Monday, 16 June 2014

Personal Health Record








What is it?

A Personal Health Record (PHR) is an electronic resource containing clinical information necessary for people to be able to make decisions with regards to their health. A common feature of the PHR platforms that I have consulted is the accessibility that the patient has to a certain amount of relevant information from his/her medical records (hospital admission reports, emergency reports, lab results, etc.) Additionally there are other remarkable characteristics of PHR, not featured or adopted by all the platforms:
  • Scheduling doctor, nursing and test appointments.
  • Self-monitoring of relevant variables: blood glucose, blood pressure, physical activity, calorific intake, weight, etc. The patient is responsible for maintaining this element of the PHR. It is very useful for ‘at-risk’ and chronic patients.
  • Medication control and prescription management.
  • Access to radiology images. This is a technically sophisticated function often still under development.
  • Secure messaging Mailbox to connect with the healthcare team. See post "E–mail: it starts showing results"
  • Managing insurance policy (only American PHR).

Three American PHR

https://healthy.kaiserpermanente.org/health/care/consumer/my-health-manager
 


http://www.mayoclinic.org/healthmanager/art-20050589


This initiative began in the Veterans Administration (VA) and has now spread to Medicare and many private insurers. Blue Button has become an icon of Obamacare, highlighted by the fact that 450 organisations have committed to giving substance to the platform. One example is that two associations of nurses are endorsing a campaign encouraging nurses to use Blue Button to connect to their most isolated patients.




Results

Given the constant and frantic evolution of the introduction of communication technologies in clinical practice, it is still very early to make assessments, but of all those that I have access to, I’ve highlighted the following three:

A National Action Plan to support consumer engagement via e-health. This is a report prepared by experts of the U.S. federal government released in Health Affairs (February 2013). This article analysed the state of implementation of e-health in the U.S. and concluded that overall 65% of the adult population would be interested in online access to their clinical information, although professionals are not that keen on it, as it would mean changes to working practices. Additionally, the situation is not helped by the lack of adequate digital platforms available. All this means that, according to the report, in the U.S. only 17% of the population now has access to PHR platforms.

Association of online patient acces to clinicians and medical records with use of clinical services. This evaluative article published in JAMA in 2012 analysed the behaviour of a user group of "My Health Manager" and concluded that contrary to expectation, people using the Kaiser Permanente PHR actually consumed services more than the non-users: they visited more, they called more, they went to the emergency room and were hospitalised more.

Two evaluative articles, one on PHR and hypertension and the other on PHR and diabetes, concluded that the PHR for chronic patients should be accompanied by programs of care continuity. It is therefore a very useful platform as a supplement, but not as a replacement.


Discussion

Personal Health Records (PHR) is certainly an excellent tool, especially if it is interactive and allows the patient to be involved in self-care. I think the platforms should also be an internet window for people suffering from any chronic or serious illness to have a safe and secure place to check-in.

No doubt you will notice that the above article from JAMA (thank you  Miguel Angel Mañez @manyez  for  the contribution) could be interpreted as meaning that the PHR could be a talisman for hypochondriacs which shatters the forecasts for the effectiveness of PHR, as now it is clear that the availability of digital services to citizens doesn’t reduce dependence on the health system, on the contrary, it encourages the most demanding people and turns them into consumers of a new service.


Jordi Varela
Editor

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