Personal EMR primer

Harvard Business Review's article Your Medical Information in the Digital Age
by John D. Halamka, MD is a great primer....see the following excerpt. What more can I say, so I didn't. The following is from the HBR article.
"So far, four types of electronic personal health records are available:
Hospital- and clinician-hosted records are great if all your information resides at a single institution. One example is PatientSite, used by more than 40,000 patients of Boston’s Beth Israel Deaconess Medical Center to view their hospital records, send secure e-mails to doctors, make appointments, refill prescriptions online, and the like. But this kind of service is not widespread. A recent study in the New England Journal of Medicine found that only 9% of the acute-care hospitals surveyed had an electronic-records system in place in even one clinical unit.
Payer-hosted records, such as HPHConnect from Harvard Pilgrim Health Care, give you access to claims information relating to your medications, doctor visits, and hospitalizations. Some let you share information with family members or doctors. On the downside, you may not be able to access all of your lab and radiology results, and there’s no guarantee that you can take your record with you if you change insurers.
Employer-sponsored records are typically hosted by a trusted outside firm, creating a firewall between the employer and the medical data. For example, computer storage giant EMC partnered with WebMD to offer claims-based personal health records to all of its employees. Employer-sponsored systems aim to keep you healthy and productive by, say, recommending an exercise program if you are overweight. They can also help you manage your health care–spending account. However, you may not be able to take yours with you if you change jobs.
Commercial offerings, such as Google Health and Microsoft Health- Vault, allow you to link to your electronic records stored at participating hospitals, pharmacies, and laboratories. In addition to collecting existing data, you can add your own, search for information about medical conditions and drug interactions, and share information with your doctors and other appropriate parties. These services let you keep your health record for life, regardless of your job or insurer. Google recently implemented secure “social networking” for personal health records. Call it Facebook for health care. It allows you to invite caregivers or family members to access your personal health information. Invitees can be removed at any time."

Competition creates no net value currently

Michael Porter and Elizabeth Olmsted Teisberg in the current issue of HBR on competition is important reading given the progress of reform http://hbr.harvardbusiness.org/2004/06/redefining-competition-in-health-care/ar/1
"Health care competition, by contrast, has become zero sum: The system participants divide value instead of increasing it. In some cases, they may even erode value by creating unnecessary costs. Zero-sum competition in health care is manifested in several ways: First, it takes the form of cost shifting rather than fundamental cost reduction. Costs are shifted from the payer to the patient, from the health plan to the hospital, from the hospital to the physician, from the insured to the uninsured, and so on. Passing costs from one player to another, like a hot potato, creates no net value. "

I have always believed that healthcare competition does not work especially because there are parts of the market where there is demand but no real interest in providing service because of the return. But when you realize how the culture of healthcare impedes innovation; the bureacracy and unaligned incentives discourage change internally in healthcare institutions not just in the payor community, you see the need for breakthrough innovations to take market share. By the time technology is adopted in its entirety in the current structure, it is outdated and adds cost..
The structure of change and improvement is clearly a driver in this no-value equation.