Let me search for data on legitimate use cases where patients share their full EHR with third parties.## Legitimate Patient Use Cases for Sharing Full EHR: Economic Analysis
Based on my research, here's a comprehensive analysis of legitimate use cases where patients would share their full EHR and the economic implications:
- Annual Volume: ~2-2.5 million applications filed annually
- Medical Records Need: Many states waive or limit fees for disability claims, with free copies for SSI/SSDI claims
- Current Process: Manual requests, paper forms, state-specific pricing
- Estimated PDC Users: 200,000-300,000 (10-15% of applicants)
- Market Size: Life insurance companies routinely request medical records for underwriting, with companies accessing records through MIB or direct requests
- Annual Applications: ~15-20 million life insurance applications
- Full Records Needed: ~30% require APS (Attending Physician Statement)
- Estimated PDC Users: 150,000-200,000 annually
- Annual Volume: Approximately 400,000 personal injury cases filed annually in the US
- Medical Records Critical: Nearly 100% require comprehensive medical documentation
- Current Cost: Often $500-2,000 per case for records retrieval
- Estimated PDC Users: 100,000-150,000 cases
- Annual Volume: ~1 million new claims filed
- Records Requirements: Insurers request extensive medical records to verify work-relatedness and assess pre-existing conditions
- Estimated PDC Users: 100,000-150,000 claimants
- Annual Volume: ~600,000-800,000 new claims
- Documentation Need: Insurers often request excessive, old medical records when evaluating claims
- Estimated PDC Users: 60,000-80,000 claimants
Conservative Estimate: 710,000-980,000 legitimate use cases annually Realistic PDC Adoption: 350,000-500,000 users (assuming 50% adoption)
Per-Query Costs for QHINs:
- Compute/bandwidth: ~$0.05-0.10 per query
- Full EHR retrieval: ~$0.50-1.00 (larger payload)
- Annual cost for 500,000 PDC users × 5 queries each = $1.25M-2.5M
Infrastructure Already Exists: QHINs must provide Individual Access Services free of charge anyway
Traditional Commercial Path Revenue:
- Law Firms: Would pay $2,500-10,000/year for HIE access
- Insurance Companies: Pay $5,000-50,000/year for network access
- Disability Evaluation Firms: $2,500-5,000/year
Actual Revenue Impact:
- These entities currently use manual processes (fax, mail, portal downloads)
- Only 10-20% would become paying QHIN participants
- Lost revenue: ~$5-10M annually across all QHINs
- Per QHIN (5 QHINs): $1-2M annually
But Consider:
- Global HIE market is $2.02 billion
- US portion ~$800M-1B
- Potential "lost" revenue is 0.5-1% of market
- Already required to provide free Individual Access Services
- Infrastructure costs are marginal (already built)
- Lost commercial revenue <1% of total market
- Companies charging $1/page for first 10 pages, then $0.50/page
- Industry worth ~$500M-1B annually
- Would lose 30-50% of revenue if PDC widely adopted
- Currently spend millions on records request processing
- Staff time reduced dramatically
- Better data quality for treatment decisions
- Save $100-1,000 per use case
- Faster access (days vs. weeks)
- Complete, computable data
- Control over their information
Self-Limiting Factors:
- Complexity: Managing full EHR data requires technical sophistication
- Privacy Concerns: Many patients won't want to handle their own data routing
- Legal Requirements: Courts/insurers may still require "official" records
- Rate Limiting: 100 queries/day would handle personal use but prevent industrial scale
Market Response:
- New intermediary services will emerge (patient-authorized aggregators)
- These will likely become commercial QHIN participants eventually
- Creates innovation and competition in the market
The PDC "arbitrage" concern represents a feature, not a bug. The economic impact is:
- Infrastructure costs: Negligible (~$2-3M total)
- Lost QHIN revenue: Minimal (~$5-10M across all QHINs)
- Disruption to rent-seekers: Significant (current medical records industry)
- Patient benefit: Enormous (faster, cheaper, better access)
- Innovation catalyst: Creates new market opportunities
The real "losers" are incumbent medical records retrieval companies charging high fees for poor service. QHINs lose minimal revenue while potentially gaining legitimacy and patient trust. The market will self-regulate through natural limits and the emergence of value-added services that justify commercial participation fees.