Personal Health Records




                          Personal Health Record
                           CDR Christopher La...
“These are exciting and very promising times for the
                          widespread application of information techn...
– You should always have access to your
Personal Health Records




                            complete health informatio...
Personal Health Record
                          • The PHR is a collection of important information
Personal Health Record...
What should be in your PHR
                          •    Personal identification, including name and birth date
Personal ...
Personal Health Records




                           Secure    Patient
                          Database   Portal




 ...
Personal Health Records




                           Secure    Patient
                          Database   Portal




 ...
Personal Health Records




                           Secure    Patient
                          Database   Portal




 ...
Personal Health Records




                           Secure    Patient
                          Database   Portal




 ...
Personal Health Records




                             Other       Secure    Patient
                          Health Ca...
Patient
                                                   Handouts/
                                                   Ed...
Family      Patient
                                        Health     Handouts/
                                        H...
Family      Patient
                                        Health     Handouts/
                                        H...
Family      Patient
                                        Health     Handouts/
                                        H...
Centralize Information
                          • Medications
Personal Health Records




                          • All...
• A recent survey found 64 percent of
Personal Health Records




                            respondents who had a person...
Increase Participation
Personal Health Records



                          Participatory medicine is a movement in which
...
• Patients who have online access to their health
Personal Health Records



                            information are t...
Save Time and Money
Personal Health Records




                          • Providing interoperable PHRs to 80%
          ...
Sharing Information
                          • Family members/caregivers
Personal Health Records




                    ...
Access to Services
                          • Medication refills
Personal Health Records




                          • ...
Health Communication
                          • Knowledgeably discuss your health with
Personal Health Records



       ...
Patient Wellness Handout
                          •   Combines information from the clinical information system with
    ...
Personal Health Records
Can be generated at
                          different points of care
Personal Health Records
Patient focus groups
                          “My son was sick and he had to see so many doctors and this could
Personal ...
Clinician feedback
                          “I have been telling patients that they are
Personal Health Records



      ...
PWH version 2.0
                          • Version 2 released in February 2009
Personal Health Records




              ...
New components
                          •   Reminders for health        •   Quality of Care measures (to
Personal Health ...
Plans for PWH v3.0
                          •   Pediatric
Personal Health Records




                          •   Intak...
Health Communication
                                 Website
Personal Health Records
System Benefits
                          • Providers’ staff saves an average of four minutes
Personal Health Records



 ...
• Offering this access to patients raised the patient
Personal Health Records



                            perception of...
Concerns
                          • Privacy and Security
Personal Health Records




                            – 75 per...
Driving Forces
                             National
Personal Health Records



                          Coordinator for
...
Healthy People 2020
                          • HC/HIT HP2020–7: (Developmental) Increase the
Personal Health Records



 ...
EHR Certification
                          • ADM. 22 Demonstrate how a
Personal Health Records




                      ...
Presidential Executive Order
                          • Offer personal health records to enrollees based
Personal Health ...
Personal Health Records
                          Meaningful Use
Personal Health Records
                          Meaningful Use 2011
Personal Health Records
                          Meaningful Use 2015
Personal Health Records           Meaningful Use

                          By FY11, view data:
                          ...
IHS Internet Access
                                     2006/2007
Personal Health Records



                          5....
Internet Access is increasing
Personal Health Records
Patient Registration
                          Internet Access Questions
Personal Health Records



                      ...
Patient Registration
                                  E-Mail Address
Personal Health Records



                         ...
Choosing a PHR
                          • Use Appropriate technology for the patient, their
Personal Health Records



  ...
PHR Options
                          • Stand alone - you enter, modify and
Personal Health Records




                  ...
Cloud Databases
                          • Microsoft Healthvault
Personal Health Records




                          • ...
Personal Health Records




        IHS Plans for PHR
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PHR intro

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A presentation to describe the purpose for pursuing an IHS personal health record and early plans for development. This is part one of a two part presentation given at the IHS IHIM conference this year.

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  • RPMS passes information to Health Vault
    This information is displayed in the portal
    Patients can enter information into the portal and it will be stored in health vault (Someday, patients may be able to send information to RPMS)
    Telehome information will pass to healthvault
    Information from other health care systems will be made available as well
    Link other websites and information such as tailored patient education to the portal
    Family health history will populate health vault and plans to populate RPMS as well
  • RPMS passes information to Health Vault
    This information is displayed in the portal
    Patients can enter information into the portal and it will be stored in health vault (Someday, patients may be able to send information to RPMS)
    Telehome information will pass to healthvault
    Information from other health care systems will be made available as well
    Link other websites and information such as tailored patient education to the portal
    Family health history will populate health vault and plans to populate RPMS as well
  • RPMS passes information to Health Vault
    This information is displayed in the portal
    Patients can enter information into the portal and it will be stored in health vault (Someday, patients may be able to send information to RPMS)
    Telehome information will pass to healthvault
    Information from other health care systems will be made available as well
    Link other websites and information such as tailored patient education to the portal
    Family health history will populate health vault and plans to populate RPMS as well
  • RPMS passes information to Health Vault
    This information is displayed in the portal
    Patients can enter information into the portal and it will be stored in health vault (Someday, patients may be able to send information to RPMS)
    Telehome information will pass to healthvault
    Information from other health care systems will be made available as well
    Link other websites and information such as tailored patient education to the portal
    Family health history will populate health vault and plans to populate RPMS as well
  • RPMS passes information to Health Vault
    This information is displayed in the portal
    Patients can enter information into the portal and it will be stored in health vault (Someday, patients may be able to send information to RPMS)
    Telehome information will pass to healthvault
    Information from other health care systems will be made available as well
    Link other websites and information such as tailored patient education to the portal
    Family health history will populate health vault and plans to populate RPMS as well
  • RPMS passes information to Health Vault
    This information is displayed in the portal
    Patients can enter information into the portal and it will be stored in health vault (Someday, patients may be able to send information to RPMS)
    Telehome information will pass to healthvault
    Information from other health care systems will be made available as well
    Link other websites and information such as tailored patient education to the portal
    Family health history will populate health vault and plans to populate RPMS as well
  • RPMS passes information to Health Vault
    This information is displayed in the portal
    Patients can enter information into the portal and it will be stored in health vault (Someday, patients may be able to send information to RPMS)
    Telehome information will pass to healthvault
    Information from other health care systems will be made available as well
    Link other websites and information such as tailored patient education to the portal
    Family health history will populate health vault and plans to populate RPMS as well
  • RPMS passes information to Health Vault
    This information is displayed in the portal
    Patients can enter information into the portal and it will be stored in health vault (Someday, patients may be able to send information to RPMS)
    Telehome information will pass to healthvault
    Information from other health care systems will be made available as well
    Link other websites and information such as tailored patient education to the portal
    Family health history will populate health vault and plans to populate RPMS as well











  • Focus groups were conducted by the HPDP program in each of the 12 areas to assess patient feedback on the PWH. Recommendations on wording changes and displayed information are being included in version 2.0 which will be released in February 2009
  • Clinicians were asked to provide feedback on the PWH as well. In one evaluation, clinicians reported that patients pay attention to the information in the PWH and ask questions about this information. Healthcare communications increase and many providers felt that they spent more time talking with the patient by reviewing the PWH.
















  • Although home internet access in the general population is increasing based upon survey data, there are many barriers identified that may decrease the potential for users to access the internet for health care information including living in a rural area






  • PHR intro

    1. 1. Personal Health Records Personal Health Record CDR Christopher Lamer PharmD, MHS, BCPS, CDE Office of Information Technology/Health Education
    2. 2. “These are exciting and very promising times for the widespread application of information technology to improve the quality of healthcare delivery, while also Personal Health Records reducing costs, but there is much yet to do, and in my comments I want to note especially the importance of the resource that is most often under-utilized in our information systems – our patients.” – Charles Safran MD, testimony to the House Ways & Means subcommittee on health in June 2004 Since Dr. Safran’s testimony US healthcare costs have more than doubled, quality has not improved, and virtually nothing has been done to leverage the engaged patient. Let Patients Help!
    3. 3. – You should always have access to your Personal Health Records complete health information. – Information in should be accurate, reliable, and complete. – You should have control over how your health information is accessed, used, and disclosed.
    4. 4. Personal Health Record • The PHR is a collection of important information Personal Health Records about your health or the health of someone you’re caring for that you actively maintain and update. – Basis for planning your care and treatment – Means by which you can discuss your care with healthcare professionals – Documentation describing care you received from healthcare professionals
    5. 5. What should be in your PHR • Personal identification, including name and birth date Personal Health Records • Emergency contacts • Names, addresses, and phone numbers of your physicians, dentists, and specialists • Health insurance information • Important events and hereditary conditions in your family history • Opinions of specialists • Important test results • Eye and dental records • Correspondence between you and your provider • Permission forms • Living wills, advance directives, or medical power of attorney • Dates of significant illnesses and surgical procedures • Current medications and dosages • Immunizations and dates received • Allergies or sensitivities to drugs or materials
    6. 6. Personal Health Records Secure Patient Database Portal RPMS
    7. 7. Personal Health Records Secure Patient Database Portal RPMS
    8. 8. Personal Health Records Secure Patient Database Portal RPMS
    9. 9. Personal Health Records Secure Patient Database Portal RPMS
    10. 10. Personal Health Records Other Secure Patient Health Care Database Portal System RPMS
    11. 11. Patient Handouts/ Education Personal Health Records Other Secure Patient Health Care Database Portal System RPMS
    12. 12. Family Patient Health Handouts/ History Education Personal Health Records Other Secure Patient Health Care Database Portal System RPMS
    13. 13. Family Patient Health Handouts/ History Education Personal Health Records Other Secure Patient Health Care Database Portal System RPMS Home Monitoring
    14. 14. Family Patient Health Handouts/ History Education Personal Health Records Other Secure Patient Health Care Database Portal System RPMS Home Monitoring
    15. 15. Centralize Information • Medications Personal Health Records • Allergies • Laboratory Results Maintai ni • Discharge Summaries persona ng your own l is one o health record f • Problem list to have the best ways constan to your t access • Procedure Information health i through nformat out the ion of your course lifetime.
    16. 16. • A recent survey found 64 percent of Personal Health Records respondents who had a personal health record said the biggest advantage was the ability to check online the accuracy of their medical information. • 57 percent said the best feature was the ability to view test results.
    17. 17. Increase Participation Personal Health Records Participatory medicine is a movement in which networked patients shift from being mere passengers to responsible drivers of their health, and in which providers encourage and value them as full partners You Make the Difference. Improve Your Health. Research shows that when consumers actively participate in their own care,
    18. 18. • Patients who have online access to their health Personal Health Records information are twice as likely to receive suggested routine screening. • Consumers with online access to their health information pay more attention to their health. • PHR users are young, highly educated and higher income, yet surprisingly, less educated, lower- income and chronically ill patients report greater value from using a PHR.
    19. 19. Save Time and Money Personal Health Records • Providing interoperable PHRs to 80% of the US population would cost – $3.7 billion in startup costs – $1.9 billion in annual maintenance costs • Widespread use of PHRs could save the US healthcare industry between $13 and $21 billion a year. http://www.myphr.com/index.php/start_a_phr/why_should_you_keep_a_phr
    20. 20. Sharing Information • Family members/caregivers Personal Health Records • Emergency situations • Other healthcare providers • Self documented information
    21. 21. Access to Services • Medication refills Personal Health Records • Medication renewal • Secure messaging • Home monitoring management • Community alerts • Links to education • Social networks
    22. 22. Health Communication • Knowledgeably discuss your health with Personal Health Records healthcare providers • Provide information to new caregivers • Have easy access to your health information while traveling • Access your information when your doctor’s office is closed • Record your progress toward specific health- related goals • Refer to physician instructions, prescriptions, allergies, medications, insurance claims, and more • Track appointments, vaccinations, and numerous other wellness healthcare services
    23. 23. Patient Wellness Handout • Combines information from the clinical information system with programmed logic to create a document that provides personalized Personal Health Records information from the patient's medical record that is explained at a 6th grade or lower level including information on: Personalize RPMS Logic d PWH Explanation • Measurements (Height, Weight, BMI) • Quality of Care measures • Reminders for health maintenance • Patient goals screening (Mammogram, PAP, Colon • Activity level cancer, HIV) • Ask Me 3 • Reminders for diabetes screening (A1c, Nephropathy assessment, • Cholesterol Retinal screen, Foot exam) • Blood Pressure
    24. 24. Personal Health Records
    25. 25. Can be generated at different points of care Personal Health Records
    26. 26. Patient focus groups “My son was sick and he had to see so many doctors and this could Personal Health Records have helped, it’s easier to carry a record, instead of trying to remember all the information.” “Medication listed would have been helpful because it was hard to remember the names of them - I can’t even pronounce the names.” “(When you can’t) establish a (primary) doctor, you can carry a record to share with doctors at different clinics to make it easier.” “This paper would save people a lot of time, especially with waiting. When I had problems with my chest my family wanted to take me to (my IHS clinic), I said no, no. Take me to (the big city hospital). When I got there, they had to call (the IHS clinic) and it took them forever to get my information. It would be quicker if I had this.’
    27. 27. Clinician feedback “I have been telling patients that they are Personal Health Records overweight for years, now they get the handout and are asking me what weight they should be at” “Patients are asking for their immunizations and want to know what their blood pressure should be” “Patients will look at their medications on the list and tell me that they are no longer taking some of them”
    28. 28. PWH version 2.0 • Version 2 released in February 2009 Personal Health Records • Ability to auto-generate at patient registration, check-in through PIMS, and through the pharmacy package • Ability to create customized PWH by selecting only the component that you want printed - a medication reconciliation PWH will be included that only prints the demographics, allergies, and medications • Provides many new components
    29. 29. New components • Reminders for health • Quality of Care measures (to Personal Health Records maintenance screening compare with aggregate data – Mammogram on the QOC website) – PAP • Documented goals – Colon cancer • Activity level (based on documentation of the activity – HIV level health factor) • Reminders for diabetes • Ask Me 3 screening – A1c – Nephropathy assessment – Retinal screen – Foot exam • Reminders for LDL
    30. 30. Plans for PWH v3.0 • Pediatric Personal Health Records • Intake forms • Emergency contact • Problem List • Procedure List • Vital Histories • Anticoagulation • Recent/Pending Labs
    31. 31. Health Communication Website Personal Health Records
    32. 32. System Benefits • Providers’ staff saves an average of four minutes Personal Health Records per medication refill when requested online versus being phoned in. • They save approximately $3 per lab result delivered online versus being mailed to the patient. • Patients are more likely to show up for appointments that they schedule themselves online. Patient no-shows were reduced 30% with online scheduling. • Providing patients with the convenience of being able to pay their bills online reduced 1 day of outstanding A/R on average.
    33. 33. • Offering this access to patients raised the patient Personal Health Records perception of quality by 20%. • 73% of the physicians using the tool agreed that the access improved patient/physician interaction, and 97% of the patients said it was important in their choice of where to receive care.
    34. 34. Concerns • Privacy and Security Personal Health Records – 75 percent of survey respondents said they still are skeptical about how safe their private medical information would be in an electronic health record. – Many expressed concern that the data could be accessed by their employers and health insurance plans. – Concern is reduced by experience with and benefits received from a PHR.
    35. 35. Driving Forces National Personal Health Records Coordinator for Meaningful Use Healthy People Executive Order
    36. 36. Healthy People 2020 • HC/HIT HP2020–7: (Developmental) Increase the Personal Health Records proportion of persons who use electronic personal health management tools. • HC/HIT HP2020–8: (Developmental) Increase the proportion of patients whose doctor recommends personalized health information resources to help them manage their health.
    37. 37. EHR Certification • ADM. 22 Demonstrate how a Personal Health Records patient can obtain online access to their clinical information including, at a minimum, lab test results, problem list, medication list, medication allergy list, immunizations, and procedures.
    38. 38. Presidential Executive Order • Offer personal health records to enrollees based Personal Health Records on their claims, medications and medical history information currently available in carrier healthcare systems
    39. 39. Personal Health Records Meaningful Use
    40. 40. Personal Health Records Meaningful Use 2011
    41. 41. Personal Health Records Meaningful Use 2015
    42. 42. Personal Health Records Meaningful Use By FY11, view data: By FH2013: • Medications • Reporting • Allergies • Patient Preferences • Laboratory Results • Secure Messaging • Discharge Summaries • Device Data Upload • Problem list • Family Health History • Procedure Information • Languages
    43. 43. IHS Internet Access 2006/2007 Personal Health Records 5.1% 37% 21% 27% 15.5% 17% 16% 30.8% 21% 28.6% 18% 26%
    44. 44. Internet Access is increasing Personal Health Records
    45. 45. Patient Registration Internet Access Questions Personal Health Records IHS REGISTRATION EDITOR (page 1) CIHA HOSPITAL ================================================================================ DEMO,PATIENT (upd:MAR 17, 2010) HRN:1 ================================================================================ 1. ELIGIBILITY STATUS : CHS & DIRECT 2. DATE OF BIRTH : 03/22/1947 3. PLACE OF BIRTH [CITY] : ALBUQUERQUE 4.ST : NC 5. SEX : MALE 6. SOCIAL SECURITY NUMBER : 000000003(Not yet verified by the SSA) 7. MARITAL STATUS : MARRIED 8. CURRENT COMMUNITY : SNOWBIRD -------------------------------------------------------------------------------- 9. STREET ADDRESS [LINE 1] : snowbird dr 10.STREET ADDRESS [LINE 2] : 11.STREET ADDRESS [LINE 3] : 12. CITY : snowbird 13.ST : NC 14. ZIP CODE : 28779 15. LOCATION OF HOME : LOCATION OF HOME CONTAINS DATA -------------------------------------------------------------------------------- 16.PHONE NUMBER [RESIDENCE] : 828-497-2465 17.WORK PHONE : 828-497-9163 18. OTHER PHONE : cell 828-735-5555 19. INTERNET ACCESS : YES WHERE : WORK (upd DEC 10,2009) 20. EMAIL ADDRESS: DEMOPATIENT@GMAIL.COM -------------------------------------------------------------------------------- ================================================================================ CHANGE which item? (1-20) NONE//:
    46. 46. Patient Registration E-Mail Address Personal Health Records IHS REGISTRATION EDITOR (page 1) CIHA HOSPITAL ====================================================================== ========== DEMO,PATIENT (upd:MAR 17, 2010) HRN:1 ====================================================================== ========== 1. ELIGIBILITY STATUS : CHS & DIRECT 2. DATE OF BIRTH : 03/22/1947 3. PLACE OF BIRTH [CITY] : ALBUQUERQUE 4.ST : NC 5. SEX : MALE 6. SOCIAL SECURITY NUMBER : 000000003(Not yet verified by the SSA) 7. MARITAL STATUS : MARRIED 8. CURRENT COMMUNITY : SNOWBIRD -------------------------------------------------------------------------------- 9. STREET ADDRESS [LINE 1] : snowbird dr 10.STREET ADDRESS [LINE 2] : 11.STREET ADDRESS [LINE 3] : 12. CITY : snowbird 13.ST : NC 14. ZIP CODE : 28779 15. LOCATION OF HOME : LOCATION OF HOME CONTAINS DATA -------------------------------------------------------------------------------- 16.PHONE NUMBER [RESIDENCE] : 828-497-2465 17.WORK PHONE : 828-497-9163 18. OTHER PHONE : cell 828-735-5555 19. INTERNET ACCESS : YES WHERE : WORK (upd DEC 10,2009) 20. EMAIL ADDRESS: DEMOPATIENT@GMAIL.COM -------------------------------------------------------------------------------- ====================================================================== ========== CHANGE which item? (1-20) NONE//:
    47. 47. Choosing a PHR • Use Appropriate technology for the patient, their Personal Health Records family, community and the health care delivery system • Considerations – Functional Model (standalone, tethered, integrated) – Patient Factors • Desires and goals of patient, community and population • Patient Activation • Health literacy – Appropriate (for patient) information display • Access to Internet (technology reflective of patient population) – Return on investment – Evaluation of impact
    48. 48. PHR Options • Stand alone - you enter, modify and Personal Health Records update everything. • Tethered - you can view your health information from an EHR or electronic system. • Integrated - you can view and enter information into your record that can be shared or added to your medical record.
    49. 49. Cloud Databases • Microsoft Healthvault Personal Health Records • Google Health – Survey found only 25 percent of citizens would choose to sign up for either of those services. – Majority of respondents said they preferred to use health records provided by doctors and hospitals. – Limited in what can be added or how this information can be used.
    50. 50. Personal Health Records IHS Plans for PHR
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