February 19, 2007

Hey Doc, Can You Update My PHR?
By Carolyn P. Hartley
For The Record
Vol. 19 No. 4 P. 6

How’s your plan coming along to involve patients in your clinical and administrative activities? President George W. Bush’s plan to have a personal health record (PHR) in the hands of every American by 2014 is closer than you think.

Following the Executive Order to make healthcare costs and quality of care transparent to federal agencies and consumers, nearly all governors who have not yet done so will issue similar orders directing the development of state policy to improve healthcare through the rapid implementation of HIT. Consumer involvement in HIT is a popular bipartisan agenda, supported by nearly 40 congressional bills—and it’s guaranteed to spark debate and election rhetoric.

IT is as much a personal issue as it is political, but consumers are reaching it indirectly. The digital mobility explosion created by iPods, PDAs, cell phones, Skype, and MySpace has prompted consumers to look at building their own consumer-driven PHR of sorts. Nike and iPod have already taken the lead by connecting blood pressure monitors to shoes. Following a workout, a runner can visit www.nikeplus.com and electronically track their activity, evaluate progress, and monitor calories burned.

Since 2003, more than 136 million people have registered to be a Skyper, while 230,000 people each day register to build a MySpace page. A Google search for PHRs nets more than 400,000 results, hits that have not gone unnoticed by the search engine giant. Consumers using Google Health Co-op can search online for health information from notables such as the National Library of Medicine, the Centers for Disease Control and Prevention, and the Mayo Clinic.

So when the Association of Health Insurance Plans (AHIP) and Blue Cross and Blue Shield Association (BCBSA) announced they would allow members to build PHRs, hospitals and physicians began putting the concept on the “lunch and learn” agenda—in particular, what to do with them when patients bring them into the office.

Will patients, driven by Google, Yahoo, AOL, and eBay—and the plethora of companies offering PHRs—change the way physician practices gather and manage patient health information? Twenty agencies within the federal government that represent 38% of all healthcare expenditures in America say it will, and private investors are banking on it. Today, nearly every physician and practice manager in the United States has an electronic health record (EHR), if nothing else, on his or her mind.

Technical Look and Feel of PHRs
A PHR can be a simple paper file kept at home, or it can be created and maintained on a home computer or from a reputable Web site. Internet-based PHRs are usually accessed through Microsoft Internet Explorer Version 5.5 or Netscape Version 7 or higher. Both browsers support the 128-bit security encryption level. To transport from home or from one provider to another, the digital patient downloads the content to a CD or USB drive to enable health information sharing with multiple providers.

What’s in a PHR?
A PHR typically contains a summary of the patient’s health history: insurance information, medication history, allergies and adverse reactions, and a snapshot of current health conditions. At the MyPHR Web site (www.myphr.com) developed by the AHIMA, consumers can use the following list to build a PHR:

• people to contact in case of an emergency;

• names, addresses, and phone numbers of your personal physician, dentist, and other specialists;

• health insurance information;

• living wills and advance directives;

• organ donor authorization;

• a list and dates of significant illnesses and surgeries;

• current medications and dosages;

• immunizations and their dates;

• allergies;

• important events, dates, and hereditary conditions in your family history;

• a recent physical examination;

• opinions of specialists;

• important tests results;

• eye and dental records;

• correspondence between you and your provider; and

• permission forms for release of information, operations, and other medical procedures.

Building the PHR
Most patients wanting to build an electronic file will collect data from healthcare providers then add any information such as reactions to medication, blood pressure, weight changes, or diet management. If a patient seeks medical history housed in office records, physicians must follow the procedures established in the HIPAA privacy rule and the practice’s Notice of Privacy Practices.

If the practice has a Web site, patients can download, read, and sign forms before coming into the office. Many EHR vendors also provide a portal where patients can chronicle demographic information, current symptoms, family medical history, and insurance forms.

Liabilities
EHR vendors also provide the capabilities to build a treatment summary. If a practice is still paper-based, it has up to 30 days to respond to the patient’s request.

Wendy Angst, a general manager at CapMed, an organization that has private-labeled more than 600,000 PHRs for employers, payers, and providers, acknowledges that one of the most frequently asked questions from providers is, “What are the liabilities if I provide accurate information that will be used in a PHR and the patient loses the PHR?”

Angst says a PHR is considered the patient’s personal property, owned and managed by the patient. She says, as the owner, patients should treat a PHR as they would a credit card or driver’s license. If a consumer loses or misuses a driver’s license, they don’t sue the state’s Department of Motor Vehicles.

“Part of our PHR user training includes information on how to use and protect health information,” Angst says.

Patients Most Likely to Get a PHR
A PHR for older adults or young children has great appeal for state policy makers and HIM organizations. According to Brief Summaries of Medicare and Medicaid, Medicare beneficiaries use between four and seven medications each day, maintain an average of four physicians, and consult them an average of 14 times per year.

Also, parents of young children need immunization records to enroll children in preschool or day care.

Both populations represent an excellent entry point for PHR adoption. Building a PHR for older adults will likely require the assistance of a computer-savvy son or daughter. Should that person also be a Baby Boomer grandparent, it’s likely the grandchildren will also get a PHR to begin managing immunizations.

Less than 50 years ago, my parents were actively engaged in their family’s healthcare, from knowing the price of aspirin to agreeing to a doctor’s fee before they let him stitch my brother’s split and bleeding chin. They watched the miracle drug penicillin drop from $20 per dose in July 1943 to 55 cents per dose in 1946. They learned what doctor delivered the most babies and what hospital was price-gouging on appendectomies.

Most patients can’t remember the color of one pill, let alone its name, dosage, or why they are taking it. But at the age of 88, my mother’s healthcare is still part of her personal business. Even though she’s legally blind, she does not take federally funded insurance for granted to manage the five medications she now takes for hypertension, glaucoma, arthritis, and macular degeneration. Instead, she still asks the doctor’s staff what Medicare will and will not cover before taking a seat in the waiting room. She knows the name and dosage of every medication, and she can spell them out, thank you very much, for any clinician who participates in her care. “Robust,” her doctor calls her. “They don’t make women like her anymore.”

A Stopgap Measure
Right after building a PHR for my mother, I built one for myself. I felt particularly fortunate that my doctor used the same EHR vendor that had partnered with medical associations and prescription benefit managers to reconnect Hurricane Katrina refugees with their medications. I went online, spent quality time putting my history together, and excitedly called my doctor’s office.

“Great!” the scheduler said. “Print it off and bring it into the office.”

“Print it?”

“Sure, we’ll use it to update our medical records,” she said. In an EHR-driven office, that meant they would scan my paper PHR into my record. The PHR was an exercise in HIT for me, and if it benefited my doctor, all the better. I finally have in one place a current history of my medications, allergies, adverse reactions, family medical history, history of previous operations, and insurance information. So now when I go to the doctor’s office, I print a copy of my PHR and take it with me. Rather than filling out form after form, I save both myself and the doctor’s office a little administrative time.

This year, some patients will bring their running history into the office, while others will provide a link to access their online health information. And soon, a patient will say, “Hey Doc, can you Google my PHR?”

— Carolyn P. Hartley is president and CEO of Physicians EHR, LLC, in Cary, N.C.

PHR Resources
Barlas S. New Push for PHRs by AHIP and BCBSA Seeks to Spur Developer and Clinician Communities. Digital Healthcare & Productivity.com. December 28, 2006. Available here.

MedlinePlus, a service of the Institute of Medicine and the National Institutes of Health, offers links to educational materials available from public and nonprofit organizations interested in PHRs.

MyPHR, offered through the AHIMA, provides instructions for patients on how to build and manage a PHR.

Patients can build a family medical health portrait from a service provided by the U.S. Surgeon General, the U.S. Public Health Services, and Health and Human Services.