2. Outline
Case Summary
Personal Health Records explained
Types of Personal Health Records
Policy and Adoption
Examples
Benefits
Ethical Consideration
Conclusion
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. 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. 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. 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. 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. 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. 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. 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. 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
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. 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. 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)
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
