Personal health records, patient engagement and EHR meaningful use

Pros and cons of provider-based personal health records versus emerging PHR models, and how they all could drive patient engagement.

Have you thought about setting up a personal health record, but haven't gotten around to it yet? Or are you concerned about the privacy and security issues associated with putting your personal health information online? If either of these apply, you're not alone. A 2011 study showed that fewer than one in 10 Americans had a personal health record, and only about half knew exactly what one was.

Getting patients more involved in their own healthcare can lead to dramatic improvements in quality of care by emphasizing wellness and prevention rather than treatment of chronic disease. Personal health records (PHRs) enable healthcare consumers to keep track of such preventive measures as screening tests and immunizations; they also can play a role in encouraging healthy lifestyle habits, such as regular exercise, smoking cessation and diet management.

Personal health records can be made available to healthcare consumers by healthcare providers, commercial vendors or health-record banking associations. Based on early optimistic marketing forecasts, many vendors entered the marketplace in the mid-2000s by offering users Web-based PHRs at little or no cost. Some of these large players assumed that the cost of offering these PHRs would be offset by selling the personal health data culled from user records to researchers after "de-identifying" the data. The fear that their medical data might be used without their permission discouraged many potential users, who already had concerns about the privacy and security of online medical records. One of the major vendors, Google, decided to discontinue offering its PHR, Google Health, in January 2012, citing low user adoption rates.

Thomas JepsenThomas Jepsen

On the other hand, PHRs offered by healthcare providers to their patients appear to be gaining wider acceptance. Put simply, most patients trust their doctors with their personal health information and appreciate being able to access it online. PHRs have become a major component of the Patient Centered Medical Home concept. Major EHR vendors have responded by making patient-accessible PHR options available with the EHR software they intend physicians and hospitals to use for internal medical record management.

Personal health records are also becoming more interactive. Some PHR offerings have morphed into smartphone apps that enable users to monitor vital signs, such as pulse, blood pressure, weight and metabolic rate, in real time through the use of attachable sensors. Monitoring vital signs enables healthcare consumers to see the benefits of adopting healthy lifestyles, such as exercise and diet management, by tracking their progress toward goals.

Significant issues remain to be addressed, however, if widespread adoption is to occur. Many physicians are reluctant to incorporate the vital signs taken by patients into their "formal" health records; on the other hand, having access to such data can lead to early disease detection and prevention. The role of regulators is also unclear; while the American Reinvestment and Recovery Act of 2009 gives the Federal Trade Commission regulatory control over commercially available PHRs, much of the data in the PHR falls under the umbrella of "protected health information" that HIPAA created.

The bottom line, however,, is that widespread adoption of PHRs can play a vital role in moving from a costly healthcare paradigm of treating chronic diseases to an approach based on wellness and prevention that improves quality of life. A recent study shows that screening tests can reduce mortality rates by 15% to 30%, while immunizations can reduce the risk of serious disease by as much as 50%. Getting people involved in managing their own healthcare needs, rather than just being passive spectators, could be just what the doctor ordered.

About the author:
Thomas Jepsen is a health IT consultant and IEEE Computer Society member. Let us know what you think about the story; email editor@searchhealthit.com or contact @SearchHealthIT on Twitter.

PHR use news and advice

This was first published in April 2013

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