eHealthTrust opened its first large-scale health record bank (HRB), a secure repository where consumers can store and control their health information, in Phoenix last month. "We know the demand is there," said William Yasnoff, MD, founder of eHealthTrust, noting that thus far, a modest amount of local marketing to generate visibility has drawn "good reception from a small number of folks."

eHealthTrust is also in active discussions with a number of physicians who are interested in its Web-based, zero-cost electronic health records (EHRs). The proposition is attractive, given that stimulus dollars, while substantial, won't fully compensate physicians for both the conversion of paper to electronic health records and the initial productivity drop-off. "The business case for physicians still isn't very good," Yasnoff said.

eHealthTrust and Arizona Health-e Connection (AzHeC), which is leading a coalition to serve as the state’s only regional extension center (REC), have had discussions about how the two could work together. To date, no partnership has been formed, according to Melissa Rutala, CEO of AzHeC.

The not-for-profit organization, which was formed in 2007 to lead the state's creation of health IT adoption and health information exchange (HIE), is committed to moving nearly 2,000 physicians to meaningful use of EHRs over a two-year period, Rutala said. While many other RECs have selected vendors to work with, Rutala said their REC is vendor neutral and will work with any certified EHR vendor.

eHealthTrust is in discussions with several EHR vendors, who are "cautious but interested," he said. "They see the advantage of having their product in the market at zero cost, which will help increase their penetration," he said.

eHealthTrust is deploying the Internet business model of providing free basic services and various upgrades. Consumers can take advantage of a free "in case of emergency" form, which includes vital health information on the patient that can be printed out and carried. The company is planning an electronic-access version of the form.

Consumers can upgrade with a $99 one-time data collection fee to have an HRB account set up, which enables consumers to both enter their data and receive automatic deposits of their lab and medication information (and, later, other electronic records).

eHealthTrust is currently testing its data connection with the major laboratory in Phoenix and is in negotiations with several sources of medication information. "We expect our electronic feeds to be fully operational soon," said Yasnoff.

The third offering is an optional annual subscription to receive three different types of alerts for $19-$29/year each, or all three for $39. The "peace of mind" alert notifies loved ones if the patient's HRB is accessed by an emergency room physician. The other two are prescription refill reminders for health maintenance and prevention alerts, such as a reminder that a colonoscopy is due, tailored to the patient's demographics and medical conditions for the promotion of wellness.

eHealthTrust is also in the process of putting together a community advisory board of well-known community leaders. "Having a community advisory board is an important part of addressing the issue of consumer trust," said Yasnoff.

Privacy and security are cornerstones of the HRB concept, he said. "Our privacy policy is that the patient controls all access to their information in the health record bank," he said.

Deborah Peel, MD, national expert on medical privacy and founder of Patient Privacy Rights, is an advocate for the HRB model. In her report, "The Case for Informed Consent: Why It is Critical To Honor What Patients Expect – for Health Care, Health IT and Privacy," Peel wrote that "Health record banks or trusts are the simplest and best solution to the challenge of storing and enabling the exchange of data. A health record bank can make exchanges inexpensively while fully protecting privacy via patient control."

eHealthTrust's HRB concept gives patients complete control over who accesses their medical information, Yasnoff said. "We don’t interrupt the flow of information to obtain consent," he said. Instead, the company records patient consent in advance, which lets patient decide who can access their information, what information they want to share and when they want to share it.

eHealthTrust has many proverbial irons in the fire, but the first order of the day is getting its HRB system fully operational in its first community. Phoenix made sense as the pioneer to go live with an HRB system because of its large market and the fact that there are no existing local health information organizations or health information exchanges trying to create an infrastructure, Yasnoff pointed out. AzHeC helped build a solid foundation by educating the community about the problems and issues surrounding health IT and HIE, he said. "This is an innovative and enlightened healthcare community," Yasnoff said.

Phoenix is the first to go live and should serve as a model for other communities – and even subgroups – in the state and beyond to adopt. Indeed, eHealthTrust is looking ahead to how its HRB system will interact with the state HIE, whose goal is to establish a financially sustainable access to comprehensive electronic patient records across its communities. eHealthTrust anticipates responding to the state's HIE RFP, offering an innovative approach. If the state allocates some of its federal funding to pay for the one-time fees for HRB accounts, eHealthTrust will create a sustainable HIE infrastructure by providing the state's Medicaid and uninsured populations health record accounts.

The company expects to grow its base of consumers, physicians and vendors. As the healthcare provider community focuses on the meaningful use of EHRs, Yasnoff is quick to remind them that the meaningful use criteria requires moving information among healthcare providers. "That's one of the challenges of meaningful use implementation; it's not just the doctor and the hospital," he said. An infrastructure needs to be in place to enable health information exchange, and Yasnoff is betting that HRBs are the solution.