Editor's Corner

Anne

I submit to you that PHRs, no matter how they are deployed or sponsored, are the future. The reason is that EMRs are restricted to the perspective of a particular institution or IT silo and run into insurmountable privacy issues when they try to cross institutional boundaries while bypassing the consumer.

Modern medicine is no longer the domain of a single institution, no matter how large. Care teams will increasingly communicate through the PHR and will help manage it as the current and concise clinical summary of a patient that everyone needs in order to administer care and evaluate the outcome.

EHR vendors that ignore communications with the PHR will seem as quaint as doctors without email.

Adrian

I agree that employer warehousing of records is a waste of time and energy, but,in my opinion, a portable PHR that can be controlled by the individual is infinitely more valuable than any provider's EMR. In the first place, seldom if ever is all the information in every medical encounter needed; having to wade through all this "data" when what you need at the moment is "information" may well defeat the purpose. In the future when everyone has gone electronic, record locator service technologies will be able to pull in all clinical details, labs, pharmacy, etc. on an as-needed basis. A basic portable "key events" or continuity of care record that can be maintained and modified by individuals and/or providers with patient permission seems not only more usefull than an EMR but also avoids many of the security pitfalls.

You have attached the same news release for the Employer Smoking story and the fighting the battle of the bulge story.

I have recently taken an interest in ePHRs as a patient who manages two chronic illnesses and sees several different doctors. The idea of having a portable ePHR would make life much easier, but I don't think it needs to contain your ENTIRE medical history in detail! If it does, the patient looses ownership of the PHR and privacy rights could be threatened. That's why the physicians have EHRs - which should be treated the same as their paper health records.
I believe the ePHR should be a summary and snapshot of your vitals & medical history: past illnesses, vaccinations, surgeries, current medications, blood type, allergies, etc. As it is now, most of us fill out paperwork on clip boards when we see a doc for the first time. The ePHR should eliminate that hassle for the patient.
A second feature needs to include a customized chronic condition page, that monitors different conditions as it pertains to patient: Diabetes, Cystic Fibrosis, HIV/AIDS, Cancer - each condition would be customized to track the important metrics of that disease like lab reports, weight gain and loss, etc.
Thrd, should be Emergency Contact Information: Primary Physician, Next of Kin, preferred pharmacy and even prime directives, DNRs and a power of attorney. I also think it wise to include your insurance carrier, group number and member number.
Finally there should be a Medical Calendar and/or Journal. Entries would simply record what physician you saw on a certain date and a brief summary of the visit. The Journal entry could be written by the physician, nurse, check out attendent or patient. It would tell what happened on that visit: a diagnosis made, medication changes, treatment plans formed, lab tests ordered or results received, etc.
Anything beyond those 4-5 features (depending on if the calendar is seperate from the journal) seems like it would begin to get too complicated for the average patient.
Insurance claims and billing information is not needed on the ePHR. These are more or less financial issues and should be kept seperate from your personal health records.
I don't see the need to have an entire medical library or medication interaction list built in to the ePHR either. Chances are even if the PHR is on a flash drive it will be compatible with the internet. A few web links to some medical reference websites would be great.
Scheduling appointments could easily be incorporated into the Calendar page. It would either be done at check-out, or done online if your provider offered online scheduling. If it's just to remind yourself of the appointment, I don't see the need really. I would put that on my PDA/Cell Phone/Date Book.
Requesting refills on medications can just be done on the Pharmacy's website or over the phone. That or the Physician can use the office EHR to email the prescription in. The patient doesn't need that on their personal health record either.
Get the idea, the more simple, the better!!The more articles and standards/guidelines I read about regarding the ePHRs, the more I believe it's overkill for the average patient. The ePHR is supposed to be an electronic Personal Health Record that is mainained and owned by the patient. It's great if the doctor can import updates or make additions. I just think the idea of the PHR should be to make it easier for the patient to communicate their health history and current care to all phsycians they see. Patients should carry their flash drives or have access to online PHRs to serve more of a reminder of what they need to share with their provider. If it is to be owned and maintained by the patient, then privacy needs to be at the forefront. The PHR is a medical diary. The more people or platforms that have access to it, the less privacy the patient has.
I like the idea of robust ePHRs that do-it-all/record-it-all! I'm a computer savvy 29 year old that has grown up with computers! But thinking of my parents or grandparents trying to use some of these PHR's I've read about or seen - there is no way they could do it. It would scare them away. My gradparents use a word processor and just record the date, the doctor, and who they saw and keep it on their computer's hard drive and they don't want anything more complicated than that. And the largest demographic for PHRs will be senior citizens. If the ePHR is to technically glamoured up, I don't think it will sell.
Just a thought to some of the providers and companies that are creating PHRs. I'm facinated by the direction the health industry is headed technologically. I really am looking at going back to school and going into Health Information Management. I would love a career and the chance to help shape this health care revolution. If anyone has any suggestions on other majors or entry level positions that would prepare me for a career in this direction, I would love to hear from you.

Bryen