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http://www.csun.edu/~dn58412/IS531/IS531_SP15.html
Lecture 6Personal Health Record
(Chapter 16)
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Learning ObjectivesLearning Objectives
1. Personal Health record (PHR) vs. Electronic Health Record (EHR)
2. Stand-alone, tethered, and networked PHRs.
3. Common functionality available in the PHR – Benefits and concerns
4. Impacts of PHRs5. Issues in implementation and adoption
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Personal Health RecordsPersonal Health Records• A private, secure application (different
from an EHR)• Data from an EHR or providers
accessible to patients, 24/7 from home
• Information from multiple sources entered by the patient
• Driven by patients: access, provide, manage, share personal health info
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Personal Health RecordsPersonal Health Records
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PHRsPHRs
• Precursors to Electronic PHRs: notebooks, files, written records.
• Standalone systems: not tied to any healthcare system. – Google Health PHR, Microsoft’s Health Vault
• Tethered systems: tied into a healthcare system.– My HealtheVet PHR from the VA
• Networked systems : access data from multiple locations
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Attributes of an ideal PHRAttributes of an ideal PHR
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Personal Health RecordsPersonal Health Records
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PHR Functions . . .PHR Functions . . .
• EHR personal heath information–Lab and test results–Medication lists–Appointment–After-visit summaries–Clinical notes–Patient clinical reminders
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. . .PHR Functions. . .PHR Functions
• Secure messaging• Self-entered data• Proxy use (delegation)• Administrative and finance
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EHR Personal Health EHR Personal Health InformationInformation
• Lab and test results• Medication lists• Appointments• After-visit summaries• Clinical notes• Patient clinical reminders
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Lab and Test resultsLab and Test results
• Display test names, test values, normal ranges (may have some extra info: what for, why, what next)
• Benefits:– Reduce patient waiting time– Avoid letters and phone calls
• Concerns:– May confuse and worry patients– Display non-sensitive results only
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Lab and Test resultsLab and Test results
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Medication ManagementMedication Management
• List past and current prescribed medications (doses, instructions, allergies)
• Benefits:– Can check prescriptions for administering– Discussion with physician for clarification– Share info with other providers
• Concerns:– Inaccurate and incomplete if medications
are from multiple providers
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Appointment ManagementAppointment Management
• Time, date, location for scheduled visits, tests, procedures. – Can request appointments (subjected to provider
confirmations)
• Benefits:– Keep track upcoming care: reduce missed /cancelled
appointments– Patient convenient, less phone scheduling
• Concerns:– Institutions can not control open access – Self-selected appointments not match with level/type
of care needed
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After-visit SummaryAfter-visit Summary
• What, advice, vital signs, prescriptions• Benefits:
– Help patients recall the discussion during clinical encounter
– Reinforce clinical advices– Can share info with caregivers
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Clinical NotesClinical Notes
• The actual physician write-up of the visit• Benefits:
– Better understand clinician assessments and decisions
– Better understand clinician issues and treatment options
• Concerns:– Terminologies may confuse patients– Clinicians resist sharing notes or even
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Clinical RemindersClinical Reminders
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• Notices on recommended screening and preventive cares
• Benefit:– Increase patients adherence to
preventive care
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Secure MessagingSecure Messaging• Confidential and secure online communication
between patients and their providers• Benefits:
– Convenient 24/7 access– Can include available medical record
• Concerns:– Fitting in professionals’ workflow: time,
responsibility– Reimbursement for time in online service– Patient may unintentional misuse
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Self-Entered DataSelf-Entered Data• May include prior medical history, family
history, alternative medications, self-recorded vitals
• Benefits– Important data complementary to EHR– Patient can see the trends needing attention
• Concerns:– What type of data to enter– Clinical responsibility to view and response
to information
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Proxy UsersProxy Users• Permit other persons (parent, caregivers)
access to patient PHR (may have different levels of access)
• Benefit:– Sharing information and care with givers
• Concern:– Release information intended to be
private
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Administration and FinanceAdministration and Finance
• Ability to view bills, copayments, coverage benefits (may take online payments)
• Benefits– Help manage care and finances– Improve knowledge of benefits
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Issues Related to PHRsIssues Related to PHRs
• Delegation of access to PHR via a proxy user
• Access to financial, medical claims• Privacy (who accessing what)
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Impacts of PHRImpacts of PHR
• Patient satisfaction (timely interaction with providers, 24/7 from home)
• Provider satisfaction (conflicting perceptions)
• Quality of care (subjected to digital divided)
• “Participatory Medicine”: patients are responsible for their health
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IssuesIssues
• Effective utilization from users increase the efficiency of the systems
• Change in clinical works: process, responsibility, time
• Handle patient data: what data, what format, who is responsible for viewing/ answering
• Provider resources and liability • Consumer protection of privacy
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PHR AdoptionPHR Adoption• Access: connect to Internet by users• Awareness: knowledge about the PHR tools
and their values• Usability: easy-of-use• eHealth literacy: computer literacy (how),
effective usage of the system (what for)• Meaningful use: favorable user perception• Clinical integration: PHR should be
considered as a source of information for healthcare professionals
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A PHR SampleA PHR Sample
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http://www.myphr.com/Default.aspx
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Closing NoteClosing Note
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“Most patients should have access to EHR by 2014 (Executive Order 13335, 2004)”
Why we haven’t had it NOW !