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Ken Terry
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Cloud Services May Replace EHR Portals

EHR integration with Box suggests a trend: cloud services for care coordination and one-stop patient record access.

Patient portals attached to EHRs are spreading rapidly, mainly because of the Meaningful Use Stage 2 requirement that providers share records electronically with patients. According to a new Frost & Sullivan report, 50 percent of hospitals and 40 percent of ambulatory physician practices already have such portals. But it's unclear whether this kind of patient portal has the functionality required in the long run for patient engagement and collaboration among unrelated providers.

One recent development shows the possibility of an alternative path. The cloud-based file-sharing vendor Box announced that a link to its service has been embedded in the cloud EHRs of Dr. Chrono and CareCloud. Physicians using these EHR systems can easily transfer patient records to Box, where patients can securely download them or transfer them to other providers.

Theoretically, if Box or some other cloud service provider persuaded enough EHR vendors to sign on, patients with multiple providers could download and aggregate all their records in one place. Instead, they must now access their records on multiple portals attached to the EHRs of different practices and hospitals. According to a recent KLAS report, just 14 percent of EHR-tethered portals included information from health information exchanges (HIEs), and 11 percent included data from other EHRs.

Albert Santalo, president and CEO of CareCloud, told us that it decided to embed Box because it is ubiquitous and easy to use. "While CareCloud also has the ability to share records through our own portal, we feel that Box is a more widely used platform." Also, patients want to download records from multiple providers. "Sometimes they want to go beyond a patient portal, so Box facilitates that."

Santalo believes that patients should be able to access all of their records in one place. "Patients should be in control of their records, it should be easy to get to, and it should be a byproduct of what the doctor does. The patient shouldn't have to do a lot of work to populate their personal health records. That's why other initiatives have failed, like Google Health and Microsoft HealthVault. They put too much burden on the patient."

Microsoft, which still operates HealthVault, has long tried to get providers to send patient records to HealthVault, so they can be stored in patient-controlled personal health records (PHRs). Its website says "a growing list of labs, pharmacies, hospitals, and clinics" will send patient records to HealthVault upon request, but it hasn't made any big announcements about this in years.

The Meaningful Use regulations allow providers to send records to PHRs to meet the record-sharing requirement. So Microsoft has applied for certification of HealthVault as EHR technology that can be used to show Meaningful Use in Stage 2. Missy Krasner, managing director of health and life sciences for Box, said it is considering whether to seek Meaningful Use certification.

However, Femi Ladega, global industry technologist for healthcare and life sciences at the consulting and research firm CSC, told us the ability to help providers achieve Meaningful Use is secondary to the other advantages of a cloud-based patient portal. The care delivery model is shifting toward "a shared accountability with the patient," and this requires the capability to create two-way online communications between patients and all their providers.

To do that, he said, providers must create an infrastructure that goes beyond the EHR of an individual practice or hospital. "A health information exchange may be part of that infrastructure, and its dataset may be part of that ecosystem. But you need to pull data together from multiple sources."

A cloud-based portal will be needed to serve as a central point for patients to aggregate their medical records and forward them to their providers. However, such a portal must be able to "provide the right infrastructure for the associated data governance while assuring the data can be relied on and trusted." The portal also must show where each piece of information came from and enable providers to understand the context of the data "to drive the right interventions."

This kind of cloud-based portal can co-exist with EHR-related portals, Ladega said, but it must be able to give patients all the information they need to manage their own conditions, including educational materials, care alerts, and other self-management tools. And it must provide the capability for bilateral communications between patients and providers across care settings.

"That’s why you need an ecosystem that enables effective data sharing, underpinned by this infrastructure that allows you to trust the information that is being shared and allows you to act effectively on it," he said.

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Ken Terry
Ken Terry,
User Rank: Apprentice
11/17/2013 | 5:56:02 PM
A workaround, at least
What Box is trying to do--and what many other companies are trying to do--is increase patient engagement in their own healthcare. Not only must data from multiple EHRs be aggregated in a patient controlled PHR, but providers must find a coordinated way to work with patients online to support their self-management efforts. None of this can be done by a single healthcare organization, unless that organization provides all of a patient's healthcare. While a cloud-based portal for this purpose might be regarded as a workaround, it will eventually be necessary to provide coordinated care and get patients more involved in their own care.
User Rank: Apprentice
11/17/2013 | 11:06:51 AM
Workaround possibilities
For Box to become a real contender in this space, it will have to partner with the EHR vendors. With more and more healthcare facilities and their networks implementing large EHR systems, someone is bound to start connecting the dots and create a total solution that suits doctors and patients alike (with the least amount of effort on both parts).
User Rank: Ninja
11/16/2013 | 1:41:27 PM
Re: A work-around, at least
Medical doctors should not have to become technology experts, on top of everything elde they do. If EHR is to work, it must make no additional demands on physician time
Kim Davis
Kim Davis,
User Rank: Apprentice
11/15/2013 | 4:41:17 PM
Re: A work-around, at least
True, and there are probably some better options than Box out there now.
Thomas Claburn
Thomas Claburn,
User Rank: Author
11/15/2013 | 1:25:02 PM
Re: A work-around, at least
Medical schools really ought to encourage physicians to treat technology as a way to differentiate their services. My primary care physician is of a different generation and maintains everything on paper. 
David F. Carr
David F. Carr,
User Rank: Author
11/15/2013 | 9:36:56 AM
A work-around, at least
At a miniumum, it strikes me that services like Box could be a work-around for some types of sharing that the patient portal doesn't allow, while still ensuring an acceptable level of security.
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