***Testimony of WebMD Health Corp.***

***by Philip Marshall, MD, MPH,***

***Vice President, Product Strategy***

***520 NW Davis, Suite 300***

***Portland, Oregon 97209***

***(503) 416-2523***

[***pmarshall@WebMD.net***](mailto:pmarshall@WebMD.net)

***Before the Consumer Empowerment Workgroup***

***U.S. Department of Health and Human Services***

***July 27, 2006***

WebMD Health Corp. ("*WebMD Health*") is pleased to discuss the role of
the Personal Health Record ("*PHR*") as part of an emerging environment
of consumer empowerment within the US health care system. Our experience
with providing PHR solutions on behalf of commercial health plans and
employers has shown that consumers can be active participants in the
process of ensuring their essential health data is available
*[when]{.underline}* and *[where]{.underline}* it is needed. Regardless
of its context, *i.e.*, in the design of a National Health Information
Network ("*NHIN*"), for emergency preparedness, or for providing the
foundation for greater health care choice and consumerism, the PHR can
serve an important role as an application that helps the consumer to
gather, store, manage and share their essential health data. Gathered
from across multiple providers, systems, and data sources, the PHR can
support improved treatment, benefit and provider decision-making, and
enhance communication with health care providers. The PHR is an enabling
technology, but not an end unto itself. The PHR is a vehicle for
consumer choice and can serve as a bridge across a fragmented health
care system.

The key points that WebMD believes to be especially important are as
follows:

1.  While a Personal Health Record can be created in a variety of ways
    using a variety of data sources, the objectives remain the same:

    -   To enable consumers to gain insight into their health history in
        order to provide a better context for treatment, benefit, and
        provider decisions.

    -   To enable care providers to have the essential, actionable
        health history in order to make clinical decisions, especially
        when a clinical record on that patient is not otherwise
        available.

    -   To support consumer mobility across the health care system

2.  The consumer should be engaged in the process of gathering, storing,
    managing and sharing their essential health data. Many things can
    support that engagement---including populating their health record
    with electronic data sources, providing value-added functions and
    decision support, and even providing incentives for participation.
    WebMD's experience shows that consumers can and will become engaged
    participants in the health information process.

3.  Consumers can be trusted to apply their own discretion on who to
    share their personal health information with, and how best to share
    it.

4.  A consumer-centric health record is an essential enabler for
    consumer-centric choice, and supportive of decisions within the
    context of a health care encounter, as well as outside the context
    of a health care encounter.

    -   While the value of the PHR within the context of a health care
        encounter is often discussed, the value outside the encounter
        could be even greater. In the private sector, the PHR today is
        serving a secure and actionable profile for automated delivery
        of personalized patient education materials, targeted clinical
        messaging, health management services and individualized
        decision support services that support greater consumer
        involvement in their health and health care.

    -   WebMD believes that a PHR that is tied to a particular care
        provider, or the system used by the care provider, therefore, is
        disadvantageous to the patient-consumer and perhaps even to the
        care provider. It is disadvantageous to the patient-consumer
        because it decreases their mobility and choice within the health
        care system, and does not provide access to all the relevant
        information necessary for consumer decision-making. It may be
        disadvantageous to the care provider because many care providers
        are unprepared to offer a PHR application to the consumer. True
        consumerism should include open, market-based choice of care
        providers based upon quality and cost.

5.  The NHIN and Regional Health Information Organizations ("*RHIOs*")
    must contemplate the potential of consumers using their own systems
    to connect into the NHIN. And yet we recognize that data portability
    and user validation are essential issues to solve. Perhaps
    reflective of these two challenges is the fact that most of the NHIN
    pilot projects only enable "closed" access to the NHIN whereby a
    consumer may only access their information through the provider's
    "tethered" system. WebMD believes that these barriers can be
    overcome.

    -   When it comes to user validation, a valid identity for the
        consumer should be able to be established not only by a care
        provider, but also by other trusted parties. At the very least,
        "covered entities" including health plans and plan sponsors
        should be trusted to validate the identity of a consumer.

    -   When it comes to data portability, we believe that data
        portability is critical for our health care system. But in
        particular, it is critical for creating a longitudinal,
        consumer-centric record that can support health care
        consumerism. And we believe that consumers can drive the process
        of data exchange with multiple systems through their PHR. Using
        \"tokens\" or similar mechanisms that express both the
        consumer\'s identity and their willingness to exchange data,
        consumers should be able to use their PHR as a \"bridge,\"
        motivating data exchange with multiple systems, including EMR
        systems.

Finally, WebMD would like to address certain specific
*[questions]{.underline}* that typically arise in the discussion of PHRs
across various settings:

1.  *What is needed to increase consumer awareness and engagement in
    Personal Health Records (PHRs)?* In our experience, the following
    motivations are linked to greater awareness and engagement in PHRs:

-   Promotional/Educational material that highlights the importance of
    greater insight into a person's health and health risks, the lack of
    essential health data at the point of care, and the role of the PHR
    in rectifying those problems.

-   Financial incentives that promote specific actions, such as the
    completion of a Health Risk Assessment or a PHR registration
    process.

-   Encouragement from care providers.

-   Chronic illness, especially with multiple care providers across the
    care continuum.

-   Value-added functions driven from the PHR, including communication
    tools and personalized information and resources.

-   The automatic importation of data:

    -   Laboratory Test Results

    -   Track Immunizations and other Preventive Services

    -   Medication History

    -   Condition History

1.  *What are the most valuable features and functions of a PHR from the
    patient perspective? Please summarize the real world experience or
    evidence to support this part of the testimony.* We support the
    findings from the Connecting for Health initiative, which identified
    several key features of PHRs that were attractive to consumers. But
    we believe that there are some functions which augment but are not
    core or essential to the PHR. Decision support applications,
    personalized content and resources, patient-to-provider messaging,
    and other services that may leverage the PHR can be quite valuable,
    but are not typically included in our core definition of the PHR.
    Our experience shows that the following functions are the most
    valuable features of a PHR:

-   Care Provider Access (e.g. in an emergency)

-   Automatically Importing Data

    -   Laboratory Test Results

    -   Track Immunizations and other Preventive Services

    -   Medication History

    -   Condition History

-   The delivery of personalized healthcare information including
    important clinical messages (alerts and recalls)

2.  *Would a minimum set of PHR elements ensure that consumers have the
    features and options most important to them when choosing a PHR?*
    The markets will dictate which features and options are most
    important to include in a PHR product. Using the definition of a PHR
    above, there are many different applications which may specialize in
    a particular area, or be designed to achieve a particular goal.
    Requiring additional or inconsistent elements to that design or that
    need could represent a barrier to consumer adoption and value.

3.  *Who should identify the most important elements of a PHR?* Consumer
    users and purchasers of PHR solutions, including health plans and
    plan sponsors, should identify the most important elements of a PHR.

4.  *If applicable to your testimony, please comment on how health and
    HIT literacy needs should be addressed through PHRs.* In our
    experience, Personal Health Records can be the foundation for
    greater health and HIT literacy. There are a number of ways in which
    PHRs can address this issue: through promotional materials driving
    consumer participation; the display of health concepts in the PHR
    that are consumer-understandable; the delivery of personalized
    patient education and decision support based upon the consumer's own
    health needs and learning style; improved condition management;
    enhanced quality of care; and more efficient patient-provider
    communication.

5.  *How can interoperability be achieved between PHRs and electronic
    health records (EHRs)? Please also comment on when this could be
    accomplished.* WebMD believes in the ability for consumers to drive
    the process of interoperability between PHRs and other systems. The
    consumer's PHR is the most logical vehicle for essential health data
    between points in the care continuum, allowing the consumer to apply
    both discretion to the data that is shared, while also being able to
    augment that information wherever necessary. We support the emerging
    standards, in particular the CCR document standard and HL7 messaging
    standards, for facilitating this exchange. However, in our
    experience, most PHR-EHR interoperability solutions that have been
    announced to date have been "tethered" PHR concepts, whereby the
    identity of the consumer is held closely within the care
    environment, and the consumer interaction with their own data is
    only within the context of that provider's website. An alternative
    model is for the consumer to grant the care provider a key, or
    token, that can serve as a "bridge" between the EHR and the PHR.
    Such a model is attainable, with consumers taking a key position in
    driving interoperability. We anticipate that such solutions will be
    introduced into the marketplace in the next 12-24 months.

6.  *How can interoperability be achieved between PHRs and all of the
    providers from whom the patient receives health care services?
    Please also comment on when this could be accomplished.* As
    described above, WebMD believes that consumers can drive
    interoperability with data collected by providers across the health
    care continuum. Using the mechanism already described, whereby
    consumers "bridge" disparate health care systems using their PHR, a
    longitudinal health record can be managed by the consumer and made
    available to all care providers.

7.  *Should the market be left alone for innovation or could vendors
    compete around a minimum criteria set for PHRs?* The PHR solution
    providers should be able to respond to the needs of their consumer
    users and purchasers without a requirement to adhere to a minimum
    criteria set. Such a criteria set could provide a barrier to an
    effective PHR solution designed for a narrowly-defined population or
    set of functions.

8.  *If you think certification is necessary for privacy and security,
    interoperability or a minimum set of functionality, is the timing
    important and is there a sense of urgency given the diversity,
    complexity and mobility of today's population and the demand for
    availability of PHRs at the point of care?* For those systems which
    are going to connect to the NHIN or RHIOs, a process of privacy and
    security auditing, and evaluation of consumer authentication, seems
    appropriate. However, as previously stated, we believe that PHR
    solution providers should be able to respond to the needs of their
    consumer users and purchasers without a requirement to adhere to a
    minimum criteria set. For this reason, the timing of certification
    or audit would best coincide with the evolution of the NHIN.

In closing, thank you again for allowing WebMD Health to comment and
offer its perspective on the role of PHRs as part of an emerging
environment of consumer empowerment with the national health care
system. We stand ready to support the US Department of Health and Human
Services, AHIC and the Workgroup in this important initiative.