Personal Health Records (PHR) on the Rise Again

In last several years, the term PHR has risen, fallen and then risen again. What caused the rise in interest in PHRs again? Where is the interest coming from?

What is a PHR?
What functionality can a PHR have?
What value does a PHR bring?
Can I mix my PHR with my EHR?
Tethered
Untethered
What are the different PHRs out there?
Is it part of meeting meaningful use?

What is a PHR?
This is a quote taken directly from The Centers for Medicare and Medicaid Services  (CMS) website, “In general, a Personal Health Record (PHR) is controlled by the individual, and can be shared with others, including caregivers, family members and providers.  This is different from a provider's electronic health record, which is controlled by the provider just as paper medical records are today.  Ideally, a PHR will have a fairly complete summary of an individual's health and medical history based on data from many sources, including information entered by the individual (allergies, over the counter medications, family history, etc.).”[i] In summary, a PHR is a way for patients to input their own health data and review it. This is a step closer to the Medical Home concept (also known as Patient-Centered Medical Home [ii]).

What Functionality can a PHR have?
PHRs can have all different sorts of functionality, just like an EHR. Here is a list of different functionalities that can be found in PHRs currently:

• Entering Medical History
• Entering Allergies (Medical & Environmental)
• Present Medication Alerts
• Drug to Drug Reactions
• Drug Dosage
• Drug Duplications
• Drug Reactions to Allergies
• Entering Past Social History
• Immunization Records
• Entering Family History
• Entering Medical Device information
• Automatically
• Manually
• Scheduling/rescheduling for Doctor Visits
• Renewing Medication Requests
• Send Communications to Hospital Staff
• Doctor
• Triage Team
• Etc.
• Update Demographic information
• Share Data
• Share with such entities as the Genomix research link
• Link to Pharmacies to receive up to date medication information
• View Test Results
• Access Radiology Reports
• View Portions of Medical Chart

With this list of possible functionality, we can start to see the value that a PHR can bring. If a patient updates their medication list or has a direct link to the pharmacies that he or she uses, such as CVS, Walgreens, etc., their medication lists can update automatically, and in turn, update their medication list in their physician’s EHR as unverified medications. The physician can then verify the medications at the patient’s next visit. There are multiple values to be found in this aspect alone: patients have a medication list up to date, physicians have the medication list up to date, and clinical intake time decreases without having to find and enter medications in the EHR. Another aspect that can save time and increase patient health is the patient’s ability to give access to any ER or other physician to all of their PHR data. Also, the patient can opt to wear a PHR bracelet. In this case,  the physician can use an emergency physician code to access the data if the patient is unconscious.  The patient would have to allow this type of access.

Another value adding functionality is the scheduling and rescheduling function that a PHR can offer. This functionality will cut down the amount of calls and work required by the front desk.   Additionally, this will cut down confusion and time delays regarding appointments.

Can I mix my PHR with my EHR?
There is a lot of value to be found in a PHR, but that added value can only be realized when a PHR is linked (tethered) to the physician’s EHR/PMS.  Without this link, a PHR is only a tool for a patient to collect and store medical information, which, in itself, is not a bad thing, but does not bring as much value to the Medical Home concept as a linked PHR. Many EHR vendors offer a PHR that will link to their system, however many of them offer limited integration. Be sure to review the capabilities/functionality before choosing a PHR to link with your system.

What are the different PHRs out there?
There are many PHRs available; below are some examples: 
GoogleHealth -https://www.google.com/health
Microsoft’s HealthVault -http://www.healthvault.com/
Dossia –http://www.dossia.org
MyChart -http://www.epic.com/software-phr.php
Indivo-http://indivohealth.org
MyHealtheVet – (Used by VA) –http://www.health-evet.va.gov
iHealth –http://medfusion.net/ihealthrecord/

Is it part of meeting meaningful use?
With meaningful use coming into play, we need to know how a PHR applies.  According to the 2011 Objectives [iii] (listed on the Meaningful Use Matrix):

The goal is to electronically capture in coded format, and to report health information and use it to track key clinical conditions.

Provide patients with an electronic copy of, or electronic access to, clinical information (including lab results, problem list, medication lists, allergies) per patient preference (e.g., through PHR). [OP, IP]

With that stated, a PHR is required by 2011 to meet ‘meaningful use’.

It is clear that a PHR will be part of your HIT roll out, either to meet meaningful use and/or to bring value to both patients and your organization. In upcoming articles we will discuss PHRs in more detail, and perhaps provide comparative analysis.