View source for Going Mobile: How Mobile Personal Health Records Can Improve Health Care During Emergencies

This  is a review of the article "Going Mobile: How Mobile Personal Health Records Can Improve Health Care During Emergencies" by Nidhi Bouri and Sanjana Ravi created in 2014.<ref name="mPHRs">Going Mobile: How Mobile Personal Health Records Can Improve Health Care During Emergencies Bouri, N., & Ravi, S. (2014). Going Mobile: How Mobile Personal Health Records Can Improve Health Care During Emergencies. JMIR mHealth and uHealth, 2(1), e8. http://doi.org.ezproxyhost.library.tmc.edu/10.2196/mhealth.3017</ref>

==Introduction==
Patients typically use [[PHR|Personal Health Records (PHR)]] in one of three formats: a provider-maintained digital summary of clinical information accessible to patients; a patient-owned software program that allows users to view and update their own health information; or portable, interoperable digital files with which patients can manage and transfer information. PHRs in mobile format (mPHRs) fall into the third category and allow patients to access health information via the Internet or telecommunication devices, such as cellular phones. Mobile devices possess the potential to withstand certain types of infrastructural failures during disasters. They may be uniquely qualified to play important roles in responding to public health emergencies (PHEs). During natural disasters large number of people are displaced and injured. In such situations, reliable sources of clinical information are invaluable to patients who cannot communicate or receive treatment from caregivers who are unfamiliar with their medical histories. Integrating PHRs and mPHRs into emergency response plans could help ensure quality health care delivery if or when existing methods of information sharing (eg, paper- and/or computer-based records) fail.<ref name="mPHRs">Going Mobile: How Mobile Personal Health Records Can Improve Health Care During Emergencies Bouri, N., & Ravi, S. (2014). Going Mobile: How Mobile Personal Health Records Can Improve Health Care During Emergencies. JMIR mHealth and uHealth, 2(1), e8. http://doi.org.ezproxyhost.library.tmc.edu/10.2196/mhealth.3017</ref>

==Methods==
For analysis and research in use of mPHRs in emergency settings, the authors conducted a literature review using the research databases PubMed and SCOPUS. They identified scientific studies and peer-reviewed literature that address PHRs and their use in emergency and nonemergency settings, as well as legal and regulatory concerns relating to their use. They also reviewed literature from federal agencies, particularly the Department of Health and Human Services (HHS), regarding [[health information technology]] (HIT) and EHRs, and the potential integration of PHRs into these processes.

==Results==
mPHRs give providers a mechanism to share information with patients, including clinical summaries, diagnoses, educational resources, and appointment reminders. They also enable patients to refill prescriptions, access lab results, track immunizations, and schedule appointments. PHRs also facilitates continuity of care if a patient receives treatment from a new provider. Therefore, mPHRs, may improve provision of care during PHEs, giving health care providers instant access to a patient’s medical history. For vulnerable and special populations, such as non-English-speaking persons, those belonging to ethnic minority groups, mentally unstable patients, and those who are deaf or blind, mPHRs may be the only communication method between patient and provider. Pediatric populations can also present unique challenges to providing health care in emergency settings, particularly when children either do not have or are separated from parents and guardians. mPHRs will likely benefit clinicians serving this particular population, given the increasing use of smartphones among teenagers and young children.  mPHRs may also be one of the only ways to quickly obtain patient information when medical facilities are struck by disaster leading to power outages, making EHRs inaccessible. mPHRs are therefore the most viable “back up” option to provide individual patient information when original health records are destroyed or unavailable.<ref name="mPHRs">Going Mobile: How Mobile Personal Health Records Can Improve Health Care During Emergencies Bouri, N., & Ravi, S. (2014). Going Mobile: How Mobile Personal Health Records Can Improve Health Care During Emergencies. JMIR mHealth and uHealth, 2(1), e8. http://doi.org.ezproxyhost.library.tmc.edu/10.2196/mhealth.3017</ref>

==Challenges==
* The United States Lacks a Unified Infrastructure for Managing and Verifying the Integrity of Data Stored in PHRs. Many PHR systems are integrated with a specific EHR systems. Some are standalone PHR's, where users must manually enter information. Depending on the PHR service in question, clinicians may lack the ability to verify the accuracy of patient-entered data. 

* Most available PHRs and mPHRs currently operate on different, noninteroperable platforms, and thereby complicate efforts to gather pertinent medical information.  The loss of critical infrastructure and personnel during PHEs impedes data collection. Many PHR systems are integrated with a specific EHR system so, if EHR systems are not interoperable with each other, providers can be limited as to what content they can view.

* Costs Associated With Maintaining PHRs Are Unclear and May Present a Significant Barrier to Medical Institutions.

* Patient-Managed Health Records Present Consumers and Policymakers With Several Legal, Regulatory, and Privacy Challenges. Legal and regulatory frameworks for governing mobile health care applications remain absent. The current lack of regulation could impede health care delivery efforts in post-emergency settings.<ref name="mPHRs">Going Mobile: How Mobile Personal Health Records Can Improve Health Care During Emergencies Bouri, N., & Ravi, S. (2014). Going Mobile: How Mobile Personal Health Records Can Improve Health Care During Emergencies. JMIR mHealth and uHealth, 2(1), e8. http://doi.org.ezproxyhost.library.tmc.edu/10.2196/mhealth.3017</ref>

==Conclusion==
mPHRs provide Patient Medical Histories at the Point of Care. This may improve provision of care during PHEs, giving health care providers instant access to a patient’s medical history. However, some critical challenges remain, which need to be addressed. The authors feel that PHRs must be implemented and regulated by the federal government due to its involvement  in emergency preparedness at national, state and local levels. Congress should identify meaningful use criteria to govern the use of mPHRs. A federal agency, such as the ONC, should assume a regulatory role and establish a legal framework for mPHRs.  Federal entities, such as the Office of the National Coordinator for Health Information Technology (ONC), FDA, and HHS, should identify how to integrate PHRs and mobile portals into mainstream health care, especially for use during emergencies.

==comments==
mPHRs offer a viable solution during emergencies. Several mPHRs created specifically for emergencies exist. [[Microsoft HealthVault|Microsoft HealthVault]], for example, enables users to create medical records specifically for unexpected hospital visits or to inform first responders. Another application, Gazelle, allows smartphone users to receive and share lab results. Similarly, a Web-based PHR service called Synchart stores patients’ health information and can grant clinicians emergency access to said information during a crisis. However, mPHR's have to surpass challenges described above to be widely adapted and used.

== Related Articles ==

[[PHRs and HIPAA]]

==References==
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[[Category: Reviews]]
[[Category: PHR]]
[[Category:HI5313-2015-FALL]]
[[Category: MHealth]]
[[Category: Patient Safety]]