There’s a lot of talk in the US and other countries about the moment about Health Reform and how Personal Health Records (PHR) aka Electronic Health Records (EHR) from the like of Microsoft (HealthVault), Google (Google Health) and others (e.g. Dossia) are going to make things more efficient.

Sadly in a lot of cases the people they seem to make more efficient for are the Hospital Administrators and Insurance companies who’ve done a good job of letting costs spiral out of control to improve their shareholder returns rather than providing good value healthcare at low cost to the consumer and the tax payer.

Maybe adopting PHR frameworks is going to help reduce costs and make Doctors lives easier but without a personal-centric view I’m not sure how it’s going to help the recipients of health-care – you and me.

What happens if I’ve chosen to put my data into HealthVault yet the hospital I get admitted to only has a Dossia based system. What happens if I change dentists from a Google Health affiliated provider to a HealthVault practitioner. Will my Chiropractor in the US who uses HealthVault be able to access the X-Rays taken at a Medical Center in Australia or the UK?

And will any of them be able to access personal data the should be taken into account as part of holistic health based approach to maybe stave off the need for medical attention – personal training, gym and other exercise?

I use an Omron pedometer which I track in HealthVault via the WalkMe service. My Polar FT80 HRM however stores data in their service. I use the equally isolated gtFtr to track random workouts and weigh-ins. Other people may use something like a Nike+, FitBit or a Philips DirectLife (with personal recommendations) to track their activity and a Withings scale that twitters your weight to your followers. Every time I go to the gym there’s no record of what I actually did there (hence the need for a Gym Buddy) so there’s no way my doctor knows I’m actually following their recommendations or my personal trainer to see the results of my latest checkup.

There are initiatives like Continua to come up with common standards for connected equipment but at the moment they seem to have some IP requirements standing in the way of getting more people to the table.

Without a way to put the focus on the individual and get people to buy into the concept adoption will be slow and painful but if there’s a way for people to connect and see the impact of their choices (or the benefit of their good behaviors – as sites like Dental Optimizer try to go) I think the impact of PHRs will be more far reaching than just helping a few administrators cut down on their paperwork

After a year here in the US I've noticed some changes. My accent is once again shifting in some inexorable drift to a new median sound (I don't sound English, Australian or American. Most often I'm asked if I'm South African. Or Danish. That must say something about my linguistic skills), I can order a double tall eggnog latte with whipped cream and only shudder a little bit, I can actually work out from a handful of change and greenbacks how much money I have in my pocket... and (possibly a result of the lattes) I now need bigger trousers.

So, in an attempt to stop me becoming elliptical we've installed a hulking brute of a machine downstairs (Nautilus EV718).

Even if I feel the will power slipping I suspect the sheer mass of the machine will be enough to drag me out of bed an extra half hour early in the morning lest it make it's way up the stairs and do something Terminator-style to me while I sleep!

The problem with pounding away on this thing and having time to think (between yelling at the dog to get out of the way of the moving bits and trying to catch the iPod as it flies off on it's own little adventure) and imagine a future where this beast is part of SkyNet (or at least a less inimical version) and using my LiveID and Spaces I could automatically share my workouts, track my progress, get friends to nag me if they don't get a daily twit to say I've done my time. We could have leagues and do lots of trend analysis to see if it's working. Network machines together and I could race a friend the other side of the world (perhaps with the Xbox or Media Center delivering cool graphics and a pumping sound track to complement the exercise) and if I'm staying in a hotel I could hit they gym, type in my LiveID and have the exercise profile and tracking work from there as well.

I don't know what it would cost to add a network enabled, token reading Windows Embedded device to these things (and even if it could be retro-fitted to older models) or how much work it would take to push this "platform" out across multiple vendors... but I'd love to have my Facebook profile say "Jeremy burnt 150 calories this morning, and traveled 1 mile. Average level 5.6, average heart rate 158"

If will power doesn't work... peer pressure sure would ;)