By Jason Fortin and Erica Drazen
Despite the potential convenience of accessing medical records online, there is still limited interest by consumers and providers in creating a true personal health record (PHR).
The personal health record (PHR) model must continue to evolve from a business model that largely benefits providers, payers, and employers to one that is aligned with patients' needs and integrated with their lifestyles.
From the comfort of his or her home, a consumer can tap into one of these patient-friendly online portals to access information about their own medical histories. But according to one survey, only 7 percent of consumers have accessed PHRs to receive, keep, or update their health information.
A widespread change in behavior is the expectation of what will happen if patients have access to a true PHR, but it should not be viewed as a foregone conclusion.
Four Characteristics of a True PHR
There is no widely accepted definition for what specific capabilities a PHR should include, but at a minimum, any true PHR needs to at least possess the following four characteristics.
Comprehensive. The PHR includes accurate and complete data from all settings of care. This includes any data required to make a healthcare-related decision:
- Clinical information from a primary care physician or hospital
- Data uploaded from a device in the patient's home
- Details on health insurance coverage
- Notification of upcoming appointments or when a medical bill needs to be paid
Interactive. Information flows both to and from the PHR. Patients are provided with proactive and timely feedback based on the information provided. Authorized physicians can be automatically notified of important changes or new information.
Patient-controlled. The patient has lifetime access to any information in the PHR and decides which stakeholders can access the information.
Secure. The information in the PHR is accessible only by the patient or third parties authorized by the patient.
Adoption by Consumers Remains Low
Despite being a patient-friendly tool for consumers and providers, recent data from the California HealthCare Foundation suggest that, outside of a few well-known initiatives, adoption of a PHR by consumers is low.
According to the 2010 study, only 7 percent of adults nationwide have ever used a website from a doctor's office, health plan, or other company to get, keep, or update health information, such as lab test results, medicines, and doctor's visits. Other survey results include:
- Fifteen percent of all respondents said they have renewed a prescription online
- Eight percent said they have sent or received email to or from a doctor
- Six percent reported they have looked at lab results online
There are large integrated delivery organizations that have had success with PHRs. For example, at Beth Israel Deaconess Medical Center (BIDMC) in Boston, patients can use PatientSite to view medication information and test results, renew prescriptions, request appointments, and securely message with providers.
According to BIDMC, between April 2000 and March 2004, 18,435 patients registered on the site and logged in at least once. By 2008, BIDMC reports that more than 35,000 unique patients were actively using the site. The most popular features as of March 2008 were provider messaging (27.8 per month per 100 patients), prescription refills (3.1 per month per 100 patients), appointment scheduling (2.6 per month per 100 patients), and referrals (2.1 per month per 100 patients).
Given the longstanding silos of data that exist in health care and the limited interest from patients to date, it is highly unlikely there will be a true PHR on the market anytime soon. Niche uses clearly have value to many stakeholders and are likely to increase, especially given the increase of social networking sites and the availability of mobile health applications. But what needs to change before a true PHR is possible?
Clinical information needs to be available electronically from providers. The best source of data for the PHR-the provider's electronic health record (EHR)-is also the least prevalent. A majority of hospitals and physician practices are still paper-based, and despite HITECH incentives and penalties, many remain years away from widespread EHR adoption. Until PHRs can be populated in real time with structured data from providers across all care settings-and integrated with coverage, billing, and other health-related information-there are inherent limits to any benefits that can be achieved from a patient using the PHR.
Both patients and providers need to think of PHRs as more than just repositories for information. As capabilities continue to evolve, patients need to think of the PHR as an interactive tool that plays an integral role in how they make decisions about their health care. The PHR will need to provide timely, proactive information in a way that is a natural extension of the patient's daily workflow, such as access to their clinical information on a mobile device or condition-specific content integrated with their use of social networking.
The way that providers think about PHRs will also need to evolve. The PHR should be viewed as a vehicle to provide patients with health information, but also as a source of data. To help patients make informed decisions, providers need access to patient-centered information that might not be in the EHR-such as data from a device in the patient's home-as well as any information that is contrary to what is in the EHR-such as differences in medication or allergy lists.
PHR use needs to trigger an actual change in behavior. Some of the successful PHR initiatives to date have shown PHRs can increase patient satisfaction and make them feel more informed about their care. But happy, satisfied patients-while an important first step-are not necessarily healthier patients. Using the PHR must result in patients taking actions they would not have otherwise taken. This could be as simple as scheduling an overdue screening or as drastic as changing their entire diet-but without a majority of patients making some kind of change, the benefits of a PHR are limited.
The reality is that the healthcare industry is still no closer to a true PHR than it was five or 10 years ago. Fundamental barriers still exist, and without major changes in behavior and dramatic increases in technology adoption, a true PHR-and the benefits associated with it-will not be possible.
Jason Fortin is a senior research analyst, Emerging Practices Group, CSC, Falls Church, Va. (firstname.lastname@example.org).
Erica Drazen is managing partner, Emerging Practices Group, CSC (email@example.com).
This article is excerpted with permission from the following resource: Fortin, J., and Drazen, E., Personal Health Records: A True "Personal Health Record?" Not Really … Not Yet, CSC, Falls Church, Va., 2011.
Publication Date: Monday, July 11, 2011