Difference between revisions of "PHR"

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(PHR-Information Types, Functions, and Attributes)
(Types of Information in Personal Health Record)
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==Types of Information in Personal Health Record==
 
==Types of Information in Personal Health Record==
The information in PHR in its electronic version can be entered in many format and from many different sources, personally entered by the owner of the PHR, and professionally by the health care provider, manually or automatically when integrating with other professional healthcare systems and applications. The PHR serves as a core repository for personal health information that identifies the patient clinical data - similar to information in the provider version of electronic medical record - utilized by the individual or health care provider to perform actions and/or help in the joint decision making process. The key feature of this accumulation of multi source information is that its all kept and presented in one entity. List (1) contains a summary of most common information types in the PHR defined by AHIMA. For more of detailed information types and as a start point to establishing a Personal Health Record, AHIMA recommends a set (List 2) of information collected by PHR owner from the various patient medical records sources [3].
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The information in PHR in its electronic version can be entered in many format and from many different sources, personally entered by the owner of the PHR, and professionally by the health care provider, manually or automatically when integrating with other professional healthcare systems and applications. The PHR serves as a core repository for personal health information that identifies the patient clinical data - similar to information in the provider version of electronic medical record - utilized by the individual or health care provider to perform actions and/or help in the joint decision making process. The key feature of this accumulation of multi source information is that its all kept and presented in one entity. List (1) contains a summary of most common information types in the PHR defined by AHIMA. For more of detailed information types and as a start point to establishing a Personal Health Record, AHIMA recommends a set (List 2) of information collected by PHR owner from the various patient medical records sources [3].*
  
 
List 1: Minimum Common Data Elements in PHR
 
List 1: Minimum Common Data Elements in PHR
  Personal Demographic Information
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* Personal Demographic Information
  General medical information
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* General medical information
  Allergies and drug sensitivities
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* Allergies and drug sensitivities
  Conditions
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* Conditions
  Hospitalizations
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* Hospitalizations
  Surgeries
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* Surgeries
  Medications
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* Medications
  Immunizations
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* Immunizations
  Clinical tests
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* Clinical tests
  Pregnancy History
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* Pregnancy History
  
  
 
List 2: Information collected by PHR owner from the various patient medical records sources
 
List 2: Information collected by PHR owner from the various patient medical records sources
  People to contact in case of emergency  
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* People to contact in case of emergency  
  Names, addresses, and phone numbers of physician, dentist, and other specialists  
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* Names, addresses, and phone numbers of physician, dentist, and other specialists  
  Health insurance information  
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* Health insurance information  
  Living wills and advance directives  
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* Living wills and advance directives  
  Organ donor authorization  
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* Organ donor authorization  
  A list and dates of significant illnesses and surgeries  
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* A list and dates of significant illnesses and surgeries  
  Current medications and dosages  
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* Current medications and dosages  
  Immunizations and their dates  
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* Immunizations and their dates  
  Allergies  
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* Allergies  
  Important events, dates, and hereditary conditions in family history  
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* Important events, dates, and hereditary conditions in family history  
  A recent physical examination  
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* A recent physical examination  
  Opinions of specialists  
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* Opinions of specialists  
  Important tests results  
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* Important tests results  
  Eye and dental records  
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* Eye and dental records  
  Correspondence between provider(s)  
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* Correspondence between provider(s)  
  Permission forms for release of information, operations, and other medical procedures  
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* Permission forms for release of information, operations, and other medical procedures  
  Any information whish to include about one's health  
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* Any information whish to include about one's health, such as exercise regimen, any herbal medications and any counseling may received.
  -such as exercise regimen
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  -any herbal medications and any counseling may received.
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==Functions of Personal Health Record==
 
==Functions of Personal Health Record==

Revision as of 14:55, 12 October 2011

A personal health record (PHR) is an internet-based electronic medical record that allows consumers complete access to their medications, appointment history, test results, etc. [1] [2]

Personal health record (PHR)

Standards based

  1. HL7 CDA
  2. openEHR
  3. ASTM CCR
  4. DICOM

Integration of EMRs and PHRs

Integration of EMRs and PHRs


Patient entered data

Patient entered data

Benefits of Tethered PHR

Benefits of Tethered PHR

PHR 2.0

Personal Health Records are private, however, society’s willingness to share information can lead to patient empowerment and knowledge. Personal Health Record 2.0, as postulated by Gunther Eysenbach [3] , is grounded in the belief that users freely share pertinent data with other users. Certain sections are available for a controlled set of users or the public as a whole to see. That data can then be combined and shared with a tethered EHR. There is an enhanced ability to learn and thus be empowered. Eysenbach feels this is a disruptive concept and is not without a large measure of risk [4].

An example of the PHR 2.0 concept is PatientsLikeMe.com [5]. PatientsLikeMe was created as an attempt to find a cure for amyotrophic lateral sclerosis and was based on the idea that if patients are allowed to share their data with each other, better approaches to treatment could be achieved. PatientsLikeMe is the largest database of ALS patients to date, and has partnered with a company called 23andMe, Inc. to create a "genetics search engine" for the ALS community. This allows patients with ALS to share genetic information. A data intensive social network such as this can be incorporated into Eysenbach’s concept of the PHR 2.0.

PHR Challenges

PHR Challenges

Personal Health Record

The American Health Information Management Association (AHIMA) defines the PHR as “an electronic, universally available, lifelong resource of health information needed by individuals to make health decisions. Individuals own and manage the information in the PHR that is collected from healthcare providers or entered by the individual. The PHR is maintained in a secure and private environment with the individual determining rights of access, it is separate from and does not replace the legal record of any provider.” [1]. This definition empathizes on the importance of the individual’s ability to maintain and update data as well as the PHR universal availability as accessed from anywhere and the sustainability of the tool as a lifelong dynamic resource of the individual health related information. Another definition of the PHR by Markle Foundation Connecting for Health Initiative Group describes the PHR as "The Personal Health Record is an Internet-based set of tools that allows people to access and coordinate their lifelong health information and make appropriate parts available to those who need it. PHRs offer an integrated and comprehensive view of health information, including information people generate themselves" and "The PHR is a single, person-centered system designed to track and support health activities across one’s entire life experience; it is not limited to a single organization or a single health care provider” [2]. This definition further identifies a platform for PHR operation and incorporates the lifelong span of individual’s information collection and management. Beside owners’ ability to view their own healthcare information created by them, it provides the ability to view clinical data and information entered and or generated by their providers and medical care institutes. Furthermore, it introduces three key aspects of the PHR, comprehensive, integrated with other systems and applications, and accessible from anywhere via internet.

Types of Information in Personal Health Record

The information in PHR in its electronic version can be entered in many format and from many different sources, personally entered by the owner of the PHR, and professionally by the health care provider, manually or automatically when integrating with other professional healthcare systems and applications. The PHR serves as a core repository for personal health information that identifies the patient clinical data - similar to information in the provider version of electronic medical record - utilized by the individual or health care provider to perform actions and/or help in the joint decision making process. The key feature of this accumulation of multi source information is that its all kept and presented in one entity. List (1) contains a summary of most common information types in the PHR defined by AHIMA. For more of detailed information types and as a start point to establishing a Personal Health Record, AHIMA recommends a set (List 2) of information collected by PHR owner from the various patient medical records sources [3].*

List 1: Minimum Common Data Elements in PHR

  • Personal Demographic Information
  • General medical information
  • Allergies and drug sensitivities
  • Conditions
  • Hospitalizations
  • Surgeries
  • Medications
  • Immunizations
  • Clinical tests
  • Pregnancy History


List 2: Information collected by PHR owner from the various patient medical records sources

  • People to contact in case of emergency
  • Names, addresses, and phone numbers of physician, dentist, and other specialists
  • Health insurance information
  • Living wills and advance directives
  • Organ donor authorization
  • A list and dates of significant illnesses and surgeries
  • Current medications and dosages
  • Immunizations and their dates
  • Allergies
  • Important events, dates, and hereditary conditions in family history
  • A recent physical examination
  • Opinions of specialists
  • Important tests results
  • Eye and dental records
  • Correspondence between provider(s)
  • Permission forms for release of information, operations, and other medical procedures
  • Any information whish to include about one's health, such as exercise regimen, any herbal medications and any counseling may received.

Functions of Personal Health Record

Results from Harris Interactive survey in April 2002 about Patient-Physician online communication - asked; “If you could do so, which of the following would you like to be able to do online with your doctor or doctors?” - shows (77%) want to ask questions without a visit to the doctor office, (71%) want to make an appointment, (71%) want to request prescriptions refills for medications, (70%) wants to receive the results of medical tests, (6%) none of these, and (4%) don’t know [4]. This survey shows that two thirds of the people surveyed are interested in four defined key PHR functions that are not limited to these four functions. As PHR provides easy access to all of the individual health related information to view and share with the healthcare provider for care planning treatment and preventive care management, the process where PHR provides dynamic and comprehensive information set and presents it at the time of care, itself is core functionality [5].

The Markle Foundation Connecting for Health Initiative Group defines the internet based PHR by its functions as introducing internet based transaction and services. One function is the ability of the healthcare provider to access the PHR, not only, to view but also update information and communicate it to patient. Another function is the integration to the Electronic Health Record (EHR) of the healthcare setting if applicable. To use the PHR to provide certain services, the information entities in the PHR require management and maintenance beside the initial entry, a PHR function included by the Connecting for Health Initiative Group 2004 report is the management of the following type of information: identification and demographic, personal contact, medical insurance, pharmacy insurance, and medical care provider contact. Services the PHR can provide also include drug interaction checking, online prescription request and refills, and preventive service and appointments reminder. Anther set of functions that can help in documentation and data organizing is a health data tracking utility to create charts and graphs, and patient diaries to document information about pain, symptoms, and possible drugs side effects. An important function of the internet based PHR described in the report is the ability to schedule appointment on line with a health care provider. One function PHR can also provide that can store and update medical data and patient information for frequent access, is the summarization into standardized specialist visits forms or questionnaires and patient specific instructions for frequent hospital visits. Other relevant functions that can be integrated and utilized easily in the internet based PHR - defined as optional - are links to knowledge bases, and links to patient education, self-care content and consensus guidelines. Two PHR functions - viewed as benefits - that might not be often used, or even rarely, are the inclusion of Advance Directive Form and Continuity of Care Record [6-7].

Attributes of Personal Health Record

PHR attributes can crossover some of the functions defined for a PHR and can deduce its benefits or advantages. The (e-HIM) Work Group - was formed as an initiative by AHIMA that focuses on PHR to formulate its guidelines - organized six attributes categories for PHR [8]. Ownership: Defines the owner of the PHR, as the person who controls and owns information, and decides which parts of their PHR accessible, by whom and for how long. Function: The PHR is a portable electronic record keeping tool that provides functions easy to use and understand, customizable to fit personal need in information retrieval, display and access, and helps individual to organize personal health information. Furthermore, helps individuals with general health education, and educates them about their personal health information. Another PHR functional attribute is that, its flexibility to expand to support evolving health needs of individual and family. Format and Content: PHR is an electronic, dynamic record (continuously updated), linked with, or contains copies of, provider's legal or electronic records, and able to identify the original and immediate source of information. The PHR Contains lifelong health information and all information include dates of entry and occurrence. Privacy Access and Control: While PHR must be private and secure; control is by the owner who assumes responsibility for the information in it. PHR should be accessible any place any time by the individual and provide means to emergency access to provider when needed. Maintenance and Security: An audit trail is required as part of the PHR, and to maintain data integrity, data can be changed or deleted only by the original source under the given authority of the owner, and the owner decides what is incorporated into the record. Interoperability: The PHR should be a standard driven tool, exchanging and communicating easily, consistent and accurately with systems. The PHR has a structured data collection and storage, and the ability to link to knowledge, educational, and other databases.

The Markle Foundation Connecting for Health Initiative Group is the first to produce a definitive set of characterizations of the PHR, list (3) contains seven attributes categories to the PHR as defined by the group [2]. Although the context of these attributes categories explained by the attributes and functions published by (e-HIM) group, the Markle Foundation report classified them into what is available today and which ones are not easy to achieve. With many attributes can be available today to implement in PHR, the attributes that are difficult to achieve include the entire lifelong health information records and the acquiring of the provider's legal or electronic records. Interoperability classified as an attribute available today, but only for a small number of patients, and mainly for data associated with single a source [6].


List 3: PHR Attributes defined by The Personal Health Working Group – Markle Foundation

1.Each person control his or her own PHR, Individuals decide which parts of their PHR can be accessed, by whom and for how long.
2.PHRs contain information from one’s entire lifetime.
3.PHRs contain information from healthcare providers.
4.PHRs are accessible from any place at any time
5.PHRs are private and secure
6.PHRs are “transparent.” Individuals can see who entered each piece of data, where it was transferred from and who has viewed it.
7.PHRs permit each exchange of information with other health information systems and health professionals.

The PHR model that provides individuals with online access to their secured data professionally, as described by Markle Foundation, consist of two functional models [6]. One: institutional gateway model that connect the PHR to a single institution and it is the main source of data. These gateways collect information from secured multiple services within the institution, or from secured single service. Two: aggregator model, as an application that gathers information form the patient and from multiple professional sources with a multiple or single service, or pull data from multiple institutions across multiple types of services. The architecture models to support the described functional models are: One: Third-Party Repository where a third party database stores centrally data from both the PHR and provider systems with the patient consent. Two: Record locator service, where a third party has a repository of identifying information about an individual – the only thing held centrally- then authorizes and securely queries and request data for a particular patient from all the participating professional health data sources as data not held centrally, but generated on demand.

Aiman Alrawabdeh 5/11/2006

References

  1. The Role of the Personal Health Record in the EHR October 2003. The American Health Information Management Association (AHIMA). Available at: http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_027539.hcsp
  2. The Personal Health Working Group Final Report. July 1, 2003. Markle Foundation. Available at: http://www.connectingforhealth.org/resources/final_phwg_report1.pdf.
  3. What Should Your PHR Contain?. October 2003. The American Health Information Management Association (AHIMA).

Available at: http://www.myphr.com/your_record/record_contents.asp

  1. Taylor, H. and Leitman, R., Patient/Physician Online Communication: Many patients want it, would pay for it, and it would influence their choice of doctors and health plans. April 2002. Harris Interactive.

Available at: http://www.harrisinteractive.com/news/newsletters/healthnews/HI_HealthCareNews2002Vol2_Iss08.pdf

  1. Why Start a PHR?. October 2003. The American Health Information Management Association (AHIMA).

Available at: http://www.myphr.com/your_record/why_start.asp

  1. Connecting Americans to Their Healthcare - Final Report of the Working Group on Policies for Electronic Information Sharing Between Doctors and Patients. July, 2004. Markle Foundation.

Available at: http://www.connectingforhealth.org./resources/wg_eis_final_report_0704.pdf

  1. Continuity of Care Record. Foundation of e-Health Initiative.

Available at: http://ccbh.ehealthinitiative.org/communities/community.aspx?Section=105&Category=230&Document=514

  1. The Role of the Personal Health Record in the EHR Appendix A: Attributes of the PHR. October 2003. The American Health Information Management Association (AHIMA).

Available at: http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_027455.hcsp