EHRs, PHRs, EMRs: Making Sense of the Alphabet Soup

1. EHRs, PHRs, EMRs:   Making Sense of the Alphabet Soup  October 15, 2009 Annelen Archbold, Strategy and Innovation, CDC Richard H Walsh , Director of Strategic Initiatives Greenway Medical Technologies Suzanne Gates, Consumer Health Informatics, CDC C. Joseph Cadle, MD, Asst to Medical Director for External Relations, Kaiser Permanente

2. Health Healthcare Problems •  Cost •  Quality of care •  Consistency of care •  Continuity of care •  Disaster/Emergency response •  Isolated, piecemeal, inaccessible records •  Medical care separated from health, life prevention

3. Why HealthIT? Health information technology (HIT) allows comprehensive management of medical information and its secure exchange between health care consumers and providers. http://healthit.hhs.gov/

4. HIT has the potential to •  Improve health care quality •  Prevent medical errors •  Increase the efficiency of care provision and reduce unnecessary health care costs •  Increase administrative efficiencies •  Decrease paperwork •  Expand access to affordable care and •  Improve population health http://healthit.hhs.gov/

5. Interoperable HIT can improve Individual Patient Care •  Complete, accurate, and searchable health information, available at the point of diagnosis and care, allowing for more informed decision making …………. •  More efficient and convenient delivery of care, without having to wait for the exchange of records or ….unnecessary tests …. •  Earlier diagnosis and characterization of disease, with the potential to thereby improve outcomes and reduce costs. •  Reductions in adverse events through an improved understanding of each patient’s particular medical history, ………... •  Increased efficiencies related to administrative tasks, allowing for more interaction with ….. patients, caregivers, and clinical care coordinators, and monitoring of patient care.

6. HHS/Health Information Technology http://healthit.hhs.gov

7. Electronic Record Definitions •  Electronic Medical Record (EMR): An electronic record … on an individual… within one health care organization. •  Electronic Health Record (EHR): An electronic record ……..on an individual ………across more than one health care organization. •  Personal Health Record (PHR): An electronic record …….on an individual… managed, shared, and controlled by the individual. Types: Standalone, Tethered, Integrated The National Alliance for Health Information Technology, Report to the Ofﬁce of the National Coordinator for Health Information Technology on Deﬁning Key Health Information Technology Terms” (April 28, 2008; http://www.hhs.gov/healthit/documents/m20080603/10_2_hit_terms.pdf)

8. Medically-Focused Efforts Connecting for Health Framework, Markle Foundation, 2008 http://www.connectingforhealth.org/

9. Tracking Emergency Patients 7/15/2009  http://www.disasterhelp.gov/ EDXL‐Tracking of Emergency Paents, (TEP), Phase 1  disastermanagement/library/archive/open/ 090715EDXL-TEP.ppt

10. Key Element of Information Use •  Privacy (protections and regulatory provisions) and other legal and medical legal issues •  Security and Interoperability of systems (so data can be exchanged among various sources and users) •  Incentives (must bring value in some way) •  Convenient •  Robustness (able to acquire easily from all sources) •  Trust (on the part of clinicians consumers) HP2020, July 16, 2009, K Bell

11. Part Two

12. PH Opportunities in Health Reform •  Increase prevention wellness, disease management. Modernize disease surveillance/ registries. •  Expand public engagement, participation, and communication through social media, mobile technology and participatory web applications. •  Reduce health disparities. •  Respond to emergencies.

13. The Personal Health Record (PHRs) “Polynomial Heterogeneous Record systems” •  Patient portals to providers’ legal electronic health records •  Vaults, banks, clouds, platforms that collect and store basic health data on an individual from wherever it is available •  Applications that “translate” health data for specific uses •  Flash drives, CD’s, smart cards, other personal devices •  Future?????? One health database per person accessed, added to, and/or used by anyone with patient permission……. HP2020, July 16, 2009, K Bell

14. Who’s Acting?

15. Rapidly Changing Landscape Government Non-profit/ Profit •  HHS – standards,   RWJ Project Health coordination; ONC/ Design (open-source NHIN(2), HP2020, application ecosystem) NCVHS, meaningful use   CA Health Foundation •  CMS – large-scale PHR   Health Privacy Project pilot (3rd party PHR   Markle Foundation application)   University research •  AHRQ –demonstration/   Patients Like Me guidelines   Personal Health Technology •  NIH – provider systems Council •  VA – My Healthe Vet   Pew Research •  DOD – MiCare pilot   Standards: CCHIT, HL7 – PHR Functional model

16. American Opinion Preferred medium for PHR: High perception of value Ages 45 and Under 79% or more of the public 3% believe using an online PHR 18% would provide major benefits to 33% individuals in managing their health and health care services. 22% June 2008 24% High interest Almost half of the public --46.5%-- say they would be interested in using an online PHR service. This represents about 106 million adults. June 2008 Source: Connecting for Health, Markle Foundation (http://www.connectingforhealth.org/)

17. Ideal PHR Characteristics: 2009 •  Electronic record of health information •  Drawn from multiple sources •  Controlled by the individual •  Data managed, augmented, used, and shared by the individual at his/her discretion HP2020, July 16, 2009, K Bell

18. Where are we today? •  4% of US population are using some sort of electronic means to access and use their own personal health information •  Dominated by “tethered” systems (patient portals into provider controlled EHRs) and employer/payer based systems populated with claims data •  Primary usage driven by transactional processes with providers •  Dominate user: “CMO” of family – middle aged female HP2020, July 16, 2009, K Bell

19. Areas of Interest Cross-cutting EMRs/EHRs •  Public Health alerts •  Unobtrusive decision support •  Registries (with patient education and referral information) •  Health monitoring/tracking •  De-identified surveillance •  Family health history •  Occupation and employer PHRs history •  Risk identification •  Guidelines for correct 3rd party •  Disease management use of information •  Education/guidelines •  Design standards/data fields •  Personalized tailoring •  Data quality, Privacy, Health •  Pets (exposure) literacy •  Opt-in surveys and longitudinal •  Equity/reducing disparities research

20. A Few Free, Web-based PHRs •  AboutMyHealth •  MedsFile.com •  dLife •  Microsoft Health Vault •  Dr. I-Net •  My Doclopedia PHR •  EMRy STICK •  My HealtheVet •  Google Health Records •  myHealthFolders •  HealthButler •  MyMediList •  Healthy Circles •  NoMoreClipBoard.com •  iHealthRecord •  Patient Power •  It Runs in My Family •  Telemedical.com •  MedicAlert •  VIA •  MediCompass •  WorldMedcard •  ZebraHealth…………. http://www.myphr.com/resources/phr_search.asp

21. Resources •  HHS/Health Information Technology-- http://healthit.hhs.gov •  National Institute of Standards and Technology (NIST) -- http://www.itl.nist.gov/div897/index.html •  Health Level Seven, Inc. (HL7)-- http://www.hl7.org/ •  Integrating the Healthcare Enterprise (IHE)-- http://www.ihe.net/ •  Health Information Technology Standards Panel (HITSP) -- http://www.hitsp.org/ •  CCHIT– Certification-- www.cchit.org •  Healthcare Information and Management Systems Society (HIMSS) -- “RHIO” and “Health Information Exchange” or “HIE” http://www.himss.org/ASP/chaptersHome.asp •  American Health Information Management Association best practices/training-- http://www.ahima.org/ www.MyPHR.com AMIA, ANSI-HISB, CITL, eHI, Internet2, CCR, CCD……

22. Thank You Suzi Gates (sgates@cdc.gov ) CDC’s National Center for Public Health Informatics

23. Definitions •  Portable/Data Portability-- Being able to move data from one database or repository to another. •  Cross-platform-- Developing software for, or running software on, more than one type of hardware platform. The most universal cross- platform application is the Web browser. •  Interoperable--The ability for one system to communicate or work with another.

24. PHRs Public Health •  Assessment –  Data Collection –  Investigation –  Monitoring/Sentinel Citizen •  Assurance –  Links to resources and services –  Quality Improvement –  Benchmark Health –  Emergency Preparedness •  Policy Development –  Inform, Educate, Empower –  Design considerations •  Research

25. Opportunities For Consumers Public Health •  Prevention • Health status monitoring •  Health promotion • Community problem solving •  Local service referral • Policies and planning • Service links •  Emergency/outbreak information • Inform, educate, empower • Evaluation •  Individual health monitoring • Research and development benchmarking • Sentinel citizens •  Integrating health into • Other: Equity, health literacy, daily living health status,…….

26. Standards Considerations for PH –  Ability to •  opt-in to receive (personally tailored) prevention materials/messages •  obtain info from cell phone or submit data from cell phone •  choose to be a sentinel citizen--share data one time or ongoing •  Include psychosocial add-on widgets including health risk assessment, pets, occupation/place of employment/years –  Doesn't encourage employers to change insurance annually

27. Impact Planning for Public Health Informa5cs: Sample Model and Measures   DRAFT – 08/17/09  Outputs Informatics Public Health Public Health Inputs Activities Impacts Impacts Outcomes (Short-term) (Mid-term) (Mid-term) (Long-term)o Informacs  Contribuon to a larger public health goal   Engage Users: individuals / Users: Are reached    community Use the solution (% target audience Changes Human (number of users, engaged, representativeness audience individuals,  Assess needs frequency, knowledge, community, health  duration of use) of participants, accessibility) attitudes, workforce  Employ and behavior train staff Have necessary Effec5veness  infrastructure Adopt the solution (Settings/providers Reduce  Solicit feedback capacity, morbidity/  participating, Organiza5on   workforce sustainable mortality  operang  Form readiness partnerships organizational Improve  procedures, legal  structure) Creates social, quality of life  structure,  Solution: policy, and organizaonal  Scan Reduce  environment Solution: physical Health  assets  Enables Is high quality, environments that collaboration Dispari5es  safe, efficient, promote good Identify reliable, relevant, health Improve  inefficiencies, Is usable, useful, popula5on  disparities complete, timely Technology  effective, and public  computers and  transparent Improves care or health  Secure funding user-centered, interventions connecvity,  technical  flexible, simple, Analyze interoperable, Enables reporting architecture and  requirements Maintains healthy standards,  physical  private, secure attitudes, Is scalable, infrastructure  Build/deploy adaptable behaviors Is implemented on technical budget, on time Faster, better, solutions cheaper, smarter

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