Should you upload info to a personal health record?
Use of online PHRs raises questions, concerns
Hospice nurses are accustomed to point-of-care technology for completing charts and assessments. But, is your agency prepared for access to, or uploads to, your patient's personal health record (PHR)?
"We're entering uncharted territory with online personal health records," says Karen Golden Russell, MBA, senior marketing manager for Philips Home Healthcare Solutions in Andover, MA. The difference between PHRs and electronic health records used by home health agencies and other health care providers is that the patient has complete control of his or her record and determines who else has access to it, she explains.
Because the interest in personal health records is just beginning, now is the time to develop a plan to handle a request by a patient for information to upload into the record or a grant of access to a PHR, says Golden Russell.
While electronic records now used by hospice agencies can be used to enhance the medical information contained in a personal health record created by the patient or a patient's family member, there are several questions about liability, security, and appropriateness of uploading information to a patient's health record, points out Golden Russell.
"Currently, electronic health records are closed systems that are only accessed by the provider who creates the record," she says. "There may be information in notes regarding diagnoses, treatments, or the patient's condition that a clinician does not want the patient or a patient's family member to see." If a clinician knows that the entire record might appear on a personal health record that can be accessed by several individuals, he or she might not include the same details or the same information, she says. There are too many issues related to privacy, security, and liability that might restrict the clinician's willingness to make detailed notes, she adds.
Although there are challenges, the benefits to patients and providers will be significant with a growing use of personal health records, says Holly Miller, MD, MBA, medical information officer for University Hospitals in Shaker Heights, OH. A personal health record can be used to improve communication between providers as the patient offers access to the record to hospice providers or to a new physician to review, and it also can be used to improve communication with family members who don't live near the patient, she points out.
Even though a large number of hospice patients are older, don't assume that age determines a patient's willingness to use the Internet, points out Miller. "I've seen studies that show that age does not predict a willingness to use an online PHR. Instead, the number of health issues, or diagnoses, a person has is a better predictor than age," she says.
Having one record into which the patient collects information from all providers will improve coordination of care, points out Miller. "Medication reconciliation will also be improved," she says. In fact, Miller foresees the day when technology will enable a physician not only to prescribe medication, but also to monitor whether or not the patient takes the medication. "I will prescribe medication and two weeks later change the medication because the patient's condition has not improved," she says. "In reality, the patient never filled the first prescription." E-prescribing will not only make sure the patient's record reflects accurate prescriptions, but also will send a message to confirm that the prescription was filled, she says.
While no one can predict how prevalent personal health records will become or how they can be safely uploaded with provider information, Miller does anticipate increased interest as baby boomers age. "By 2030, one-fifth of our population will be over the age of 65, and this is a generation that is accustomed to having information and using the Internet, so PHRs will appeal to them."
Source and Resource
For more information on personal health records, contact:
- Karen Golden Russell, MBA, Senior Marketing Manager, Philips Home Healthcare Solutions, 3000 Minuteman Road, MS 024, Andover, MA 01810. Telephone: (978) 659-2698. Fax: (978) 659-3456. E-mail: [email protected].
- The Healthcare Information and Management Systems Society (HIMSS) offers free resources related to personal health records. For access to guidelines, studies, and tools related to the use of personal health records, go to www.himss.org. On the left side of the page, select "view all topics." Under "Interested in ambulatory IS?" choose "personal health records."
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