Personal Health Records

The advent of personal health records (PHR) is on the way, if not already here. These records are intended to help patients monitor their own care particularly for chronic conditions. Possibly, these records will allow for improved communication with doctors, reduce unnecessary office visits, and improve the health of patients.

Should patients use a personal health record strongly associated with their doctor's EMR (such as the EMRs portal serving as the PHR), or should they get their own personal health record that travels with them?

There are many, many other questions and ideas to be discussed and debated around personal health records. Any comments?

Lowell

I've made the comment previously that a company called CapMed has developed the PHR in a jump drive format that could just plug into any USB port and it will invoke a standardized record that does not require having the application it was generated from, i.e. NextGen (whom sponsored this advent at last year's TEPR show in Ft. Lauderdale.

Americans worry too much about their privacy to allow wholesale implementation of a PHR that the individual does not control. Insurance companies would save a ton of money; and physicians' office staff would have a much easier time if an easily accessible PHR was available.

How many times have you ordered tests that the patient had done only a week before in another doctor's office or in the hospital?

The system TShavor describes might be just the ticket. The information is not centralized, only carried by the patient with some private backup system and accessed by the end-user, patient, physician or insurance company only with the permission of the patient.

"PHR in a jump drive format"
- I cannot see this ever becoming even remotely popular. There will never be enough providers accepting the jump drives nor enough patients interested in using it. Possibly if a national body decided on a format for the drives this idea may have some legs.

Certainly systems like this would have to be the pinnacle of insecurity. If info on a jump drive is encrypted, most providers would not be able to read it. If it is decrypted, anyone getting a hold of the drive could read the entire patient's medical file.

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Personal Health Records - The chance of seemless data flow from the doctor's EMR to the patient's PHR seems impossible. Why would the doctor want to do that anyway ?

I can see a potential market down the road where a patient's portal has both patient organized information and information from the doctor's office. EMR vendors may be able to charge patients a fee for a PHR component to a patient portal. Kind of like a Portal Addon that the patient pays for. Probably the best model would be that the Vendor and the Doctor split the "portal addon" money to encourage both parties to tell the patients to get the addon.

I hear that in Canada, doctor's offices have special bank sponsored ATM machines that offer cash for the visit as well as a special scannable and shredable PHR. [8D]


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I understand your apprehension to such a format. I was assured by CapMed that their product was HIPAA compliant. Of course, every vendor says that. It does require a username and password to access the data. I had considered it when I was at Visionary and spoke to a few folks over there. Their booth was next to mine at TEPR, so I had one of their people come over and give me a demonstration. I asked all the pertinent questions and it seemed plausible, however; I did not feel the EMR was ready to take on the PHR when so much more needed to be done.

Speaking conceptually, there is a lot to gain from a PHR. In fact, many of the reasons for getting an EMR cross over and are shared by patients. I am talking about, as usual, many of the goals of the registry; safety, improved care a la guidelines and decision support, tracking of chronic conditions, etc.

While patients don't think about guidelines and decision support as we do, they are really concerned about the same things. For example, patients want to know that they are taking the right medicine for their conditions. They want to know that they are on track regarding how well their chronic conditions are being monitored. They want to know that they are getting appropriate tests. Essentially, they want to know what we want to know.

Conceptually, I see the PHR as many things. Foremost, in my mind, is that it empowers the patient so that they can be a "partner" in their care. It also allows patients to oversee their care watching for medical errors and making sure treatments are appropriate. (Many doctors will not like this and there are many examples of how this can be problematic).

A PHR can include many of the things that are primarily only used by doctors right now. Let's say a 50 year old patient with a tobacco history and HTN were to have access to Inforetriever and the Cochrane database. They would be abale to have access to the latest information much the way we are.

As another example, let's say the PHR was able to receive lab data through HL7. Patients would be able to track information as we do.

A PHR could act independently of an EMR and yet be able to communicate with an EMR should the ability to do so arise. I am not sure if CCR fits the bill for this communication, but there must be a way.

As I write this post, I am thinking of all of the doctors who will not be getting an EMR anytime soon. Why should a patient have to wait for their doctor to get an EMR? Why shouldn't a patient have access to features that improve health and increase safety regardles of whether or not their doctor is being proactive? After all, we are all better off if our patients become active partners in their care.

Lowell

Dr. Quit:

Your examples are correct. Other valuable uses would be for ER visits or emergencies that require EMT's. If a patient is unconscious and needs medical help, but the EMT has no understanding of a patient's medical history...they could simply plug and play and see what medications the patient is currently taking and see a snapshot of their medical history.

quote:

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Originally posted by tshavor


they could simply plug and play and see what medications the patient is currently taking and see a snapshot of their medical history.

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I don't personally see people running around with plug and play devices, although I guess some would want that.

Conceptually speaking, I think there are models for PHRs out there. For example, there are many people who choose to closely oversee their investment portfolios and there are several companies in existence to make that process more understandable and easier to do oneself. What's TD Waterhouse's tag line..."Your In Control".

Lowell

Lowell Kleinman, MD www.drkleinman.com www.old-fashionedhousecalls.com

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