patient, who also decides what goes into it and who can [selectively] see and use your information on a case-by-case basis. I wonder how integrity and completeness is achieved in this record and where the liability for clinical decision making based on its (residual)content sits ?

Google majored on the ‘aggregative value’ of their model, endorsing a development path that ‘launched early and iterated often’. Whilst it may be a satisfactory paradigm for open source IT developments, suggesting change ‘on the bounce’ for an operational decision support system for health is very worrying. The Google Health policy guidance for third party apps suppliers (http://www.google.com/intl/en-US/health/about/devpp.html) states ‘Allow users to permanently delete and purge the data derived from their Google Health profiles; backup copies may exist for a short time’. The logic for such draconian editing was suggested to be that ‘If a Factoid is buried in chaff, can a clinician be sued for missing it’.

I wonder if a fact is deleted that materially jeopardises the treatment decisions made, can a clinician counter-sue the record subject for compromising their professionalism?. For a patient to be able to present, as fact, a selectively edited history of their clinical condition(s) would I would have thought ‘driven a bus’ through any resulting litigation attempts, and runs totally counter to the principle in the UK of allowing no deletions but only attributed annotations.

Both suppliers gave an image of a cavalier attitude to the integrity, completeness and consistency of records when used as decision support to care delivery. I too would be happy to hear discuss further BEFORE such views become reality (or even a contractual base) over here!

A naive view for Cameron

07 Jul 09 13:07

Politicians can't resist looking for simple solution to complex problems. However, in health informatics there are no White Knights or Magic Bullets. Sadly, the solutions we need are complex too.

PHRs are important and useful, but it is worrying to think that an incoming Government might see them as a major part of the solution to properly supporting the NHS and its patients with IT - They are at best an important element amongst many.

PHRs need to integrate appropriately with NHS and other healthcare provider's enterprise systems. The opportunity and environment are very different in the UK compared to the USA, in many ways more fertile, and we have as much, if not more, to learn from the work of the likes of PAERS as Google.

Talk of patients (or anyone else) "owning" their record misses the point. No one can meaningfully own a health record (they might own a particular instantiation). Rather, many people have rights and responsibilities relating to an individual's health record, all of which have to be respected, the patient maybe primus inter pares in this context but they are not sovereign.

Finally, current and proposed business models of most of the US PHR providers, won't work in the UK and indeed some (those involving direct to consumer advertising of prescription medicines) are illegal under European Law. We need to consider carefully what business models might work in the UK and not assume that the US providers will find a way of delivering their service in the long-term without cost to patients or the taxpayer.

Ewan Davis.

The Need for Rational Discussion

m.j.rigby@hpm.keele.ac.uk

08 Jul 09 09:07

How valuable an informed debate on E-Health Insider can be. The Conservatives have fallen into the very trap they claimed to want to avoid - political interference and a volley of headlines driving health policy. As ever with healthcare, and with informatics, the devil will be in the detail, which politicians do not have time for and headlines exclude. There is no problem either with patient choice, or with use of the private sector. But how will the elderly, and those without home computing, exercise informed choice? Jean Roberts and others neatly argue the issues of the ethics of targetted advertising, and of incomplete edited records. How will the competing systems advertise their respective merits? What regulation will there be? And who will look after the disadvantaged, young, elderly, and those with mental health or other difficult conditions? But equally, the paradise of the cradle-to-grave electronic record, initally promoted by the US Institute of Medicine but with no models, metrics, or demonstrations of practical feasibility, has its own problems. There is a need for an objective analysis, removed from both politics and vested interests, to examine options. Will the BCS (possibly with the Royal Society given their previous constricutive intervention) take the lead?

Why not trust local trusts with patient records?

10 Jul 09 15:07

The Conservative proposals not only fail to address a number of fundamental issues such as security, funding, existing NHS standards and integration with other NHS systems but they draw attention away from the real debate at a critical time for the National Programme for IT (NPfIT). Do we really need a centralised patient record system or should responsibility be devolved down to NHS trust level? NHS Trusts already have investments in patient record and appointment booking systems and relationships with / and the trust of local citizens. Why not use the web to enable individual trusts to provide secure access to records for other trusts and patients themselves, rather than duplicating everything centrally? This needn't mean new systems for each and every NHS Trust, far from it! In the time that the NPfIT has been running, web technologies have developed to the point where a web front-end can be quickly and cost-effectively developed and overlaid onto existing systems.

Surely making local trusts the guardian of patient records offers the best of both worlds? A trusted and responsible guardian that the public can identify with, without the huge costs and duplications of a centralised system would be a far better use of public funding.

Simon Skillen, health practice manager, Adobe UK