This article appears in the November 2011 issue of HealthLeaders magazine.
Personal health records have been a forward-thinking idea for some time now, but the rewards and requirements of achieving meaningful use are putting more pressure on providers to adopt a system that allows easy access for the patient but a reliable conduit of information from the health provider. Of the many models available, how does a provider know which way to go?
The key may be creating a PHR that is actually used by the patient and provider, not just offering a system that sounds good on paper but might not be what either party wants. In the past, healthcare providers have found that some PHRs aren’t user-friendly for the patient; the data is often incomplete or inaccurate, and many doctors don’t trust the accuracy of records created and maintained by patients. The result is that the PHR isn’t utilized to any significant extent.
One of the first decisions when considering a PHR is whether to have it tethered to the electronic medical record so that data can be linked automatically, or to have the PHR be a standalone system in which information must be entered. The tethered (or shared) option is winning favor among many providers, says G. Daniel Martich, MD, FACP, chief medical information officer and vice president for physician services at the University of Pittsburgh Medical Center. 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.
UPMC explored both options originally, developing its tethered HealthTrak system but also partnering with Google and its untethered PHR called Google Health. Even before the recent demise of Google Health, UPMC was seeing better results with the tethered option, which saw higher participation and more positive feedback.
“Our research shows that patients like having a direct connection to their physician. A shared connection is what consumers really want,” Martich says. “They want to communicate directly with them, get their lab results in a timely fashion, and see their appointments. They like seeing what their doctor sees.”
UPMC’s HealthTrak system was developed in-house six years ago through a grant from the Department of Defense, because the health system treats many military patients. UPMC uses Epic’s EMR system, and the UPMC HealthTrak PHR was built on the framework of Epic’s MyChart PHR. When Epic developed its MyChart patient portal, the health system linked its PHR to MyChart and the EMR. The PHR allows patients to see their lab results, vital signs, appointments, and most other data in real time, as soon as it is available to the physician, with the exception of MRI, CT, and radiology results. In addition, patients can correspond directly with the doctor, who is expected to reply within one business day.
Another question involves who is going to pay for this access. There are fee-based models for PHRs, in which the patient pays for the right to access the system, but Martich says UPMC patients were not interested in paying—even though they are enthusiastic about the PHR when it is free to them. UPMC does charge $40 for e-visits, in which an established patient with a new condition fills out an online form for 21 possible diagnoses and submits it to the physician for evaluation.
Epic charges UPMC for each patient using the PHR linked to its EMR, but the health system does not pass that expense on to the user. The charge is approximately $2 per year per patient, Martich says.
Once your PHR is in place, how do you engage both patients and physicians in using it? More than 1,100 physicians at UPMC use the Epic EMR, and they are encouraged to have their patients sign up for the PHR. The health system fosters participation by both patients and physicians by holding tutorials during staff meetings and having contests with a prize—such as a catered lunch for the staff—for the physician office that signs up the most participants.
The corporate communications department also helps market to patients by providing leaflets and screen savers for computers in the exam rooms that encourage patients to ask their doctors about HealthTrak. Sign-ups average about 700 per week, up from 500 last year, Martich says.
Patients with the most diagnoses—the sickest—are the most likely to use a PHR, says Holly Miller, MD, MBA, FHIMSS, chief medical officer with MedAllies, a company in Fishkill, NY, that provides PHR and other technical support for healthcare providers. She also is on the board of directors of HIMSS and is former CMIO for Cleveland-based University Hospitals and Health Systems.
“There have been many instances of PHRs that were relatively disappointing in terms of patient adoption,” Miller says. “Over the last 10 years there has been a great deal of research about what patients want and what they respond to. What has become clear in my mind is that patients are looking for tools that allow for communication and services with their physicians, but they also respond to PHRs that connect them with communities of other patients.”
Allowing patients to connect with others through the PHR can encourage participation, Miller says, because many patients appreciate being part of a virtual community of people with the same diagnosis.
“We also have seen that if the physician suggests they use the PHR, the patient is far more likely to use it,” Miller says. “They respond well when the doctor says this is a way that the two of them can stay in touch better and more directly.”
Martich notes that any PHR plans should include a proxy procedure for minors. Parents will want access to their children’s records, and teens may require special arrangements. State laws will vary on proxies, he says.
At UPMC, the PHR is supported by the information technology group and no new position was created to manage it. The health system is part of a health information exchange in the area that includes nine hospitals, so Martich says it is only a matter of time before the UPMC PHR is linked with other providers outside the UPMC community, allowing patients to access all of their health information in one place even if they see
multiple physicians.
That would address the one big downside of tethered PHRs, says Alfred Campanella, vice president and chief information officer with Virtua, a healthcare system based in Marlton, NJ. In most situations, a tethered PHR for a patient (not a provider) includes only the information from the single provider’s EMR, which usually is highly proprietary. In an HIE, providers may agree to share records for common patients, with rules for how that data is accessed and protected, he notes.
Concern about the limits of a tethered option led Virtua to go in the other direction. Virtua launched its PHR in May 2010, using an application purchased from the Mayo Clinic and Microsoft’s HealthVault. The
PHR allows the patient to enter health data but also accepts input from laboratories, Virtua, and many other healthcare organizations that align with Microsoft.
“We didn’t want a tethered PHR because we didn’t want it limited to our data,” he says. “We wanted it to be something that the patient felt they owned, and if they moved this was still going to be their PHR. Even though it is branded Virtua, it has a sense of independence to it for the patient.”
This article appears in the November 2011 issue of HealthLeaders magazine.