PHR intro

Personal Health Records

Personal Health Record
CDR Christopher Lamer PharmD, MHS, BCPS, CDE
Office of Information Technology/Health Education

“These are exciting and very promising times for the
widespread application of information technology to
improve the quality of healthcare delivery, while also

reducing costs, but there is much yet to do, and in my
comments I want to note especially the importance of
the resource that is most often under-utilized in our
information systems – our patients.”

– Charles Safran MD, testimony to the House Ways
& Means subcommittee on health in June 2004

Since Dr. Safran’s testimony US healthcare costs have more than
doubled, quality has not improved, and virtually nothing has been done
to leverage the engaged patient.

Let Patients Help!

– You should always have access to your

complete health information.

– Information in should be accurate,
reliable, and complete.

– You should have control over how your
health information is accessed, used,
and disclosed.

Personal Health Record
• The PHR is a collection of important information

about your health or the health of someone you’re
caring for that you actively maintain and update.

– Basis for planning your care and treatment

– Means by which you can discuss your care with
healthcare professionals

– Documentation describing care you received
from healthcare professionals

What should be in your PHR
• Personal identification, including name and birth date

• Emergency contacts
• Names, addresses, and phone numbers of your physicians, dentists, and specialists
• Health insurance information
• Important events and hereditary conditions in your family history
• Opinions of specialists
• Important test results
• Eye and dental records
• Correspondence between you and your provider
• Permission forms
• Living wills, advance directives, or medical power of attorney
• Dates of significant illnesses and surgical procedures
• Current medications and dosages
• Immunizations and dates received
• Allergies or sensitivities to drugs or materials


Secure Patient
Database Portal

RPMS


Other Secure Patient
Health Care Database Portal
System

RPMS

Patient
Handouts/
Education

System

RPMS

Family Patient
Health Handouts/
History Education

System

RPMS

Family Patient
Health Handouts/
History Education

System

RPMS Home
Monitoring

Centralize Information
• Medications

• Allergies
• Laboratory Results Maintai
ni
• Discharge Summaries persona ng your own
l
is one o health record
f
• Problem list to have the best ways
constan
to your t access
• Procedure Information health i
through nformat
out the ion
of your course
lifetime.

• A recent survey found 64 percent of

respondents who had a personal
health record said the biggest
advantage was the ability to check
online the accuracy of their medical
information.

• 57 percent said the best feature was
the ability to view test results.

Increase Participation

Participatory medicine is a movement in which
networked patients shift from being mere passengers
to responsible drivers of their health, and in which
providers encourage and value them as full partners

You Make the
Difference. Improve
Your Health.
Research shows
that when consumers
actively participate in
their own care,

• Patients who have online access to their health

information are twice as likely to receive
suggested routine screening.

• Consumers with online access to their health
information pay more attention to their health.

• PHR users are young, highly educated and higher
income, yet surprisingly, less educated, lower-
income and chronically ill patients report greater
value from using a PHR.

Save Time and Money

• Providing interoperable PHRs to 80%
of the US population would cost
– $3.7 billion in startup costs
– $1.9 billion in annual maintenance costs
• Widespread use of PHRs could save
the US healthcare industry between
$13 and $21 billion a year.

http://www.myphr.com/index.php/start_a_phr/why_should_you_keep_a_phr

Sharing Information
• Family members/caregivers

• Emergency situations

• Other healthcare providers

• Self documented information

Access to Services
• Medication refills

• Medication renewal
• Secure messaging
• Home monitoring management
• Community alerts
• Links to education
• Social networks

Health Communication
• Knowledgeably discuss your health with

healthcare providers
• Provide information to new caregivers
• Have easy access to your health information while
traveling
• Access your information when your doctor’s office
is closed
• Record your progress toward specific health-
related goals
• Refer to physician instructions, prescriptions,
allergies, medications, insurance claims, and more
• Track appointments, vaccinations, and numerous
other wellness healthcare services

Patient Wellness Handout
• Combines information from the clinical information system with
programmed logic to create a document that provides personalized

information from the patient's medical record that is explained at a
6th grade or lower level including information on:

Personalize
RPMS Logic d PWH
Explanation

• Measurements (Height, Weight, BMI) • Quality of Care measures
• Reminders for health maintenance • Patient goals
screening (Mammogram, PAP, Colon • Activity level
cancer, HIV)
• Ask Me 3
• Reminders for diabetes screening
(A1c, Nephropathy assessment, • Cholesterol
Retinal screen, Foot exam) • Blood Pressure

Can be generated at
different points of care

Patient focus groups
“My son was sick and he had to see so many doctors and this could

have helped, it’s easier to carry a record, instead of trying to
remember all the information.”

“Medication listed would have been helpful because it was hard to
remember the names of them - I can’t even pronounce the names.”

“(When you can’t) establish a (primary) doctor, you can carry a
record to share with doctors at different clinics to make it easier.”

“This paper would save people a lot of time, especially with waiting.
When I had problems with my chest my family wanted to take me to
(my IHS clinic), I said no, no. Take me to (the big city hospital).
When I got there, they had to call (the IHS clinic) and it took them
forever to get my information. It would be quicker if I had this.’

Clinician feedback
“I have been telling patients that they are

overweight for years, now they get the handout
and are asking me what weight they should be at”

“Patients are asking for their immunizations and
want to know what their blood pressure should be”

“Patients will look at their medications on the list
and tell me that they are no longer taking some of
them”

PWH version 2.0
• Version 2 released in February 2009

• Ability to auto-generate at patient
registration, check-in through PIMS, and
through the pharmacy package

• Ability to create customized PWH by
selecting only the component that you want
printed - a medication reconciliation PWH
will be included that only prints the
demographics, allergies, and medications

• Provides many new components

New components
• Reminders for health • Quality of Care measures (to

maintenance screening compare with aggregate data
– Mammogram on the QOC website)
– PAP • Documented goals
– Colon cancer • Activity level (based on
documentation of the activity
– HIV
level health factor)
• Reminders for diabetes
• Ask Me 3
screening
– A1c
– Nephropathy assessment
– Retinal screen
– Foot exam
• Reminders for LDL

Plans for PWH v3.0
• Pediatric

• Intake forms
• Emergency contact
• Problem List
• Procedure List
• Vital Histories
• Anticoagulation
• Recent/Pending Labs

Health Communication
Website

System Benefits
• Providers’ staff saves an average of four minutes

per medication refill when requested online versus
being phoned in.
• They save approximately $3 per lab result
delivered online versus being mailed to the
patient.
• Patients are more likely to show up for
appointments that they schedule themselves
online. Patient no-shows were reduced 30% with
online scheduling.
• Providing patients with the convenience of being
able to pay their bills online reduced 1 day of
outstanding A/R on average.

• Offering this access to patients raised the patient

perception of quality by 20%.

• 73% of the physicians using the tool agreed that
the access improved patient/physician interaction,
and 97% of the patients said it was important in
their choice of where to receive care.

Concerns
• Privacy and Security

– 75 percent of survey respondents said
they still are skeptical about how safe
their private medical information would
be in an electronic health record.
– Many expressed concern that the data
could be accessed by their employers
and health insurance plans.
– Concern is reduced by experience with
and benefits received from a PHR.

Driving Forces
National

Coordinator for

Meaningful Use

Healthy People

Executive Order

Healthy People 2020
• HC/HIT HP2020–7: (Developmental) Increase the

proportion of persons who use electronic personal
health management tools.

• HC/HIT HP2020–8: (Developmental) Increase the
proportion of patients whose doctor recommends
personalized health information resources to help
them manage their health.

EHR Certification
• ADM. 22 Demonstrate how a

patient can obtain online access
to their clinical information
including, at a minimum, lab test
results, problem list, medication
list, medication allergy list,
immunizations, and procedures.

Presidential Executive Order
• Offer personal health records to enrollees based

on their claims, medications and medical history
information currently available in carrier healthcare
systems

Meaningful Use

Meaningful Use 2011

Meaningful Use 2015

Personal Health Records Meaningful Use

By FY11, view data:
By FH2013:
• Medications
• Reporting
• Allergies • Patient Preferences
• Laboratory Results • Secure Messaging
• Discharge Summaries • Device Data Upload

• Problem list • Family Health History

• Procedure Information • Languages

IHS Internet Access
2006/2007

5.1%

37% 21%
27%
15.5%

17%
16%
30.8% 21%
28.6% 18%
26%

Internet Access is increasing

Patient Registration
Internet Access Questions

IHS REGISTRATION EDITOR (page 1) CIHA HOSPITAL
================================================================================
DEMO,PATIENT (upd:MAR 17, 2010) HRN:1
================================================================================
1. ELIGIBILITY STATUS : CHS & DIRECT
2. DATE OF BIRTH : 03/22/1947
3. PLACE OF BIRTH [CITY] : ALBUQUERQUE 4.ST : NC
5. SEX : MALE
6. SOCIAL SECURITY NUMBER : 000000003(Not yet veriﬁed by the SSA)
7. MARITAL STATUS : MARRIED
8. CURRENT COMMUNITY : SNOWBIRD
--------------------------------------------------------------------------------
9. STREET ADDRESS [LINE 1] : snowbird dr
10.STREET ADDRESS [LINE 2] :
12. CITY : snowbird 13.ST : NC 14. ZIP CODE : 28779
15. LOCATION OF HOME : LOCATION OF HOME CONTAINS DATA
--------------------------------------------------------------------------------
16.PHONE NUMBER [RESIDENCE] : 828-497-2465 17.WORK PHONE : 828-497-9163
18. OTHER PHONE : cell 828-735-5555
19. INTERNET ACCESS : YES WHERE : WORK (upd DEC 10,2009)
20. EMAIL ADDRESS: DEMOPATIENT@GMAIL.COM
--------------------------------------------------------------------------------
================================================================================
CHANGE which item? (1-20) NONE//:

Patient Registration
E-Mail Address

IHS REGISTRATION EDITOR (page 1) CIHA HOSPITAL
======================================================================
==========
DEMO,PATIENT (upd:MAR 17, 2010) HRN:1
======================================================================
==========
1. ELIGIBILITY STATUS : CHS & DIRECT
2. DATE OF BIRTH : 03/22/1947
3. PLACE OF BIRTH [CITY] : ALBUQUERQUE 4.ST : NC
5. SEX : MALE
6. SOCIAL SECURITY NUMBER : 000000003(Not yet veriﬁed by the SSA)
7. MARITAL STATUS : MARRIED
8. CURRENT COMMUNITY : SNOWBIRD
--------------------------------------------------------------------------------
9. STREET ADDRESS [LINE 1] : snowbird dr
12. CITY : snowbird 13.ST : NC 14. ZIP CODE : 28779
15. LOCATION OF HOME : LOCATION OF HOME CONTAINS DATA
--------------------------------------------------------------------------------
16.PHONE NUMBER [RESIDENCE] : 828-497-2465 17.WORK PHONE : 828-497-9163
18. OTHER PHONE : cell 828-735-5555
19. INTERNET ACCESS : YES WHERE : WORK (upd DEC 10,2009)
20. EMAIL ADDRESS: DEMOPATIENT@GMAIL.COM
--------------------------------------------------------------------------------
======================================================================
==========
CHANGE which item? (1-20) NONE//:

Choosing a PHR
• Use Appropriate technology for the patient, their

family, community and the health care delivery
system
• Considerations
– Functional Model (standalone, tethered, integrated)
– Patient Factors
• Desires and goals of patient, community and population
• Patient Activation
• Health literacy
– Appropriate (for patient) information display
• Access to Internet (technology reflective of patient
population)
– Return on investment
– Evaluation of impact

PHR Options
• Stand alone - you enter, modify and

update everything.
• Tethered - you can view your health
information from an EHR or electronic
system.
• Integrated - you can view and enter
information into your record that can
be shared or added to your medical
record.

Cloud Databases
• Microsoft Healthvault

• Google Health
– Survey found only 25 percent of citizens
would choose to sign up for either of
those services.
– Majority of respondents said they
preferred to use health records provided
by doctors and hospitals.
– Limited in what can be added or how this
information can be used.


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PHR intro

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Editor's Notes