1. PHR
The Personal Health Record
Jacksonville University School of Nursing
Kimberlee Przybysz and Jessika Reinhardt
December 1, 2012
2. Definition
• There are various definitions
from multiple agencies and
organizations so there is not
consensus on exactly what
defines a PHR.
• Some say it is a record of
health information that only
comes from the patient.
• Others say it is a record of
health information that
comes from both the patient
and from health care
professionals.
3. PHRs are electronic systems that
allow people to record, process,
and share health-related
information in order to help them
better manage their health and
healthcare (Hebda&Czar,2009).
4. What the PHR is:
1. A tool to collect, track, and share information about your health.
2. Info about you and your health usually compiled by you and maintained
by you.
3. A way for you to access certain aspects of your health info to share with
whom you decide whenever and wherever you need it.
4. A way to keep all your health info in one easily accessed place by
computer through the internet (past versions may have been paper files
or booklets).
5. A way for you to be more involved in your healthcare by assisting you
with decisions about your care.
6. Tethered- tied to a single organization or system and may contain
info from actual visits such as lab or radiology results.
OR
Stand alone- Not tied to a single organization or system. Can be on
internet or smartcard, CDs, or flash drives.
5. • It is not a complete medical record.
• It does not contain your entire EHR.
• It is not a replacement of a legal health record
of a provider.
• It does not allow for order entry or results
management by the provider.
6. On the Horizon
A possible alternative in the future is a
networked PHR.
This PHR would access information from
various sources such as various
providers, health plans, health record
banks, or laboratories.
(Hebda&Czar,2009)
7. Common Items in a PHR
Name, D.O.B., Blood Type, Emergency Contact
Dates of previous visits or upcoming appts.
Dates and results of tests and screenings
Major and chronic illnesses and surgeries
Medication List
Allergies
Family History
Immunizations
8. How can you get started with a PHR?
Health Care
Health Plans
Providers
Private
Vendors
Companies
9. Impact of the PHR on Healthcare
Increased patient
Gets people involvement in
involved in their care helps
their own meet objectives
healthcare and of Healthy People
in their overall 2020.
health.
10. PHR and Healthy People 2020
Healthy People 2020 Objectives
HC/HIT-5
Increase the proportion of persons who
use electronic personal health
management tools.
HC/HIT-5.1
Increase the proportion of HC/HIT-5.2
persons who use the internet to Increase the proportion of
keep track of personal health persons who use the internet to
information, such as care communicate with their health
received, test results, or upcoming provider.
medical appts.
11. Role of PHR in Managing Health
• Provide health care information to selected individuals
• Send email messages to providers
• Schedule appointments
• Tracking compliance with recommended screening guidelines
• Obtain information about disease and treatment
• Renew prescriptions
• Access self assessment tools
• Track insurance claims
• Check medical record for errors
• Record data from home care devices such as glucose monitors
• Record symptoms, observations, and responses to medications
12. Benefits of PHR
• Managed and controlled by the individual
• Helps individuals become active participants in their own care by
combining essential data, knowledge, and software tool (JAIMA, 2006).
• Helps maintain and promote health and wellness
• Can include decision support capabilities that can assist in managing
chronic conditions (Gandhi, 2003).
• Collaborates care for the individual that receives care from multiple
providers, facilities, and pharmacies.
• Can help decrease health care costs and improve quality of care
13. Benefit of PHR (cont.)
• Can help maintain a continuous connection and improved communication
between the patient and provider.
• Can be a life saver in a medical emergency
14. Barriers to PHR
• Lack of awareness by consumers
• Not everyone has access to PHR systems, computers, or devices
• Reliability is limited by the individual’s computer, reading, and health
literacy
• Time: It takes a lot of time to gather and enter health information
• Individuals may not keep PHR up to date
• Doesn’t include clinicians interpretations or reliable objective data
15. Barriers to PHR (cont)
• Legal concerns by providers related to treatment based on inaccurate
patient entered information
• Privacy and security concerns by the individual
• Consumers are unlikely to want PHRs that exchanges data over the
internet unless they feel confident that
their online health information is safe
and secure.
16. Privacy and Security
Online health services that store PHRs are not covered entities under the
Health Insurance Portability and Accountability Act of 1996 (HIPAA) and are
not subject to the Privacy Rule.
• HIPAA is a federal regulation which provides methods for maintaining the
safety and security of individually identifiable health information.
• Privacy Rule protects health information that is transmitted or maintained
in any form or media.
Individual PHR vendors or online health services determine their own level of
security and confidentiality and disclose that information to the consumer.
• Some insurance companies provide PHRs. Insurance companies ARE
covered entities under HIPAA and subject to HIPAA
Privacy Rule.
17. Privacy and Security (cont)
Consumers are concerned with hackers and employees misusing access to
patient information. There are technological interventions to improve system
security (Rindfleisch, 1997)
• Deterrents such as audit trails that record identity, time and circumstances
of users accessing information
• Technological obstacles which control the ability of a user to access info,
ensures users only access information they need to know. Examples are
authorization, authentication, encryption, and firewalls.
• System management precautions such as antivirus software
18. Selecting a PHR
According to the Medicare and Health and Human Services
(2012), in choosing the right PHR we should consider these
important features:
• Does the PHR provide proper tools for storing information about medical
conditions, procedures, allergies, medications and other personal
information?
• Can information about insurance claims or medical information from
doctors be uploaded to the PHR?
• Does the PHR offer the ability to print a list of medications or conditions
so it can be brought to a provider or hospital?
• Does the PHR provide education on key health topics?
• Are the features/tools in the PHR worth the costs?
19. Selecting a PHR (Cont)
• Does the PHR provide a tool to communicate with a provider’s office to
request refills for medication, ask questions or make appointments?
• Does the PHR provide emergency access to health information?
• Does the PHR have a plan for what would happen to the information if the
company either goes out of business or merges with another company?
• Does the PHR have policies for privacy and security of protected health
information?
20. Conclusion
• A PHR applies health information technology to your personal life to
improve safety, reduces medical errors, reduces gaps in communication
and reduce delays in receiving proper care.
• PHRs give all of us, as consumers of health care, control over our own
health information so that we can protect and improve our own health
and wellness through health promotion and disease management
• PHRs are a big part of the future of healthcare and will gain more and
more popularity as people become more aware of what it can do for them
and will continue to evolve as the electronic healthcare age evolves.
21. References
Ahima. (2012). Your privacy rights. Retrieved from http://www.myphr.com/
index.php/privacy_and_phrs/your_privacy_rights/.
Ahima. (2012). What is a personal health record (PHR)? Retrieved from http://
www.myphr.com/StartaPHR/what_is_a_phr.aspx.
Czar, P., & Hebda, T. (2009). Handbook of informatics for nurses & healthcare
professionals. (5th ed.). Upper Saddle River, NJ:Pearson.
Gandhi, TK., Weingart, SN, Borus, J., et al. (2003). Adverse drug events in
ambulatory care. New England Journal of Medicine, vol 308. Retrieved
from http:// www.myhealtharchive.com/m/pages/BenefitsofPHR.
Health and Human Services. (2012). Medicine, learn more about personal health
record. Retrieved from http://www.medicare.gov/PHR/LearnMoreAbout
PHR.asp#PHRChoose.
22. References (cont)
HealthyPeople. (2012). Health communication and health information technology.
Retrieved from http://www.healthypeople.gov/2020/ topicsobjectives
2020/objectivelist.aspx?topicld=18.
Journal of the American Medical Informatics Association. (2006). Personal health
records: definition, benefits, and strategies for overcoming barriers to
adoption. Retrieved from http:// www.ncbi.nlm.gov/pmc/articles/PMC
1447551.
Medicare. (2012). Personal health records (PHRs). Retrieved from http://www.
medicare. gov/manage-your-health/personal-health-records/personal-
health-records.html.
MedlinePlus.(2011). Personal health records. Retrieved from http:// www.nlm.
nih.gov/medlineplus/personalhealthrecords.html.
Rindfleisch, T.C. (1997). Privacy, information tech & health care. Retrieved from
http://www.dl.acm.org/citation.cfm?doid=257874.257896
Editor's Notes
The Personal Health Record or PHR.
A consensus has not yet been reached on a common definition of the personal health record. Many different agencies and organizations have various definitions and can’t agree on the best overall. Some believe it is a record of health information that is solely provided by the patient. Others say that it’s a record of health information provided by both the patient and from health care professionals.
more comprehensive approach is the definition from Hebda and Czar’s Handbook of Informatics for Nurses and Healthcare Professionals which says that personal health records are electronic systems that allow people to record, process, and share health related information in order to help them better manage their health and healthcare.
The next couple slides will give an overview of what the personal health record is and what it isn’t. First, what the personal health record is… It’s a tool to collect, track, and share information about your health. It’s information about you and your health which is usually compiled by you and maintained by you. It’s a way for you to access certain parts of your health information to share with whom you decide whenever and wherever you need it. So, it’s something you can have when you travel in case you are ill or injured or if your physician refers you to a specialist’s office. It’s also a way to keep all your health information in one place that you can easily access by computer through the internet. Early versions may have been paper files or booklets. Those of you who have had children may have kept the little booklet that the pediatrician gave you to record weights, milestones, feedings, etc… Those were a very basic, simple form of the personal health record. It can be a way for you to be more involved in your own healthcare by assisting you with decisions about your care. A personal health record can be tethered or stand alone. A tethered personal health record is tied to a single organization or system such as the clinic where you see your physician and so it may contain information from actual visits such as lab or radiology results. You may also be able to communicate by email with your provider or request appts. A stand alone personal health record is not tied to a single organization or system. It may be on the internet or on something like a smartcard or CD or a flash drive.
Next, what the personal health record isn’t: It is not a complete medical record. It only contains parts of your health information and records. It cannot replace your legal health record that your provider maintains and it does not allow for order entry or results management by your provider.
According to Hebda and Czar, something that is on the horizon or in the future of the personal health record is an alternative to the tethered and stand alone records. It is a networked personal health record. This personal health record would access information from various providers, health plans, health record banks, and laboratories.
Here we’ll talk a little bit about some of the common items you might find in a personal health record. Obviously, you would see basic demographic data such as your name and date of birth and probably an emergency contact. You may also have blood type information. there could be dates of previous hospitalizations or physician visits and dates of upcoming appointments. You may also see dates and results of various tests and screenings as well as lists of major and chronic illnesses and surgeries. A medication list is usually included and can be very helpful for obtaining refills or providing information to new physicians or if you are hospitalized. Any allergies you have may also be listed as well as family history and a list of immunizations you have received and dates.
So, how can you go about getting a personal health record set up for yourself? They are offered by a variety sourcces such as health care providers or the system they work for, your health insurance plan, private companies or employers, and individual vendors. A helpful website to visit in getting started is www.myPHR.com.
In the next couple slides, we’ll talk about how the personal health record impacts healthcare. First, it gets people involved in their overall health and this increased patient involvement helps meet the objectives of healthy People 2020.
The following are the healthy people 2020 objectives that are related to the personal health record. First, to increase the proportion of persons who use electronic health management tools. The other two objectives shown here are kind of offshoots of the previously mentioned objective… They are to increase the proportion of persons who use the internet to keep track of personal health information, such as care received, test results, or upcoming medical appts and to increase the proportion of persons who use the internet to communicate with their health provider.
the ways that the PHR can help your manage your overall health are listed here but of course as mentioned earlier, it depends on whether your PHR is tethered or stand alone.
There are many benefits of the PHR. One of the greatest benefits is individuals are encouraged to becomes active participants in their own health and wellness. The PHR also helps maintain patient safety by collaborating care for the person who is seen by multiple providers.
Another benefit of the PHR can be seen in an emergent situation. Health care providers can have the individual’s pertinent health information that is contained within the PHR right at their fingertips.
A major barrier to the use of PHR is a lack of awareness by the consumer of its existence. Also needing consideration are finances (as everyone can not afford a computer) and education level which includes reading and health literacy.
Physician are also concerned about the implications of potentially treating a person incorrectly based on information that was entered in a PHR incorrectly. Consumers may also be deterred because of information security issues.
Private companies such as GoogleHealth and Microsoft’s HealthVault are NOT mandated by HIPAA’s privacy rules. Insurance companies such as Aetna and BlueCrossBlueShield ARE covered subject to HIPAA regulations.
As a consumer it is important to understand the safety and security measures of the PHR vendor.
When selecting a PHR, it is important to determine if your needs can be met. Medicare and health and human services have compiled a list of important questions for consideration when selecting a PHR. This slide and the next list these important questions.
First, you should ask yourself if the PHR has a way to communicate with your provider’s office so you can request refills, ask questions and make appts. The next question to consider is does the pHR provide emergency access to your health information in the event you are ill or injured. Another important question to consider is if the PHR has a plan for what happens to your information if the company goes out of business or merges with another company.
So, in conclusion, the PHR applies health information technology to your personal life to improve safety, reduce medical errors, reduce gaps in communication and reduce delays in receiving proper care all by having your personal health information in one easily accessible place. They also give you control over your own health information so you can improve your own health and wellness through health promotion and management. PHRs are part of the future of healthcare and will continue to gain popularity with increased public awareness and the evolution of the electronic healthcare age.
