Program for Health Systems Improvement

David Lansky on Health IT

New Harvard Center Links Health and Law

Project Updates
Disparities and Quality

Summer 2006

David Lansky: The Value of Giving Consumers Personal Health Records

Many experts see giving consumers greater access to their own health information as a critical step to improving health and assuring continuity of care, particularly for those with chronic disease.  Although there has been an upsurge in the availability and use of personal health records, it remains a relatively nascent part of health care delivery.  David Lansky, senior director for health programs at the Markle Foundation in New York, recently talked to PHSI about the value of PHRs, the state of adoption, and what government and academic leaders can do to promote wider use.

Q: How does a personal health record differ from the electronic health record? 

DL:  With a PHR, the individual accesses and controls their personal health information and they decide who sees it and what is in it including information from all sources of care as well as the patient.  The EHR is a medical legal document that is under the control of and is the responsibility of a particular clinical care setting.

Q: How extensive is PHR use today?

DL:  There are many different types of PHR ranging from provider portals that allow patients to view their electronic health record from home to comprehensive programs for use on PDAs or home computers.  There may be as many as one million people using portals and far smaller numbers using independent software tools.   Many health insurance plans are offering their members PHRs that are filled with administrative data.

Q: What are some of the barriers to PHR adoption then?

DL:  Patients are more likely to use a PHR if it is recommended by their doctor and few doctors are convinced that PHRs add value, rather than risk and burden - to the care process.  And there are few standards for PHR data that would enable the patient to easily take her information to a new doctor or health plan.

Q: What will encourage uptake?

DL: The short answer is that most people, most of the time don't want responsibility for managing all of their health information.  Their information becomes much more important when they get sick and need to make complex decisions. We expect that PHRs will be more highly valued when they are able to deliver specific value to people with specific needs like managing diabetes or caring for a parent with Alzheimer's disease and they will do that best when there is a national information network that allows critical information to be easily and appropriately shared wherever it's needed.

Q: Right now adoption of EHRs is moving slowly.  Why worry about PHRs?

DL:  These are two different services meant for two different types of users. A PHR may have value even if your doctor does not use an EHR.  A lot of your medical data is already available electronically and can be brought to your home computer your medications, lab test results, diagnostic images, procedures and diagnoses. We shouldn't delay using PHRs until all health professionals are using interoperable, connected EMRs we'll be waiting a long time.

Q: What can the government do?

DL: The government should ensure that the nation has a health information environment in which information can be shared where and when it's needed.  That means having standards and policies that create information portability and instill public confidence that individual privacy will be protected.

Q: What should academic institutions like Harvard do to promote wider use of the PHR?

DL: Hospitals like Harvard's already are giving patients more access and serving as key laboratories to see the effect of PHRs on patient care and personal health.  Harvard's public health and public policy leadership also provides an opportunity to educate the nation's leaders about the importance of giving patients more information and more control and eventually redesigning health care around the empowered, informed consumer.

Q: How optimistic are you that PHRs will become mainstream?

DL: That's inevitable.  The big unknown is what they will look like and how they will be connected to a national information infrastructure tapping all of your health information wherever it is, applying specific, high value intelligence to that information, and enabling two-way communications with health professionals, other patients, and those who want to offer innovative health services.  When those pieces come together, PHRs will be the enablers of system-wide transformation.

Petrie-Flom Center: Valuing the Link between Biotechnology, Ethics and Law

Rapid developments in areas such as stem cell research, end of life decision-making and the health care marketplace have raised new and complex issues that cross the boundaries of law, health policy and medical ethics.  The Petrie-Flom Center for Health Law Policy, Biotechnology and Bioethics was established at Harvard Law School in 2005 to foster interdisciplinary research on a range of sociological, philosophical, political, economic and legal topics.  The Center is reaching out to faculty and students from around Harvard University to stimulate debate and research in areas that increasingly link in some way to each other.  "The relationship between technology and health care costs, or technology and intellectual property rights are examples of important, yet relatively unexplored areas of health care law," says Faculty Director Einer R. Elhauge.  "This Center will connect the necessary disciplines and encourage discussion of cross-cutting issues created by advances in science and technology," he adds. 

This fall Professor Elhauge will teach a health law workshop that will feature leading academics from around the country, including law school faculty from UCLA and Stanford and faculty from the Yale School of Public Health and the Duke Institute for Genome Sciences and Policy. The workshop is open on a drop-in basis to the greater-Boston academic and health policy communities.  The Center is particularly encouraging students, fellows and faculty from other Harvard health policy and bioethics programs to attend. The workshop is part of a newly-expanded health law curriculum at Harvard Law School that includes courses on health law policy and bioethics, FDA law, political economy of health care, medical malpractice and public health law.  A schedule for the workshop is available on the Center's website; the link is provided at the end of this article.
The Center supports fellowships at the student, post-graduate/mid-career and senior levels. The Center's first four post-graduate fellows arrive this summer, and the Center presently is accepting applications for a second group that will start in the summer of 2007. Although most fellowship candidates have law degrees and are on or returning to an academic track, a legal background is not a requirement. The inaugural group of post-graduate fellows will explore legal issues related to commercial arrangements for reproductive services, patents and biotechnology, bioterrorism and pandemic disease, the ethical and religious objections of medical professionals to provide certain treatments and intellectual property and biopharmaceutical research.  In addition to the post-graduate fellows, twenty students from Harvard Law School and other Harvard graduate programs have been selected for one-year fellowships during the 2006-07 academic year.  The Petrie-Flom Fellowships are the only law school-based fellowships in the country that focus on health policy and bioethics. 

The Center also sponsors conferences and lectures that are open to the public. Information on the Petrie-Flom Center and its fellowships and other programming is available at

Project Updates
New Research: Do Efforts to Improve Quality and Reduce Racial Disparities Collide?

Are the goals of improving quality and reducing racial and ethnic disparities in health care complementary or conflicting?  A pair of Harvard researchers will examine the relationship between these objectives to identify strategies to advance both goals. The Institute of Medicine and others have called for improving the quality of health care and reducing disparities.  Some claim that improving the quality of care in general will reduce health care disparities, while others claim that targeted, minority-group efforts are needed to narrow unexplained gaps in the quality of care for minority and non-minority populations. Harvard's Eric Schneider and Thomas McGuire say there is limited evidence on the question of whether these strategies are complementary or conflicting and that efforts to improve quality and reduce disparities could be at cross-purposes. The researchers will examine available evidence on the relationship between health care quality and racial and socioeconomic disparities and attempt to describe the conditions under which quality improvement initiatives and disparity reducing initiatives are likely to be complementary and conditions under which they are likely to conflict with one another. 


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