Tethered PHR

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Tethered PHRs that are integrated only with an health care organization’s EHR, but offer benefits to individuals and organizations who participate.

Benefits to individuals

Individuals like having easy access to their clinical data, especially test results, and secure messaging with their collaborating clinicians is also seen as very valuable. Care management activities including medication refill requests and making visit appointments may add convenience for users. Caregiver access to children’s or other dependent’s information and provider team is likewise seen as valuable.

Although the tethered PHR has been called a dead end, perpetuating the siloing of patient medical and health data, it is at least useful to help individuals and their health care providers gain experience in sharing information and decision making. These enhanced patient portals help shift the locus of control toward the informed, engaged individuals trying to manage their health in the context of their life and values.

Benefits to organization

This model of interaction helps providers gain experience and skill in working with individuals and their families in a more collaborative, longitudinal way, rather than the episodic, visit based model that is currently the norm. Most health care organizations include Quality and Patient Centered care as part of their mission statement and this can be a step along the path.

Since current tethered PHRs have been shown to be big patient satisfiers their use may give the organization a competitive advantage. Doctors who have changed organizations have lost some patients who have said essentially, “I like you Doc, but I like my MyChart more.” This kind of comment points out both the value patients place on the PHR as well as one of the drawbacks of a PHR tethered to one organization’s EHR.

Portability is an issue as proprietary vendor based PHRs are no more interoperable than their underlying EHRs. But EHR vendors can certainly design them to meet PHR interoperability standards once they are developed. Organizations experienced in working with vendors may be able to leverage that relationship to gain prompt access to the benefits of the truly integrated PHR once it becomes more of a reality than an ideal.

Are the benefits to the organization enough to offset the initial and ongoing costs of implementing and maintaining a tethered PHR? Should individuals be willing to pay, either singly or collectively through government or insurer programs, for the benefits these PHRs offer?

The PHR research agenda is long and broad, but currently, like most health and medical decisions, these must be made with partial information. The wisdom of these choices will only be apparent with the passage of time.


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Submitted by Michael Hunter