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04.10

Your Personal Health Record — It’s Your Responsibility

By William B. Harrison, PE

Health care reform legislation has consumed Congress, the White House and the public policy arena for many months. Previously passed legislation has already provided financial incentives and penalties for health care providers to implement electronic health and medical records. Health care organizations such as Kaiser Permanente, Group Health of Seattle, the Mayo Clinic, and others with large numbers of members/patients have developed comprehensive integrated electronic patient information systems of their own. A number of pilot projects are underway. System standards and network interoperability issues are being addressed.

Thomas Jepsen, interim chair of IEEE-USA's Medical Technology Policy Committee, cleared the alphabet soup of health information records and networks in his article in the January 2010 issue of Today’s Engineer. He suggested that one way to accomplish the goals of health care IT adoption is to give the patients/health care consumers more control over their health care and wellness by enabling them to own and manage a Personal Health Record (PHR). 

How then, as a patient, as a consumer, can I gain control over my wellness and my purchase of health care services? What is a PHR? What’s the difference in a PHR and an EMR (Electronic Medical Record), an EHR (Electronic Health Record)? Where does a PHR reside? Who owns my PHR? Who has access to my PHR? How can I create, store and access my Personal Health Record?

Several companies and health care providers offer Web-based PHR solutions. This article will attempt to answer some of those questions by summarizing features and functions available online from vendor offerings, and by addressing some ways the health care consumer can obtain and control his or her PHR.

What is a PHR?

A PHR is a personal and secure set of online tools that connects consumers to their health information and medical records. PHRs empower consumers to manage their own health, health care, and health care costs.

A PHR, which is controlled by the consumer, is different than an Electronic Medical Record (EMR) or an Electronic Health Record (EHR), which are owned by and under the control of the physician or other health care provider. A PHR may contain data entered by the consumer or by his or her health care providers.

PHRs may provide links to tools that help consumers manage their health such as wellness programs for tracking diet and exercise, information about drugs and medical devices, health education information, and applications to detect potential medication interactions.

Patients can elect to allow family members, health care providers, or whomever they choose to have access to their PHR, based on state and local health care privacy regulations. By controlling access, the patient can permit caregivers to help manage a loved one’s health, or provide critical information to a physician caring for you in an emergency. A PHR can also include information from a health plan — as is the case of a Centers for Medicare & Medicaid Services (CMS) pilots in South Carolina, Arizona and Utah, where Medicare provides health information from its claims database to PHR company databases.

Is a PHR the same as an EMR (Electronic Medical Record) and an EHR (Electronic Health Record)?

An EMR or EHR is normally collected, owned and controlled by the health care provider or health plan. The term Personal Health Record means exactly that — the individual care recipient is in charge. With a PHR, the individual is taking a leadership role and responsibility for his or her own health and health care. In large part, improving your health depends on keeping providers informed about all of your health problems, medications and history. Ideally, the health care consumer and health care providers have access to integrated, personalized medical information from the patient’s own health care data and from medical information in the provider’s files. In addition, this information can be augmented by health and wellness tracking.

Where does my PHR reside?

When you use a PHR, your personal health information is stored securely and privately online. You control how it's used. You choose what information you want to share and what you want to keep private. A provider portal enables online communication with providers’ offices to allow Internet-based communication with your Personal Health Record.

What information does my PHR contain?

The ideal situation allows individuals to interact with their health care providers in real-time to review, update and customize their own personal health maintenance and health improvement plans. Health Trio is one of the CMS Medicare PHR pilot participants. Health Trio’s PHR becomes your lifetime health record and can include:

• Illnesses/Conditions — A summary of current and past health problems, symptoms and conditions

• Surgical/Procedure History — A full summary of surgeries and major procedures

• Visit History — Provider visits and admissions are recorded by tracking and recording your visits and health events, whether they are captured from claims data, by the physician, by the patient, or by another caregiver. These events may include office visits, lab work, results from a lifestyle questionnaire, or other events

• Health/Reminder calendar — The health calendar allows members to be reminded of all types of health events. This includes member-scheduled reminders and those based on preventive health guidelines

• Patient report card/health record summary — The health plan can establish patient report card criteria for reporting information about health status to members

• Health care plan — Members can create their own care plan to help deal with their medical problems

• Immunization Profile — A full summary of the patient’s immunization history is available

Who has access to my PHR and how is the information used?

You may grant permission online for specific providers to access your health records. You can grant family members access to your record. You can establish rules to provide parents and/or custodians access to child/dependent records. State and local laws typically spell out who may be allowed access to a patient’s health-related information.

Patients and their providers can cooperatively build and maintain a permanent, secure medical history and problem list, thus increasing confidence in both the accuracy and completeness of the information.

Developing your own PHR can provide a great way for you and your medical provider(s) to set up a comprehensive care plan for you. You can be alerted when follow-up is needed and reminded when upcoming visits are scheduled. A calendar/reminder system is also a valuable tool for compliance with medication schedules, exercise regimens or other health activities.

Some PHR sites to visit

A number of companies offer secure, private Internet space to set up your own Personal Health Records. Several were accessed and accounts were set up during the preparation of this article. Screen shots show health information page layouts and typical information that can be entered online. You might want to visit these sites and check them out. You may want to discuss using an online PHR with your primary care physician. You may ultimately decide you want to select one of the online PHR solutions and start using it. A link to each company site and information about each company’s service is provided below.

Google Health — https://www.google.com/health

You take charge of your health information and organize your health information all in one place. Gather your medical records from doctors, hospitals and pharmacies. Share your information securely with a family member, doctors or caregivers.

Google stores your information securely and privately, but you always control how it's used. Google will not sell your data. You are in control. You choose what you want to share and what you want to keep private. View Google’s privacy policy to learn more.

Google’s health information entry screen:

PassportMD: https://www.passportmd.com/

Imagine you are enjoying a vacation when you suddenly experience health complications. Being away from home, it is almost impossible to quickly and accurately provide vital medical information to the local health care providers.

A personal health care record (PHR) solves this problem by centralizing all your vital health information in a secure, digital document that is easily accessible to you and your authorized health care providers anytime, anywhere you are in the world.

PassportMD is a personal health service company that helps you create, store and instantly access your personal health care records through a convenient and secure online portal. PassportMD medical record retrieval service does the work of retrieving your health care records for you. PassportMD will contact your doctor, organize and digitize your health care records then upload them into your own secure PassportMD account.

PassportMD's online service distinguishes itself from others by also helping you create personalized medical reminder messages, securely communicate with your doctors, track your health and fitness and receive trusted answers to all your medical questions.

Here is the PassportMD online health record entry page:

HealthTrio— http://www.healthtrio.com/

HealthTrio's PHR offers health plans and their members an opportunity to become involved in their health and wellness. By allowing members to view and have input into their health records, a more complete record is created. These capabilities also allow health plans to reduce medical management costs by providing personalized health and wellness content to each user and allowing them to interact with the health plan in real-time to review, update and customize their own personal health maintenance and health improvement plans. Because information is never deleted, HealthTrio's PHR becomes a lifetime record for the member.

Implementation and Use of PHRs

In addition to consumers, providers and health plans using vendor applications such as those discussed above, the Centers for Medicare & Medicaid Services (CMS) has been engaged in a number of pilot projects to encourage Medicare beneficiaries to take advantage of Personal Health Records. The type of Personal Health Records CMS has been testing are populated with health information from Medicare claims data. In the future, these records may be able to get information from a provider's electronic health record system. 

CMS is currently conducting two pilots. One called My Personal Health Record South Carolina (MYPHRSC) in the state of South Carolina, and one called Medicare PHR Choice, in Arizona and Utah. MYPHRSC is a pilot that provides an online PHR to beneficiaries with original (fee-for-service) Medicare in the State of South Carolina. The PHR allows participants to see their medical history, based on the past two years of claims. Additional information can be added manually, and the PHR provides helpful resources to understand diagnoses, conditions and procedures. This pilot is expected to run through 30 September 2010.

Implementation of Medicare PHRs has not been quick and easy. Medicare's pilot of Personal Health Records has drawn so little use that the program may not be renewed according to an article in the Arizona Republic. The CMS regional administrator said that the participation percentage was lower than the 3-6 percent nationally that use some type of personal health record.

PassportMD is one of the PHR participants in the Arizona/Utah Medicare pilot project. If you qualify for this CMS pilot, your Medicare data can be electronically transferred to your PHR. The PassportMD access page for seniors in the Arizona and Utah programs is shown below.

Positive Outcomes and Barriers to Implementation

A comprehensive article by Mark Terry, Washington G2 Reports, discusses uploading of laboratory testing to Google's version of a Personal Health Record. His article cites positive outcomes and barriers to the implementation of widespread personal and/or electronic health records. Positive outcomes from PHR adoption include:

• Improved health care quality

• Prevention of medical errors

• Reduction of health care costs

• Increased administrative efficiencies

• Decreased paperwork

• Expanded access to affordable health care

Significant potential barriers to extensive adoption of PHRs include:

• Interoperability. The various systems need to be able to interact with each other and various computer systems

• Privacy and Security. The systems need to provide HIPAA-like compliance, but also have security measures similar to the banking industry and comply with a variety of industry standards. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) ensures that personal health information is stored, accessed or processed in accordance with security rules that adequately protect patient specific information

• Data Modification. In order for physicians to be able to act on medical information, they will need to be confident of the veracity of the medical data. This will at least partly require that they be able to determine the sources and modifications that have occurred to the information in personal health records

Mark Terry’s referenced article provides an extensive list of key players in the Personal Health Record market. He divides companies currently in the marketplace offering personal health records into four broad categories:

• Standalones - primarily personal health record companies

• Spin-Offs of Information Technology or Software Companies. Most notable in this category are Google Health and Microsoft HealthVault

• Health care Providers

• Platform Providers - companies are focused less on being the patient/consumer's personal health record, than in providing the platform and/or technology for personal health records

Conclusions

Financing and delivery of health care services in the United States have a long way to go before they could be called an integrated comprehensive U.S. Health care System. It is up to us as individual patients/consumers to manage our own health care, to collect and store our personal health data, and to make it available to providers and caregivers when we need their services.

Resources

The Centers for Medicare & Medicaid Services (CMS) — www.cms.hhs.gov/PerHealthRecords/

James R. Fricton, DDS, MS and Diane Davies, MD, "Personal Health Records to Improve Health Information Exchange and Patient Safety,"   www.ahrq.gov/downloads/pub/advances2/vol4/advances-fricton_21.pdf

Google Health — https://www.google.com/health

HealthTrio— http://www.healthtrio.com/

Jepsen, T., "Electronic Medical Records — Sorting out the Alphabet Soup of Health Care IT," IEEE-USA Today's Engineer, January 2010, www.todaysengineer.org/2010/Jan/EMRs.asp

Microsoft’s HealthVault — http://www.healthvault.com/Industry/index.html

NoMoreClipboard — http://www.nomoreclipboard.com/

PassportMD: https://www.passportmd.com/

Terry, Mark, "Personal Health Records —Who Are the Key PHR Providers and How Are They Handling Laboratory Results?" Washington G2 Reports, 30 June 2008,  www.g2reports.com/issues/advisory/advisory/mark_terry/345-1.html

William B. Harrison is a member of the IEEE-USA Medical Technology Policy Committee (MTPC). He is a Past Director of Region 3 and serves as Region 3 liaison to the IEEE-USA MTPC.

Comments may be submitted to todaysengineer@ieee.org.