Benefits and Features of Personal Health Records

 As a Catalyst for Health, Safety and Wellness

Al Davies, M.D.

Valerie Purcell, RN, MBA

In 2005, Hurricane Katrina exposed the vulnerability of America's health care system. A fragmented information infrastructure posed significant risks to patients’ health. Lack of available health information due to fragmented health information systems posed very real adverse effects on patient safety. When confronted by a natural disaster such hurricane, a flu pandemic, or even a bioterrorism attack, it becomes incumbent upon each of us as individual consumers of health care to become individually accountable for the availability and reliability of our own personal health information. Fortunately, large-scale, catastrophic disasters are rare, but that does not diminish this need. As consumers of health care, we can begin to take charge of our own health information to protect health and wellness every day by having a Personal Health Record or PHR. A PHR applies health information technology to your personal life to improve safety, reduce medical errors, reduce gaps in communication and reduce delays in receiving proper care. PHRs give all of us, as consumers of health care, control over our own health information so that we can protect and improve our own health and wellness.¹

At the highest levels of our government, the benefits of Personal health are well recognized. President Bush set a 10-year goal of getting most Americans a personal electronic health record that could be accessed and added to by physicians and health practitioners with the patient's authorization. The president described a secure electronic record that could be accessed online and would include the patients' medical history, prescription information and other vital medical data. As a country, we are a long way from recognizing this goal. President Obama has also stated that having electronic access to health information through an electronic health record adoption can “improve the quality of our health care and lower costs.  This will cut waste, eliminate red tape, and reduce the need to repeat expensive medical tests. It will save lives by reducing the deadly but preventable medical errors that pervade our healthcare system."

Since most of us  receive medical care from many health care providers, our health data are dispersed over many facilities' paper- and electronic health record (EHR)-based record systems. The consequence is a fragmented system of storing and retrieving essential health information which can impede safe health care. While EHR systems function to serve the information needs of health care professionals, PHR systems capture and store health data entered by individuals and their health care providers and helps coordinate information related to that patient’s historical health care.²  

Information which can be stored within PHRs can be both subjective and objective. Subjective health information may include qualitative descriptions of symptoms and medical problems, and responses to questionnaires.  Objective health information may include patient-entered measurements such as weight or function, measurements home diagnostic equipment such as blood pressure or blood glucose levels, or can include data such as examinations, diagnostic tests from a provider-maintained medical record. PHRs which provide interactive tools for communication with physicians make it easier to ask questions, set up appointments, request referrals, medication refills and report problems. ² PHR systems can also include decision-support capabilities that can assist in managing chronic conditions by helping keep track of progress so that earlier interventions can be taken if there is a problem and by actively mitigating health risks to prevent problems. ³

There is ample research concluding that consumers who are more engaged in their health and who are more active participants in their health care can actually reduce adverse effects of medical treatment and improve the results of their medical care by working collaboratively with their physicians and health care providers. ^{1,2,3 4,5}

Having a PHR helps maintain a connection between patients and their physicians. This which changes health care from becoming episodic to continuous and reduces the time between the onset and management of a problem.² Physicians and health care providers who are authorized to have access to a PHR can  make better and more rapid and accurate decisions about medical care and reduce redundant tests which can increase health care costs. Additionally, there can be vast potential benefits to employers and payors of health care insurance as a result of more efficient and effective medical care. Lower chronic disease management costs, reduced costs of redundant health care, reduced absenteeism due to illness, and  lower medication costs can be realized. ⁴

The Markle Foundation surveyed 1, 246 American consumers representing a variety of demographics across the U.S. They found that most Americans believe that having a personal health record would: a) clarify physician instructions; b) prevent medical mistakes; c) change the way personal health is managed; d) improve the overall quality of healthcare. Valuable features of PHRs of those consumers surveyed included: the ability to communicate with their physician; store immunization records; transfer information to a specialist; record and look up test results; track medication use. Over 40% of the participants surveyed responded that they keep paper records at home, but only 2% keep their medical records in a computer. More than half of these people acknowledge that they should do a better job of organizing their medical records. ⁵

The Markle Foundation also found in their consumer survey that 91% were very concerned about the security and privacy of their own health information. With proper protections including encryption, and requirements for user authentication such as protected passwords, most participants felt comfortable using a PHR and sharing information with their physicians and health care providers. Only 23% felt comfortable sharing information in their PHR with an insurance company. ⁵

According to the Medicare and Health and Human Services, in choosing the right PHR we should consider these important features. ^{6 PHRs} having a combination of these features provides a powerful personal health information management tool: 

• Whether the PHR provides proper tools for storing information about medical conditions, procedures, allergies, medications and other personal information;
• Whether information about insurance claims or medical information from doctors can be uploaded into a PHR;
• Whether the PHR offers the ability to print a list of medications or conditions so that it can be brought to a visit to a  physician or hospital;
• Whether the PHR provides education on important health topics:
• Whether the PHR provides a tool to communicate with a physician’s office to request refills for medication; ask questions or make appointments;
• Whether the features and tools in the PHR are worth the costs;
• Whether the information stored in a PHR is portable when leaving a health plan or changing physicians;
• Whether the PHR provides emergency access to  health information;
• Whether there is a plan for what would happen to the information in a PHR if the company either goes out of business or becomes part of another company;
• Whether the PHR has policies for privacy and security of protected health information.

Some PHRs even help consumers obtain medical records if they need to send for them. For those who may procrastinate, this can be a helpful way to jump start the process of starting a PHR.

Having a PHR can place each of us at the center of our own health care. PHRs can help each of us to be a catalyst for ensuring that our own individual health information is accurate and up-to-date. The more sophisticated PHRs afford protections and privacy required by HIPAA and enable authorized accessed by those we entrust to provide our medical care.

Don’t procrastinate! Remember the old saying, “The best way to get something done is to begin.” –author unknown. 

References:

¹ Institute of Medicine, Crossing the Quality Chasm, National Academy of Sciences, 2000.

²Tang, Paul, Ash, J, et al., Bates, D., et al,  Am Med Inform Assoc. 2006;13:121-126.

³ Gandhi TK, Weingart SN, Borus J, et al. Adverse drug events in ambulatory care. N Engl J Med. 2003;348:1556–64

⁴ Walker J, Pan E, Johnston D, Adler-Milstein J, Bates DW, Middleton B. The value of health care information exchange and interoperability. Health Aff (Millwood). Health Affairs Web Exclusive, January 19, 2005.

⁵  The Markle Foundation Connecting for Health, a Public-Private Collaborative, June 5, 2003, retrieved at:  http://www.connectingforhealth.org/resources/phwg_survey_6.5.03.pdf

⁶ Health and Human Services: Medicare, Learn More About Personal Health Records. Retrieved at: http://www.medicare.gov/PHR/LearnMoreAboutPHR.asp#PHRChoose