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The Power of Personal Health Records to ensure Clinical Transformation Project HealthDesign Patricia Flatley Brennan, RN, ...
United States of America Madison, WI
PHRs in New Zealand
PHRs in New Zealand
We think health care occurs  here But  health,  and much of  health care , happens here
The CARE between the care January June December
The challenge of  personal health information management <ul><li>Clinical encounters with  > 4  providers  /year </li></ul...
<ul><li>Lay people develop robust  to manage health information </li></ul><ul><li>Advantages </li></ul><ul><ul><li>Easy to...
Personal Health Records <ul><li>The Personal Health Record is  (an Internet-based)  set of  tools  that allows people to  ...
EHR EPR PHR Patient Records Electronic Health Records, Electronic Patient Records & Personal Health Records After Stead et...
PERSONAL HEALTH RECORDS <ul><li>Tethered </li></ul><ul><ul><li>Portals to health care system </li></ul></ul><ul><ul><ul><l...
A personal health information sy stem  is needed to transform Clinical Practice Self-Monitoring Clinical Records Communica...
A systems, functional perspective on PHRs holds greater promise for clinical transformation <ul><li>To understand their ow...
We needed to move from this…
..to this!
Project  HealthDesign: Re-defining PHRs
Colorado Care Tablet Clarence
engage patients in disease self care
Next Generation  PHRs: from data to action Move perceptions of PHRs from  static repositories of information to  dynamic, ...
<ul><li>Collecting ‘observations of daily living’ may be the most important feature of PHRs </li></ul><ul><li>ODLs are inf...
<ul><li>People don’t live from  clinical episode to clinical episode ~  they manage their health every day </li></ul><ul><...
<ul><li>A common technology platform for PHR applications accelerates development, interoperability and improves security ...
<ul><li>Users’ ethical, legal, and social concerns about sharing PHR information  </li></ul><ul><li>are real, but surmount...
Consumer-facing requires knowing the consumer! <ul><li>Lay people have robust information strategies </li></ul><ul><li>Dos...
… what really challenges them <ul><li>Lay people have robust information strategies </li></ul><ul><li>Dosing strategies ch...
… how  our  standards impact them <ul><li>Lay people have robust information strategies </li></ul><ul><li>Dosing strategie...
… how to fit into their lives <ul><li>Lay people have robust information strategies </li></ul><ul><li>Dosing strategies ch...
… what they WON’T do <ul><li>Lay people have robust information strategies </li></ul><ul><li>Dosing strategies change ofte...
… what health means to them <ul><li>Lay people have robust information strategies </li></ul><ul><li>Dosing strategies chan...
Teens view of health & illness
<ul><li>Project HealthDesign Round 2 </li></ul><ul><li>Carnegie Mellon University : functional assessment </li></ul><ul><l...
imagine...
<ul><li>Intelligent medications </li></ul><ul><li>Highly-integrated care management </li></ul><ul><li>Smart band-aids </li...
imagine...
Capitalize on social networks Stimulate peer education & support Groups Broadcast public health alerts Just-in-time traini...
imagine...
healthsystems.engr.wisc.edu www.projecthealtdesign.org
 
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The Power of Personal Health Records to ensure Clinical Transformation

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Patricia Flatley Brennan RN, PhD, FAAN
School of Nursing, University of Wisconsin – Madison
(3/11/10, Illott, 11.40)

Published in: Health & Medicine

The Power of Personal Health Records to ensure Clinical Transformation

  1. 1. The Power of Personal Health Records to ensure Clinical Transformation Project HealthDesign Patricia Flatley Brennan, RN, PhD, FAAN University of Wisconsin – Madison School of Nursing
  2. 2. United States of America Madison, WI
  3. 3. PHRs in New Zealand
  4. 4. PHRs in New Zealand
  5. 5. We think health care occurs here But health, and much of health care , happens here
  6. 6. The CARE between the care January June December
  7. 7. The challenge of personal health information management <ul><li>Clinical encounters with > 4 providers /year </li></ul><ul><li>Recalling what happened when and with whom </li></ul><ul><li>Sorting information from > 10 sources </li></ul><ul><li>Patient-net : patients as an information intermediary </li></ul><ul><li>Health@Home, 2002 </li></ul>
  8. 8. <ul><li>Lay people develop robust to manage health information </li></ul><ul><li>Advantages </li></ul><ul><ul><li>Easy to use, portable </li></ul></ul><ul><li>Problems: </li></ul><ul><ul><li>Not scalable </li></ul></ul><ul><ul><li>Not transferable </li></ul></ul><ul><ul><li>Not actionable </li></ul></ul>How do people manage health information
  9. 9. Personal Health Records <ul><li>The Personal Health Record is (an Internet-based) set of tools that allows people to access and coordinate their life-long health information and make appropriate parts of it available to those who need it. </li></ul><ul><li>Personal Health Records Working Group, Markle Foundation, 2003 </li></ul>
  10. 10. EHR EPR PHR Patient Records Electronic Health Records, Electronic Patient Records & Personal Health Records After Stead et al, 2005
  11. 11. PERSONAL HEALTH RECORDS <ul><li>Tethered </li></ul><ul><ul><li>Portals to health care system </li></ul></ul><ul><ul><ul><li>MyChart, IQ Health, MyHealthyVet </li></ul></ul></ul><ul><ul><li>To Payers (private & government) </li></ul></ul><ul><ul><ul><li>Aetna, CMS </li></ul></ul></ul><ul><ul><li>To suppliers like pharmacies </li></ul></ul><ul><ul><ul><li>Walgreens.com </li></ul></ul></ul><ul><li>Untethered </li></ul><ul><ul><li>Public Portals </li></ul></ul><ul><ul><ul><li>WebMD.com, MedicAlert </li></ul></ul></ul><ul><ul><li>On PCs </li></ul></ul><ul><ul><ul><li>Quicken </li></ul></ul></ul>
  12. 12. A personal health information sy stem is needed to transform Clinical Practice Self-Monitoring Clinical Records Communication Decision Support
  13. 13. A systems, functional perspective on PHRs holds greater promise for clinical transformation <ul><li>To understand their own health patterns </li></ul><ul><li>To have a single point of access to health data </li></ul><ul><li>To bring the every-day health experience into the clinical encounter </li></ul><ul><li>To get guidance and direction in day-to-day living </li></ul><ul><li>To help one clinician know what the other one is doing </li></ul>
  14. 14. We needed to move from this…
  15. 15. ..to this!
  16. 16. Project HealthDesign: Re-defining PHRs
  17. 17. Colorado Care Tablet Clarence
  18. 18. engage patients in disease self care
  19. 19. Next Generation PHRs: from data to action Move perceptions of PHRs from static repositories of information to dynamic, interactive applications that are a seamless and integral part of daily life
  20. 20. <ul><li>Collecting ‘observations of daily living’ may be the most important feature of PHRs </li></ul><ul><li>ODLs are information that is collected and reported by the patient </li></ul><ul><ul><li>sleep, diet, exercise, mood, adherence to medications </li></ul></ul><ul><ul><ul><li>important to health, but not collected in a clinical setting </li></ul></ul></ul>
  21. 21. <ul><li>People don’t live from clinical episode to clinical episode ~ they manage their health every day </li></ul><ul><li>Recording and interpreting of ODLs empower patients to: </li></ul><ul><ul><li>create a more meaningful portrait of their health </li></ul></ul><ul><ul><li>Understand and shape daily health decisions </li></ul></ul><ul><ul><li>facilitate more productive conversations </li></ul></ul><ul><ul><li>with clinicians </li></ul></ul>
  22. 22. <ul><li>A common technology platform for PHR applications accelerates development, interoperability and improves security </li></ul><ul><li>Consultants from Sujansky & Associates identified technical requirements common to all projects and implemented them in a web environment </li></ul><ul><li>  </li></ul><ul><li>The Common Platform demonstrates: </li></ul><ul><ul><ul><li>a common technical platform can support a variety of personal health application tools  </li></ul></ul></ul><ul><ul><ul><li>“ centralizing” common functions reduces implementation time and increases interoperability among personal health applications </li></ul></ul></ul><ul><li>  </li></ul>
  23. 23. <ul><li>Users’ ethical, legal, and social concerns about sharing PHR information </li></ul><ul><li>are real, but surmountable </li></ul><ul><li>A team from University of Miami Bioethics Program looked at the ethical, legal and social issues (ELSI) associated with the grantee projects </li></ul><ul><li>Top three overarching ELSI concerns </li></ul><ul><ul><li>Control over access to information </li></ul></ul><ul><ul><li>managing privacy rights </li></ul></ul><ul><ul><li>shifting shared decision-making to the user </li></ul></ul><ul><li>  </li></ul><ul><li>  </li></ul>
  24. 24. Consumer-facing requires knowing the consumer! <ul><li>Lay people have robust information strategies </li></ul><ul><li>Dosing strategies change often </li></ul><ul><li>Med reconciliation means something different to patients </li></ul><ul><li>Reconciling calendars is important </li></ul><ul><li>People DON’T want to take pictures of food </li></ul><ul><li>To kids, health involves friends, music and photos </li></ul>
  25. 25. … what really challenges them <ul><li>Lay people have robust information strategies </li></ul><ul><li>Dosing strategies change often </li></ul><ul><li>Med reconciliation means something different to patients </li></ul><ul><li>Reconciling calendars is important </li></ul><ul><li>People DON’T want to take pictures of food </li></ul><ul><li>To kids, health involves friends, music and photos </li></ul>
  26. 26. … how our standards impact them <ul><li>Lay people have robust information strategies </li></ul><ul><li>Dosing strategies change often </li></ul><ul><li>Med reconciliation means something different to patients </li></ul><ul><li>Reconciling calendars is important </li></ul><ul><li>People DON’T want to take pictures of food </li></ul><ul><li>To kids, health involves friends, music and photos </li></ul>Digoxin Lasix Colace ASA
  27. 27. … how to fit into their lives <ul><li>Lay people have robust information strategies </li></ul><ul><li>Dosing strategies change often </li></ul><ul><li>Med reconciliation means something different to patients </li></ul><ul><li>Reconciling calendars is important </li></ul><ul><li>People DON’T want to take pictures of food </li></ul><ul><li>To kids, health involves friends, music and photos </li></ul>
  28. 28. … what they WON’T do <ul><li>Lay people have robust information strategies </li></ul><ul><li>Dosing strategies change often </li></ul><ul><li>Med reconciliation means something different to patients </li></ul><ul><li>Reconciling calendars is important </li></ul><ul><li>People DON’T want to take pictures of food </li></ul><ul><li>To kids, health involves friends, music and photos </li></ul>
  29. 29. … what health means to them <ul><li>Lay people have robust information strategies </li></ul><ul><li>Dosing strategies change often </li></ul><ul><li>Med reconciliation means something different to patients </li></ul><ul><li>Reconciling calendars is important </li></ul><ul><li>People DON’T want to take pictures of food </li></ul><ul><li>To kids, health involves friends, music and photos </li></ul>
  30. 30. Teens view of health & illness
  31. 31. <ul><li>Project HealthDesign Round 2 </li></ul><ul><li>Carnegie Mellon University : functional assessment </li></ul><ul><li>RTI International/Virginia Commonwealth University reducing depression among adults with asthma </li></ul><ul><li>San Francisco State University Improving teen health </li></ul><ul><li>University of California Berkeley living with bowel disease </li></ul><ul><li>UC-Irvine & Charles Drew University fit baby – VLBW infants at home </li></ul>
  32. 32. imagine...
  33. 33. <ul><li>Intelligent medications </li></ul><ul><li>Highly-integrated care management </li></ul><ul><li>Smart band-aids </li></ul><ul><li>Dinner plate that knows what’s on it </li></ul>How these PHRs could create clinical transformation?
  34. 34. imagine...
  35. 35. Capitalize on social networks Stimulate peer education & support Groups Broadcast public health alerts Just-in-time training & coaching Class & cohort intervention news
  36. 36. imagine...
  37. 37. healthsystems.engr.wisc.edu www.projecthealtdesign.org

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