Alternative PHR models & potential benefits

Claudia Pagliari

Context• "Many envision a health care industry that is consumer-centric and

information-rich, in which medical information follows the consumer, and information tools guide medical decisions…This will result in fewer medical errors, fewer unnecessary treatments or wasteful care, and fewer variations in care, and will ultimately improve [patient] care."

Delivering Consumer-centric and Information-rich Health Care, US DH&HS Jul 2004

• Without information there is no choice…. The future is about sharing information, sharing decisions and sharing responsibility” (précis)

Cayton H. Introduction to Better Information, Better choices, Better Health: Putting information at the centre of health. UK DoH Dec 16th, 2004

Varying definitions of the PHR• “a collection of important information about your health or the health of

someone you are caring for, such as a parent or child that you actively maintain and update. The information comes from your healthcare provider, and from you.” American Health Information Management Associationhttp://www.myphr.com/your_record/index.asp

• “… a copy of all your medical information, collected from all of your doctors, hospitals, and health insurance providers [and] other information which is important to your health that doctors are usually unaware of - like your dietary habits, sleeping habits, activities (such as smoking, or skydiving), your symptoms, and reactions to medications, etc. It contains anything YOU want. Records for Living Inc. http://www.recordsforliving.com/

• “an Internet-based set of tools that allows people to access and coordinate their lifelong health information and make available appropriate parts of it to those who need it” Markle Foundation (2003) http://www.connectingforhealth.org/resources/final_phwg_report1.pdf

PHR models & evolution• Patients can view provider’s records (paper or

electronic) in the clinical setting

• Patients hold paper copies of provider’s records (with or without personal notes)

• Patients can view provider’s EHR via internet portal (or CD)

• Personal web space for patients to store health records (provider- originated and patient-originated)

• Multifaceted web-based PHR that patients can use to manage and interact with their EHRs (e.g. to input readings), communicate with HPs (e.g. email queries, e-prescriptions, bookings) and access IHCAs (e.g. care plans in CDM, educational tools)

• Potentially –wearable/pervasive monitors feeding data into a shared multifunctional PHR linked to EHR & active decision support

Passive

Interactive

Present

Future

Provider controlled

Shared (but patient

controls)

Patient controlled

Internet Mediated Integrated Care (“Clicks & Mortar”)• Appointment scheduling• Access to Electronic Medical Record• Personal record keeping (accessible only by an agreed

set of people)• Monitoring –

– Verbal– Device

• Prescription refills• Consultation support• Formal Decision Support• Links to education & support

Patient Interaction• Collect Information

– Symptom diaries• Administrative Tasks

– Scheduling– Rx Refills– Referrals

• Clinical Tasks– Medication Refills

• Education– Self-care– Drug Interactions

• Reminders– Preventive Health

• Communication– Secure email– Explanation of Benefits

Source: Safran 2005

http://www.patientsite.orgCourtesy of Danny Z. Sands, MD

Mail:SecureAutomated routingTask assignment

Services:Prescription refillsAppointment requestsReferralsView bill

Records:SecureAll CG recordsUpcoming appointmentsMeds/Problems/Results

…Personal records

Education:Info prescriptionsPatient selected linksPredefined collectionsVideos

Key attributes of an optimal PHR

• Lifelong & Comprehensive• Accessible any place, any time• Private & secure • Access controlled by patient

Markle Foundation 2003

Patient Control of Access

Potential benefits of PHRs for the Patient

Empowerment i.e. participation, control, education (Ouschen et al, 2000; Harris & Veinot, 2004) improved•preventive behaviours for self/family (via education and personal health monitoring)

•self-management & medication concordance (e.g. self-monitoring, accessing personal care plans )•participation in treatment decision making (e.g. by priming patients or clinicians before a consultation)•relationships with health professionals (-> trust -> motivation)•personal health administration (e.g. appointments, costs)• consulting flexibility (reduces dependency on ‘own’ doctor)

Safety •Emergency access

•Increased knowledge and ability to correct reporting errors

Potential Benefits for Providers & Organisations

• Healthier, more knowledgeable patients• Reduced liability, if patients are taking control of their data and

making more informed choices• Ability to track patients’ ‘hidden’ health behaviours, risk

behaviours and medications• Fewer unnecessary consultations, reduced waiting lists• Lower costs (?)

Warning: Stand-alone ePHRsMay Be Insufficient

• Disease management applications that encourage patients to enter very detailed information pertaining to a single chronic condition may provide some immediate benefit to users, but simply offering people a means of recording information on a daily basis does not make them better managers of their health or health care. Without a clinician at the other end of the application continually providing advice, making modifications to prescriptions or otherwise providing them with some ideas to help better manage their condition; these systems are doomed to fail (precis)

– Connecting for Health (Markle Foundation). 2004. Connecting Americans to their Healthcare. Final Report of the Working Group on Policies for Electronic Information Sharing Between Doctors and Patients. www.connectingforhealth.org.

Future Evolution• Full patient access to medical record• Automated access to hyperlinked:

– Medical glossaries– Supplementary information

• Translation into different languages• Connectivity to:

– Multiple data sources / EHR– Personal Health Record– Multimedia educational material– Data from home-based monitoring– Teleconsulting facilities