This past week, Vanguard Health Systems, which operates 15 hospitals in four states, joined a growing list of healthcare organizations and employers that plan to offer personal health records to patients or employees. Vanguard joined the Dossia Consortium of employers that have pledged to implement PHR software for their employees.
I wrote about whether personal health records would be a temporary fix or here for the long haul in the August 2009 issue of HealthLeaders magazine PHRs: Worth the Effort.
Given the emphasis on personal health records in the "meaningful use" recommendations by the HIT Policy Committee, it seems that PHRs are here to stay, which I, for one, believe is a good thing.
However, not everyone is convinced that PHRs are the right path for healthcare to take. Some physicians are concerned that the "art" of medicine is being replaced by templates and checklists and that electronic health records along with PHRs could suffer from the quality of data that is entered and exchanged. Other executives believe that the patient web portal may be the better solution.
That is the route Group Health Cooperative in Seattle took when it implemented its patient Web portal. Its philosophy is that the medical record should be a shared document between patients and caregivers that provides the same data to both of them, says Ernie Hood, vice president and chief information officer. The patient view of the information does include some additional definitions and health management information, he explains.
The challenge of PHRs is that until a large number of providers are interfacing with PHR products their use will be for the patients only--and a relatively small number of people currently maintain and actively use them, Hood says. Still, he acknowledges that PHRs will play an important role in the continuity of patient information as patients move between providers.
"PHRs are not the magic bullet that will fix healthcare," Hood says. "They look like a supplement to an EHR, and in some cases a patient orientates and supplements it, but in most cases they are being used by people very concerned about their health record and willing to put their own effort into maintaining it."
For healthcare providers that are interested in building PHR applications, there are some key considerations to help ensure their long term success.
Define the primary objective. "Before you hook up with Google Health or Microsoft, you have to ask, 'Why am I doing it and what are the benefits for the organization,'" says Hood. The approach will be different if you are doing it to save money versus improving the patient experience. "Don't just jump because other people are doing it," he advises, adding that he wouldn't undervalue connecting the organization's focus on the patient to consumerism, either. “That is a factor that has been missing in healthcare."
Determine the organization's readiness. The healthcare industry has been paternalistic about health records, so organizations need to have senior leaders who want to release records and an institution that is open to this, says Aurelia G. Boyer, senior vice president and CIO at NewYork-Presbyterian Hospital. "We feel like patients own the data and we are the custodian of the data," she says.
Ownership is sticky wicket, says Hood. "If you look at from the patient standpoint, it is data about them," he says. But full ownership means that you have the right to destroy information. From a physician perspective it is also a record of the care a physician gave so it is a physician record too, Hood explains.
Giving patients the power to change data is really a paradigm shift, adds Sidna Tulledge-Scheitel, MD, medical director for Mayo Clinic Global Products and Services. "I'm a physician and we get a little bit centric about everything occurring in the office, but people are living 99% of the time outside of the doctor's office so I really believe in having health information and guidance and reminders where people are at," she says. "Right now we don't have mobile capabilities with the application, but we are going to be moving in that direction."
Prioritize health information technology. "I focused on the internal organizational work first," says Boyer. "A lot of CIOs still need to focus on an EMR." Once facilities have that EMR, they can determine how to pull together the data for a continuity-of-care record and start planning the data repository that will be needed to house the CCR, she says.
Determine patient priorities. PHRs cannot be generic. They have to incorporate elements that are critical to an individual's health, says Boyer. Both Mayo Clinic and NewYork-Presbyterian developed PHRs that help patients interpret data. NewYork-Presbyterian's PHR also alerts patients if they pick a weak password.
Patients with chronic conditions may be the more compelling users early on, but there are benefits for healthy people, such as having access to medical information and baseline data regardless of where they are, says Tulledge-Scheitel. "Having the ability for it to be very portable and not tethered to an entity—employer, insurance plan, or hospital—we believe is essential because people are highly mobile today."