Personal Health Record

A personal health record (PHR) is a digital repository, typically web-based, to store your personal health information. Ideally all your healthcare providers (via Electronic Health Record) can send and retrieve medical record information to your PHR but there are inter-operability, and more importantly, security and privacy concerns. Most health medical insurance providers now offer some form of a PHR. Other equivalent terms are patient health record or a personal medical record which are not the same as an electronic health record.

Some key features to consider are:http://telemedicina.unifesp.br/pub/AMIA/2007%20AMIA%20Proceedings/data/papers/posters/AMIA-0174-S2007.pdf>/ref>

(1) Secure access to PHR anytime, anywhere, via the Internet or a portable drive device (few PHRs have to date)

(2) Easy input and annotation or updating of comprehensive health related information (e.g., medications, allergies, treatments, etc.)

(3) User friendly structured summary of medical information to healthcare providers (few PHRs have to date)

(4) Upload relevant health related documents available in digital format (e.g., scanned images of DNR orders, x-rays, living will, etc.) (few PHRs have to date)

(5) Access to relevant health related educational materials available via web links and/or distributed by providers. (few PHRs have to date)

Basic tools of a PHR include: medical history, medical and emergency contacts, outpatient and hospital visits, immunization tracking, insurance records, and health-related alerts and reminders.

More advanced PHRs should offer the following digitally-networked features/tools:

• Accessing medical records with capacity to offer amendments to add information (such as alternative treatments being pursued by the patient), or correct errors or incomplete information.
• Adding information of primary interest to patients rather than providers, such as patient-relevant decision support.
• Drug interaction checking (when a complete medication profile is available).
• Home monitoring with recording or tele-reporting of data to the record.
• Interactive health risk profiling and patient education resources.
• Patient-physician secure e-mail.
• Prevention and wellness reminders.
• Processing of claims and payment.
• Refilling of prescriptions.
• Retrieving of laboratory and other tests.
• Reviewing of insurance eligibility and benefits.
• Scheduling appointments.

This information comes from a BioMed Central (BMC) article.http://www.biomedcentral.com/content/pdf/1472-6947-8-45.pdf

Several standards are necessary to achieve an integrated PHR.

Data Interchange Standards.

Common Data Set/Minimum Data Set.

Consumer Terminologies.

Authentication Processes.

Identification Processes.

Security Standards.

Data Integrity Processes.

Privacy Standards.

Certification.

This information comes from a BioMed Central (BMC) article.http://www.biomedcentral.com/content/pdf/1472-6947-8-45.pdf

Privacy versus Efficiency. It seems that the two are at odds with each other. The Chief Privacy Officer of IBM believes it takes building public trust in the electronic health network with transparency being important.http://brainstormtech.blogs.fortune.cnn.com/2010/01/15/digital-health-records-putting-privacy-on-par-with-efficiency/ See the report "Personal Health Records: Why Many PHRs Threaten Privacy"http://www.worldprivacyforum.org/pdf/WPF_PHR_02_20_2008fs.pdf

Certification. How does one build trust? Certification of Electronic Health Records is one way. There is an attempt to build certification requirements in the United States through the Department of Commerce/NIST.http://electronichealthrecordsus.net/reading-the-tea-leaves-in-a-disclosure-document-when-will-onc-and-nist-be-prepared-to-accredit-health-it-certifying-bodies/ Booz Allen Hamilton awarded a $400,000 contract to develop a framework for electronic health record certification.

Ethics of Electronic Health Records. According to this article, consider autonomy, justice, beneficence/non-maleficence, privacy and confidentiality.http://www.clinicalcorrelations.org/?p=2211

The potential transformative role of widespread use of PHRs are the following:

• Quality, Completeness, Depth, and Accessibility of Health Information.
• Facile Communication.
• Access to Health Knowledge.
• Portability.
• Auto-population.

If health information could play such a role, then the following could be achieved:

1. Improve interactions between patients and medical professionals
2. Enable electronic connectivity between clinical care managers and patients or their caregivers that can be leveraged to realize innovation in care management.
3. Enable a shift in the health care locus of control to consumers by moving the control of health information from providers to patients or to a more "shared control" model.
4. Offer opportunities to reduce costs and improve health care delivery

Barriers to integrated PHRs include:

• Balancing Physician and Patient Autonomy.
• Scope of Work/Responsibilities change
• Physician Compensation/Incentives.
• Concerns (Real and Perceived) about Liability Risks.
• Consumer Confidence and Trust

This information comes from a BioMed Central (BMC) article.http://www.biomedcentral.com/content/pdf/1472-6947-8-45.pdf

Android

motionPHR Health Record Mngrwww.androlib.com/android.application.com-csi-android-motionphr-tDpB.aspx

Anvita Mobile Health Viewer (to Google Health)http://medgadget.com/archives/2009/02/google_personal_health_records_going_mobile.html

Blackberry

My Personal Health Recordhttp://appworld.blackberry.com/webstore/content/1831 from the not-for-profit My Personal Health Record organization

iPad/iPhone

motionPHR Health Record http://itunes.apple.com/us/app/motionphr-health-record/id312389551?mt=8 TBD

Windows 7 Mobile

TBD

Patient Privacy Rights (PPR) studied the privacy policies of various Personal Health Records (PHR) and graded them in the following Report Card:http://www.patientprivacyrights.org/site/PageServer?pagename=PHR_Report_Card

CapMed - icePHR "C"

Google Health "D/F"

Microsoft HealthVault "B/F"

No More Clipboard "A"

WebMD "C"

PHRs Offered by Employers & Insurers "F"

Capzule PHR is a universal PHR app for iPad, iPhone, and iPod touch users built for the iOS 4 platform. Features include full editing capability from a PC over Wi-Fi so files can be uploaded via a web browser. There is also a Share feature for data transfer between iPad, iPhone and iPod touch devices. Personal customizable health monitoring templates are the cornerstone of Capzule to record variations in health conditions, progress of health goals, and other observations.http://www.prnewswire.com/news-releases/personal-health-records-app-debuts-on-ipad-95826554.html