Tips to keep in mind for personal health records
Not many home health nurses have had patients offer them access to their online personal health records (PHR), but now is the time to prepare for that offer, suggests Karen Golden Russell, MBA, senior marketing manager for Philips Home Healthcare Solutions in Andover, MA. Although the benefit of having access to a thorough medical history is obvious, there are issues that online personal health records raise that go beyond just reviewing information, she points out.
- What type of record does the patient have?
Is the patient using a system into which he or she enters all of the information? If so, how reliable is the information? Patients may be transcribing some information from physicians or pharmacies, but others may use their online record as a diary of how they feel or what their blood pressure, weight, or other vital signs were each day, points out Golden Russell. Clinical information or medication should be verified with the physician or by looking at medication containers in the home, but diaries might give a nurse extra information about the patient's condition on a day-to-day basis.
- What is the responsibility of the home health nurse with access to a PHR?
Home health managers should be talking with an attorney to answer this question, recommends Golden Russell. "If an agency is offered access to a PHR, is the nurse responsible for recommending care based on notes the patient made in the record?" she asks. For example, a patient who keeps a diary-type record might make a few statements that indicate depression, but is the nurse responsible for identifying depression and recommending a consult? Obviously, if a nurse suspects depression during an assessment or a follow-up visit, he or she will talk with the patient to determine the need for further assessment by a physician or other clinician, but what happens if the nurse doesn't see something in a lengthy online record? "There is also concern about relying on patient-entered information, because we don't know if the patient included everything," she points out.
- How much time can a nurse spend with a PHR?
"Time spent reviewing a PHR is not reimbursable, so agency management needs to determine who reviews the PHR and how much time can be allowed," points out Golden Russell. There are situations in which non-reimbursable activities are good business, such as telehealth, she admits. The investment in telehealth and the staff time needed to monitor telehealth patients has proven to be effective in improving outcomes and increasing productivity so even though telehealth activities are not reimbursed, overall they can help an agency's bottom line, she says. There are unanswered questions about the effect of personal health records on outcome so an agency manager needs to consider how much staff time is spent with PHRs.
- What type of access should an agency have to a patient's PHR?
"There are two types of access to a PHR, read-only and write," says Golden Russell. One of the first things an agency must decide is if nurses are going to enter information into a patient's personal health record, either through notes at the home or by uploading information, she says. Issues related to entering information include HIPAA [Health Insurance Portability and Accountability Act] privacy and security requirements that healthcare providers must meet but that private companies that offer PHRs don't have to follow, she points out.
If you opt to accept read-only access, be sure to set parameters, recommends Golden Russell. "You might agree to review the PHR at start of care only," she says. This initial review of the PHR might be helpful as the nurse assesses the patient and could lead to follow-up questions that enhance the assessment. A policy that specifies start of care review won't commit the nurse to spending time at each visit reviewing a PHR and that can address nonreimbursable time concerns, she adds.
Although the benefit of having access to a thorough medical history is obvious, there are issues that online personal health records raise that go beyond just reviewing information.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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