Several significant events have driven public and industry interest in personal health records. In 2004, President George W. Bush outlined a plan for the implementation of an electronic health record that could be accessed by all Americans. Although numerous companies had been in this market for several years, the announcement provided impetus for growth in this area. In 2007 and early 2008, computer giants Google and Microsoft announced their intentions to enter into this market, Google with Google Health and Microsoft with Microsoft HealthVault.

In March of 2008, laboratory industry leader Quest Diagnostics announced a partnership with Google Health to provide uploading of laboratory testing to Google's version of a personal health record (PHR).

The U.S. Department of Health and Human Services cites six positive outcomes with the implementation of widespread personal and/or electronic health records.

1. Improved healthcare quality

2. Prevention of medical errors

3. Reduction of healthcare costs

4. Increased administrative efficiencies

5. Decreased paperwork

6. Expanded access to affordable healthcare

Although there are a number of potential barriers to widespread implementation of personal health records, three are the most significant. They are:

1. Interoperability. The various systems need to be able to interact with each other and various computer systems.

2. Privacy and Security. The systems need to provide HIPAA-like compliance, but also have security measures similar to the banking industry and in compliance with a variety of industry standards.

3. Data Modification. In order for physicians to be able to act on medical information, they will need to be confident of the veracity of the medical data. This will at least partly require that they be able to determine the sources and modifications that have occurred to the information in personal health records.

Although there are a number of companies currently in the marketplace offering personal health records, they fall into four broad categories.

1. Standalones. These companies are primarily personal health record companies, such as LifeOnKey or FollowMe. In some cases these companies also specialize or have specialty subcategories, such as MiVia, which was designed for the migrant farmworker population, or LifeOnKey's Diabetes focus or Women's Health focus.

2. Spin-Offs of Information Technology or Software Companies. Most notable in this category are Google Health and Microsoft HealthVault.

3. Healthcare Providers. Examples of this are Partners HealthCare's Patient Gateway and the Group Health Cooperative's MyGroupHealth.

4. Platform Providers. In some cases, the companies are focused less on being the patient/consumer's personal health record, than in providing the platform and/or technology for personal health records. MedCommons is an example of this. Microsoft HealthVault may also fall into this category. FollowMe also is willing to customize their product for other companies, which then provide their own branding.

There are five ways personal health record providers are generating revenue.

1. Subscriptions. Typically, standalone PHR providers charge nominal annual subscription rates ranging from about $25 to $50.

2. Advertising. Google Health and Microsoft HealthVault indicate they will generate income via advertising. It's not yet clear how Microsoft intends to do this, but Google Health has indicated that their product itself will not contain advertising, but will have search boxes that connect to the traditional Google page, which does have targeted advertising.

3. Data mining. Although often mentioned as a possible source of revenue, few companies indicate they are currently selling non-user-identified health data to researchers or pharmaceutical companies.

4. Increased Service. Healthcare providers, in general, acknowledge that their personal health record systems are just part of the service and a happy client will remain with the system. Google Health indicates they aren't in the healthcare business and part of their mission is to drive users to Google.

5. Subcontracting and licensing. MedCommons is focusing on providing their services and platform technology for other users and companies that might want to deliver personal health records. It's not clear if Microsoft HealthVault plans to enter the market in this fashion, but many industry sources suggest it's likely.

Ultimately, what is clear from looking at a cross-section of PHR providers is that there are a number of approaches to dealing with laboratory results depending on the nature of the PHR. Google Health has recently announced a partnership with Quest Diagnostics.

This is likely to be the first in a number of similar relationships with other laboratory corporations. The real question, one that remains unaddressed yet, is whether competing labs will create partnerships with Google Health and other PHRs or whether it will become an exclusive and competitive marketplace, where some PHRs will find their services locked out of the market.

Another potential question is whether or not a laboratory, independent or affiliated with a particular healthcare provider, is going to be able to provide data uploads to a myriad of different PHRs. Although largely a technical issue, it's hard to see how a laboratory needing to provide results to twenty or thirty different PHRs in addition to requesting physicians and patients, is going to make laboratory medicine more efficient or cost-effective.

PHRs Gain Momentum

In his January 20, 2004, State of the Union Address, President George W. Bush outlined a plan for the implementation of an electronic health record that could be accessed by all Americans. The system was to be in place by 2015. According to the White House Web site, patient participation would be voluntarily, and "these electronic health records will be designed to share information privately and securely among and between health care providers when authorized by the patient."

To achieve that goal, the following steps were taken:

1. Health Information Standards were adopted. Under the direction of the Department of Health and Human Services, in cooperation with other Federal agencies and the private sector, voluntary standards were to be identified and endorsed.

2. Health Care Information Technology Demonstration Project funding was increased to $100 million.

3. Federal agencies were encouraged to adopt Health Information Technology.

4. A sub-cabinet level position of National Health Information Technology Coordinator was created. This falls under the Office of the National Coordinator for Health Information Technology, part of the Department of Health and Human Services.

It's important to note that the Bush Administration's proposal did not break new ground. Numerous companies providing personal health records (PHR), medical health records, and electronic health records or some way of storing and delivering medical information electronically were in existence for several years prior to the Bush Administration's efforts.

The announcement of launches into the health information technology (HIT) arena by Google and Microsoft has renewed media interest in the area, and may signal a renewed velocity and vigor to the market.