Healthcare organizations are working to encourage patients to get engaged in their healthcare data, in part by making Personal Health Records more user-friendly. Part of the adoption problem isn't just a lack of consumer awareness, but the fact that many physicians are wary of records that are created and controlled by patients.
Among their concerns: time, accuracy, and control over data.
1.Time
Physicians who are reluctant to participate in the PHR system at the University of Pittsburgh Medical Center most fear that having a direct connection between themselves and their patients would take too much time, Daniel Martich, MD, chief medical information officer and vice president for physician services at UPMC, tells HealthLeaders Media.
UPMC uses a PHR system called HealthTrak, a Web-based portal that allows patients at its 20 hospitals and 400 outpatient sites to feed data into the electronic record. More than 70,000 patients currently use the system.
"They worried that the patient would write tomes, as opposed to a quick phone conversation. They thought it would be so onerous, looking at attachments of articles the patient clipped from Reader's Digest and they'd never get through their day," Martich says. "That, by and large, is myth. In fact, we're finding that patients are much more succinct if they have to type it in rather than talking to you on the phone."
You could tell docs that they're over-reacting. But it's better to offer them data.
Holly Miller, MD, chief medical officer with Fishkill, NY–based Med-Allies and a HIMSS director says she participated in a Cleveland Clinic study that showed physicians actually saved time by allowing lab results to be released to the PHR rather than calling the patient.
2.Data Integrity
Reliability of the information in the PHR is key, Miller said. Early experiences with PHR models have shown that physicians will not trust any model that depends on the patient entering data. It is far too easy to enter incorrect or incomplete data, she says.
Physician adoption also depends on the PHR being automatically generated through the EMR, she says. "It is unrealistic to expect a provider to go outside of their work flow and log in to a disparate system," Miller said.
3. Loss of Control Over Data
Docs are certainly justified in their concerns about data accuracy, but there's also a more subtle fear that they will lose control over the data. They don't like the idea of patients getting instant access to lab results without first talking to a doctor, for example.
(A rule proposed this past fall by The Centers for Medicare & Medicaid Service and two other federal agencies would amend the Clinical Laboratory Improvement Amendments of 1988 (CLIA) and require labs to release results directly to patients or their designated representatives upon request.)
"They're worried that the patient is going to get horrific news without the doctor first being able to review it, refine it, and present it in the best way," Martich says. "That concern is understandable, but it really has not been a problem."
But even benign results can be hard for the layperson to interpret.
"A number without a contextual relationship and without some level of interpretation is totally worthless …Relaying data to a patient is totally unrelated to relaying information to a patient," Bernard Emkes, MD, medical director managed care services at St Vincent Health in Indianapolis, said in a recent interview about the proposed CLIA rule. "Data is 'Your A1C level is 11.' Information is 'Your A1C level is 11 and oh my God we've got to get on this right now and here's what we need to do.'"
Most agree that patients need help interpreting and understanding lab results—however those results are delivered. One solution is to include an explanation of any test results delivered via a PHR or other direct-to-patient means and include links to more detailed information.
The CLIA rule would make patients more involved in their own care, said Alice Leiter, director of health IT policy at the National Partnership for Women & Families, in a recent interview. It would allow patients to "loop back around to their care team so that patients and providers can work together on how to interpret and understand lab results."