In the July 11 cover story entitled "Healthcare’s Holy Grail," U.S. 1 reported on the efforts of a Princeton-based firm, Zweena, to create a system of digitized and portable personal health records. One of the experts cited in that article, David Lenihan, the co-founder of CareGain in Windsor Corporate Park, has been working in the consumer-directed healthcare field for five years (U.S. 1, February 27, 2002). When CareGain was bought by FiServ, he moved to Hx Technologies, a Philadelphia company that aims to share healthcare data, especially radiology data.

In the article, Lenihan was quoted as saying that the next big hurdle for Zweena is "to assemble broad and deep data and deliver it to where it is needed." Lenihan now writes to amplify those comments:

The U.S. government and many state governments are demanding advances in healthcare information technology. These "calls to action" usually call for Electronic Medical Records (EMR) or some mechanism for sharing information that is clinically relevant and that will deliver "better outcomes" for our population. These are noble objectives uttered by politicians, but noble nonetheless.

There are many efforts underway in support of EMRs. The sponsors of these efforts include government (calls for transparency in pricing, calls for digital records, etc.), public funding of Regional Health Information Organizations (RHIOs), E-prescribing efforts, claims-based clinical summaries (based on health care claims data held by payers), and so on.

New entrants to the marketplace include private initiatives for development of Personal Health Records, including activities by the leading software companies to create a consumer version of a PHR, self-populated PHR information companies like Zweena Health in Princeton, and an employer consortium named Dossia, sponsored by Wal-Mart, Intel and other employers. Employers – tired of waiting for health plans and/or government – are trying to jumpstart this movement on their own.

The end – having clinically relevant information in the hands of consumers – is a good end. Having clinically relevant information in the hands of those treating the consumer is also a good end. However, it is important to keep in mind what we are dealing with when we talk about EMRs (the generic); PHRs (information controlled by the consumer); or EHRs (information in the hands of a doctor or clinician).

We must remember that all these situations are "accounts" – accounts in the sense that information can be deposited into them, updated in them, presented in them. If one sees these records as accounts, then they have to be domiciled somewhere (in a bank, under the control of an employer, a health plan, the individual, on the internet, in some government computer) so that the information can be retrieved and used.

The "domicile," or place the information is held, is one of the two critical issues that need to be addressed. The other is how the record or account will be populated with data. Will it be self entered, will be based on limited information such as claims data, will it be "googled" or pulled together from disparate sources? Answers to these two critical issues will need to be addressed and there is no "right" answer, but the two issues must be addressed.

I have been interested and involved in personal health information for some time as a co-founder of CareGain, the country’s leading provider of technology solutions for consumer directed healthcare, and now as the CEO of Hx Technologies, a company dedicated to sharing clinically relevant data, starting with radiology data (one of the three really valuable pieces of data for individuals to maintain, the other two being lab data and pharma data).

My opinion: PHRs and EHRs should be offered by many vendors with the look and feel, ease of use, price and other comparable features of these products to allow consumers to use what is right for them. The domicile or location of the product can be anywhere, including banks, on the net, at employers (but who would want that unless it were truly portable), and at health plans.

Personally, I would rather have my account on the net – accessible when I want where I want and with the security that I demand – so that I could make all the information available to my wife and my doctor, but maybe only some of the information available to a nurse or pharmacist.

Given that this is America and that our population, including me, is unlikely to put the data in an account and maintain it, I would like some ability to "google" the information and pull it into my account when I need it, or when my child needs it, or when my parent needs it. We have developed marvelous search engines for all types of information. It is now the time to have the ability to access our medical information – which by the way – we as citizens own. Let’s get working on the systems to deliver us the information we need to lead healthier lives and to use our limited resources (money and time) more efficiently.

I am open for questions on this subject. – David Lenihan

The writer is CEO, Hx Technologies Inc., 340 North 12th Street, Suite 321, Philadelphia 19107. E-mail:

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