08 May DHC 2008: EMRs stimulate interest in personal health records
Madison, Wis. – The move toward electronic patient records is one of the longest-running stories in healthcare technology. Despite warring with healthcare’s typical resistance to change in policy, more and more hospitals are moving from crowded file cabinets to computer terminals in every patient room, expanding the responsibilities of their CIOs and using physical renovation as an excuse to lay a hospital-wide network.
With the advance known as EMR, there is now an interest on the part of patients to have their own access, leading to a growth in the market for personal health records (PHRs). However, experts caution against placing too much importance in them, arguing it is still too soon to tell what impact they will have and whether or not corporate involvement is the right choice.
Improving patient involvement
John Byrnes, executive managing director of Mason Wells, classified the typical PHR as a “thin record,” one with less content than a physician’s full medical record but still of interest to consumers. The records are typically used to carry a patient’s medical history as well as their day-to-day medical information, such as prescriptions, allergies, and immunizations.
What these records offer to patients, according to University of Wisconsin-Madison professor Patti Brennan, is a chance to advance their healthcare involvement. Technology has increased the amount of information available to both caregivers and patients, but frequently that information stops at “the last 10 feet” when the patient is in the hospital room. Early efforts to give patients access have lacked the necessary focus, and she likened them to simply giving patients a bigger bucket to hold more and more data.
“The jobs of everyone in healthcare have changed, but none more than the job of the patient,” Brennan said during a presentation at the 2008 Digital Healthcare Conference. “Information is flowing at people and they’re willing to catch it, the problem is they don’t have any better tools than we do.”
Development of these tools, Brennan said, will depend on establishing a common platform for patients. Providers will need to identify what is clinically important for these records and then make it accessible to patients, coming up a common vocabulary to make sure both parties accept the terms. Once this is established, technological applications such as computers and scanners can be converted to handle the information and further their accessibility.
Brennan cited patients with breast cancer as one of the key areas for PHRs, showing how it can be as simple as working a calendar into the recording system. Patients can organize their professional and family lives around their treatments and recovery, even scheduling presentations at work when they have recovered from chemotherapy.
Additionally, PHRs can be used to aid with delivery of medication, such as for younger children who may not understand the importance of a schedule, or for elderly patients who take multiple types of pills. The records can help work around social situations, such as a change in schooling or when a new prescription is introduced.
These sorts of scenarios are where PHRs will thrive, according to Don Holmquest, CEO of CalRHIO. “Patients with the special need are there, ones with lots of interactions,” he said. “It becomes life-saving, but it is a very special use.”
Corporate involvement: Handle with care
Several of the biggest names in technology have been capitalizing on the interest in PHRs. In October 2007, Microsoft launched HealthVault, a website where users can store medical details such as histories and immunizations, input data from monitoring devices, and share data with physicians. Microsoft advertised the site as compatible with several health providers, and since the launch it has partnered with companies such as ActiveHealth Management and US Wellness.
Google has also been getting involved in the field as part of their Google Health initiative, announcing that PHRs would play a role in the program a few weeks after Microsoft’s introduction of HealthVault. Though not yet open to the public, Google announced in February they would be partnering with the Cleveland Clinic to test how the software handled the clinic’s own database of PHRs.
“From our perspective, these are exchanges and we’ll use the exchanges the patients want,” said Martin Harris, CIO of the Cleveland Clinic.
The long-term value of these investments, however, has been questioned by industry figures such as Peter Strombom. Strombom, the retired CIO of Meriter Hospital in Madison and founder of Strombom Associates, suggested that the programs may have difficulty attracting mainstream support due to the private nature of PHRs. The size of the companies, combined with their relative inexperience in healthcare, could keep customers from disclosing too much information to begin with, he said.
“Both Google and Microsoft are looking at this as another revenue opportunity, and they give it a lot of press and enthusiasm, but is it in the best interest of the public?” Strombom asked.
Byrnes said that the interest of these companies goes beyond healthcare, particularly with the inevitable Internet conversion of the private networks used by the federal government. Both Google and Microsoft would like to have a part of that development, and being involved in PHR builds their case for involvement on a larger scale. It is still too soon to determine, however, whether or not they can earn the necessary trust.
“Google’s format is advertising, and most people would prefer not to have that in their healthcare records,” Byrnes said. “It’s far more complicated than maybe the [companies] understand, and it’ll be interesting to see if they can become a trusted agent.”
Trust but verify
These security concerns come down to one of the main issues with PHR, that of how valid the records are to medical practitioners. “The bigger challenge is that for it to be widely accepted, it has to have two attributes: it has to be trusted, and it has to be relevant,” Byrnes said.
Since the typical PHR is open to additions by the patient, there is the risk that the records offered may not present an accurate picture of the patient’s history, with alterations on medication doses and routines left out. There is a danger of skepticism on the part of physicians who are presented with PHRs, or that they may be viewed in the same context as people who bring pages and pages of Internet printouts to each appointment.
“How are you as a physician going to recommend treatment based on what the patient brings in and has the ability to alter?” Strombom said. “Does the physician have time, does the nurse have time to verify it?”
Strombom suggested that for the near future, patients who want to access full medical records will likely go through hospital-based software applications like Epic Systems’ MyChart. While patients do not have the ability to change the information on the record, they do have full access to their charts and can also communicate directly with their caregivers for clarification.
“That sort of individual record that the patient can look at is very viable, but is very different from what the patient can modify,” Strombom said. He added that in the future, technology such as biometrics – identifying the patient through methods such as fingerprints and retinal scans – may help to increase the validity of PHRs.
In addition to not knowing if the information is true, another question is how much of it will be useful in continued care. Byrnes said that with medicine being such a contemporaneous field, where the information gathered can change from day to day, a historical record can be less useful for the purpose of treatment.
“An 80-20 thing”
Byrnes said that he does not expect PHRs, for all their benefits, to detract too much attention from other healthcare models such as regional health information organizations (RHIOs) and expects them to co-exist peacefully. “It’s an 80-20 thing,” he added, placing PHRs in the minority.
Brennan agreed that PHRs would not replace existing caregiver strategies, saying that the overarching goal is simply to give patients access to the information they are logically entitled to. With the potential for multiple interfaces such as computers and cellular phones to process the information, PHRs handled right can decrease blockage in communication.
Holmquest described CalRHIO as “EMR agnostic,” saying the organization plans to stay out of broader healthcare records until the field develops more general standards. He added that most of the players in the field are approaching it realistically, knowing it will take some time for PHR functionality and access to develop.
“It raises some very serious questions, but also creates opportunities,” Holmquest said. “We are just excited to see this thing evolve.”
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