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HLST 4320 Group 5


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HLST 4320 Group 5

  1. 1. Advantages of Personal Health Records HLST 4320 Group 5 Dan Villamayor
  2. 2. Outline Case Summary Personal Health Records explained Types of Personal Health Records Policy and Adoption Examples Benefits Ethical Consideration Conclusion
  3. 3. Case Summary Evaluate policy, implementation, address patient and caregivers experience National Health Service (NHS) developed HealthSpace based on Kaiser Permanente’s My Health Manager model Widely successful: 2.4 million members, 10% reduction in physician visits, reduced phone calls HealthSpace goals: empower patients personalize care reduce NHS costs improve overall quality of care
  4. 4. Case Summary HealthSpace initial rollout included two account levels: Basic enter values only e.g. blood pressure readings, record health appointments Advanced access to summary records, book appointments, manage overall health, email securely with physician (via Communicator) Participant are not representative of the population Total: 56 patients (21 opened basic account) 20 suffered from chronic illness(s) (Diabetes) - was not initially using HealthSpace 15 opened advanced accounts
  5. 5. Case Summary Results: Basic account: no added benefit as physicians or caregivers could continue to maintain health records self-manage with tools already in place, e.g. blood glucose diaries, smart phone apps complex registration accessibility and usability additional factors: major familial stress, living in adverse conditions etc Advanced account: registration straightforward Communicator seen as an added bonus by some accessibility and usability
  6. 6. Case Summary Outcomes: flaws in design and implementation poorly executed therefore leading to low adoption practiced exclusion policy makers assumed patients were technologically savvy not well received by the people of England as seen by the data 173, 000 people in England created basic accounts 2.4 million received invitations to open advanced accounts 49% of those had completed the first step - downloaded forms 16% submitted forms for processing 13% fully activated advance account PHRs must be inclusive, and patient-centric in its design (Greenhalgh et al., 2010)
  7. 7. What Exactly is a Personal Health Record? ● Records that you access and maintain as a patient ● ‘’Patient-centric’’ records ■ custodianship under owner of PHR ■ this can be the patient or a family member ● Interfacing with clinician-held records (EHR) ● Can be Complete or Partial ■ Complete: ALL relevant health information over that person’s lifetime ■ Partial: health information pertaining to more specific parameters (records of blood pressure taken over a period of time)
  8. 8. Information in a Personal Health Record ● Personal record of appointments ● Interaction with physician (emails and consultations) ● Any previous interactions/interventions with various health care services ● Information on medication ● Health indicators: ■ blood pressure ■ glucose levels ■ stress/anxiety
  9. 9. Types of Personal Health Records Institution Centered or Stand alone PHRs: Managed in physician offices Paper records Electronic - Centralized with access through online portals Self- Managed PHRs: Managed by patients Allows patients to record, track and edit information about their health Linked PHRs: Managed by patients Integration between personally controlled PHR and primary care EHR
  10. 10. Policy and Adoption The adoption of PHRs in the United States: The government has implemented policies aimed at increasing the adoption of PHRs The Health Insurance Portability and Accountability Act (HIPAA) states that individuals must be granted access to their health records if they request it President George W. Bush set a goal in April 2004 The Office of the National Coordinator for Health Information Technology (ONC) was created and was later funded by the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 The American Reinvestment and Recovery Act of 2009 authorized the Centers for Medicare and Medicaid Services (CMS) to provide financial incentives for adoption of EHRs and PHRs
  11. 11. Existing Personal Health Records ● Examples of Existing Personal Health Records: Veterans Health Administration (VHA) launched its PHR called My HealtheVet (MHV) in 2003 Between 2004 and 2010, Kaiser Permanente (KP) which the largest managed care provider in the U.S. implemented a system-wide EHR called KP Health Connect with its PHR called My Health Manager Microsoft launched its web-based PHR platform, HealthVault in 2007
  12. 12. Examples Telus Health: Telus Health Space powered by Microsoft HealthVault Connects EMRs and EHRs with PHRs
  13. 13. Benefits: Preventive Care ● Many people are suffering from possible preventable diseases such as heart attacks, strokes, cancer etc. ● Clinical preventive services can be defined as: ■ screening tests ■ immunizations ■ counselling ■ preventive medications ● PHR preventive responsibilities: ■ when services are ready ■ when to renew medication ■ scheduling examinations ■ daily and weekly health progress
  14. 14. Benefits: Self- Management ● Patients can assess their own symptoms and illnesses at the palm of their hands ● Increases self-assurance and responsibility to manage their own health and well-being ■ simple to complex self- management approaches ■ asthma and diabetes are shown to be significantly self-manageable ● Many self-monitoring tools such as: ■ care plans ■ symptom graphing ■ instructive and motivational feedback ● Ownership of information solely belongs to the patient ■ increases privacy and any outside parties trying to access must have consent directly from the owner of PHR
  15. 15. Benefits: Disease Management Electronic communication with healthcare provider Manage multiple conditions Refill prescriptions Easy access to medication lists Access to diabetes-specific preventative care reminders High-quality diabetes-related educational content over 12-month period: 96% of users reviewed lab orders 94% read messages from providers 91% reviewed lab results (Tenforde et al., 2012)
  16. 16. Amanda Box Case (2013)
  17. 17. To Conclude Full ownership and custodianship to owner of the PHR increases privacy and confidentiality Patients have the opportunity and power to manage their health information Helps patients stay informed about their health to: prevent illness manage current and pre-existing conditions Access to health providers and medical experts reduces time spent waiting for results and travelling to physician's office reduces cost