From Apple to Apps: An Early Innovator’s Perspective on the Future of Personal Health Records

Few people fall in love with health information systems because of someone bombing battleships, but Peter Groen is an exception.  In 1981, while working as a computer systems analyst at a hospital in Atlanta, he was part of a team that helped a paralyzed patient to communicate by carefully attaching an electrical lead to the man’s eyelid by which he was thence able to instruct the computer to “bomb” targets in an early Apple video game. “We knew that a thinking man was trapped inside that body when he was able to follow instructions and successfully play the game.  We were then able to write a simple program that let the patient ‘write’ a simple message using a similar method of controlling the computer.”  Groen was hooked: “I couldn’t see working in finance, marketing or sales after that.  I wanted to use my knowledge to help people and working in health care was the right place to do that.”

Groen has since led an impressive career, holding several major IT positions within the Veterans Affairs (VA) administration, including service as the national project manager responsible for implementing the VA Computerized Patient Record System; he has helped guide West Virginia to a leadership position 1 2 3 in the electronic health/medical record field, capitalizing on open source solutions; he co-founded the Shepherd University Research Corporation; and has also co-authored several books on medical informatics, addressing the technical, ethical, and behavioral aspects of emerging electronic health systems.

I called Mr. Groen recently in order to gain some perspective on the future of personal health records (PHR’s), which allow patients to interact with stored personal health and medical information and employ it to improve their well-being (myPHR.com, incidentally, has a wonderful applet for recommending a PHR according to cost and format).

Three themes emerged from our discussion of PHR’s:

1)    The power of PHR’s will be affected strongly by the robustness of underlying electronic health record (EHR) networks : the ease with which an individual can draw upon records sitting in various institutions’ EHRs; in order to inform their thinking about their health it will also depend on the development of regional, and then national, networks to connect distributed medical information systems. However, we are still a long way away from that (over a decade away, according to Groen), as many institutions haven’t yet computerized their in-house medical records.  Groen drew an analogy to the history of the banking system and explained that online banking depended on a similar trajectory of local computerization and then regional and national networking that took place over a period of 30 years.

2)     Most people are not likely to peruse their entire medical history on a regular basis but would be more likely to interact with ‘health apps’ that meet specific personal needs: diabetes monitoring, eye care, weight loss efforts, blood pressure, anemia, etc. (Here, by the way, are a few health apps and here is a story about a man whose life was saved by a health app, after the earthquake in Haiti.)

3)    Electronic records are likely to change the doctor-patient relationship: This argument may go without saying but it is worth reflecting on the changing patterns of behavior since medical information sites such as WebMD took root: Imagine the increased confidence a patient will have once he is used to getting regular reminders, tips, and explanations for monitoring an existing condition, or preventing a future one.

A short blog post cannot do justice to the deep interest of Mr. Groen in health information systems: We touched on subjects as diverse as the intricacies of open source EHR software; the future of wearable monitoring systems embedded in clothing; implantable technologies; and the engagement of the entertainment industry to hep spread information and awareness about developments in the field.  I hope to revisit some of these topics, with reference to Mr. Groen’s professional work and writings, in future posts.

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