Hospitals pick up the pace on patient health records. Should you take the 'true' route or opt for a portal?
A few years ago, Google and Microsoft made big waves when they both unveiled programs intended to let consumers take control of their own health information. Personal health records had been discussed in some circles before, but the Silicon Valley mammoths brought a big oomph to the movement.
Now, the PHR effort is picking up even more steam. Providers are following two routes—the PHR portal and the true PHR. The PHR portal is integrated with the hospital's electronic medical record. The true PHR stands alone, with no current connection to the hospital EMR. True PHRs, like Google Health and Microsoft's HealthVault, can be updated by care teams as well as by patients.
Some hospitals are taking both roads. Mayo Clinic has a patient portal that includes information aggregated from its EMR. In addition, Mayo and Microsoft have co-developed a next-generation true PHR, called Mayo Clinic Health Manager, or MCHM. MCHM delivers individualized recommendations to consumers based on data stored in the patient's Microsoft HealthVault account. "Eventually, Mayo intends to make data from its patient portal available to external PHRs, such as MCHM," says Sidna Tulledge-Scheitel, M.D., Mayo's medical director of global products and services.
Tulledge-Scheitel says the portal provides functionality such as pre-visit paperwork and post-visit test results for established Mayo patients. MCHM, on the other hand, is open to anyone and is recommended for continuing condition monitoring. "Our objective with MCHM is to help people stay healthy by providing personalized guidance for things like immunizations, pregnancy and chronic conditions," she says.
The University of Pittsburgh Medical Center has taken a similar approach. "We have both a PHR tethered to the EMR, and also one that is completely untethered that we're developing with Google," says G. Daniel Martich, M.D., chief medical information officer.
At the moment, PHRs work best when they're connected to the hospital EMR, in the belief that patients are less likely to use PHRs if they have to fill out pre-visit forms for every new doctor, Martich says. But, if the PHR is tethered to the EMR, it becomes more valuable. Plus, it operates within clinician workflow.
"From a workflow acceptance, usability and patient satisfaction perspective, I'll put my penny down on those tied to an EMR," Martich says.
Intermountain Healthcare in Utah put its penny on the portal approach. CIO Marc Probst says he is not a stand-alone PHR fan. "The static nature of the PHR and lack of data controls lower their worth," he contends. Instead, Intermountain has a patient portal into its EMR that allows patients access to their records. "After about four years, it's gaining traction," Probst says.
Partners HealthCare in Boston offers an online service that lets patients access portions of their medical records, including medications, allergies, immunizations, lab results and radiology reports; consult an online health library; and communicate with provider offices to request appointments, referrals or prescription renewals.
"Partners selected these features in response to patient demands for convenience and information access," says Cynthia Bero, corporate director. She says Partners' goal is to enrich the patient experience. "We're also interested in creating an online relationship with patients because these technologies are increasing in importance as future care delivery platforms," Bero says.
Challenges abound, whichever road is taken. Obstacles to PHR implementation include lack of e-service business models and a lack of standardized connectivity between institutions and host applications.
Another challenge is overcoming limited patient utilization. "Many people are more willing to keep their Facebook page updated than their medical records," says Linda Reed, chief information officer, Atlantic Health.
Paradoxically, one culprit discouraging patients from utilizing PHRs is hospitals' efforts to safeguard the information. "Everyone wants secure records, but we found that putting robust security in place frustrates account owners and seems to discourage usage," she says.
Getting physicians to send records to the PHR can be another obstacle. Many clinicians are still uncomfortable sharing medical records with patients. "Physicians are concerned about additional phone calls and other workflow disruptions," Reed says.
Partners' experience with such fears was different. "We found the reality does not match the anxiety," Bero says. "Providers are pleasantly surprised by how few issues arise."
Douglas Page is a writer in Pine Mountain, Calif.