There's been a lot of buzz around personal health records with Microsoft and Google getting into the fray.
This shows us at least two things. First, health care is becoming more and more synonymous with Web 2.0 technology. Users of health care services are educated and technologically sophisticated, and expect that same level of maturity when searching for answers to their health care questions. Second, the barriers to entry are low. Technology companies see a very lucrative business opportunity, and they're seizing that chance with vigor.
But does the fact that these technology companies are populating the industry make the industry better? Does putting patients in charge of their health and medical information improve the healthcare system? Time will tell, but I will argue that it is a big step in the right direction.
Studies show that medical errors, adverse outcomes, and costly, and oftentimes unnecessary, hospitalizations can result when patients don't get enough quality attention and data isn't consolidated between caregivers. Health plans, employers, government agencies and consumers see the value in creating repositories for health information from which to make good diagnoses and develop effective treatment plans. This is the first phase of personal health records.
Yet, we need to move beyond data repositories and into more advanced tools which incorporate real-time interactivity, integration and intelligence. PHRs should tailor information to the unique needs of patients and play an increasing role in managing their health.
Efforts are under way by leading health plans, employers and government agencies to aggregate patient information into PHRs. These are a centerpiece for health care IT connectivity to improve care, reduce medical errors and lower costs. Multiple solutions have entered the market, from flash drives carried by the patient to more advanced Web-based tools. Health plans, employers and independent vendors offer them, with each providing varying levels of sophistication and usefulness.
Several PHRs are pre-populated with medical claims data so each doctor visit, prescription fill or lab test is added to the PHR, resulting in an evolving, comprehensive picture of the patient's health. In addition, some PHRs encourage users to enter personal health information not available from claims, such as height and weight, smoking status, allergies, over-the-counter medications and use of herbal supplements.
Possible benefits of PHRs include helping consumers take a more active role in their care, especially for people with chronic conditions seeing multiple doctors, and may be helpful in emergency situations. The keys to the success of a PHR are to strengthen the doctor-patient relationship and to keep physicians armed with knowledge about their patients' past and present health profile to best maintain their health management program.
However, the majority of these PHRs serve as a data repository, leaving the market open for a clinically intelligent, patient-centric solution. The aggregation of data into a patient-centered and patient-controlled record can optimize care among caregivers and their patients.
PHR technology exists today that provides real-time clinical analysis and two-way, interactive exchange of data. This analytical, dynamic PHR takes a data-rich environment to the next level by actively driving patient activity, patient access and physician-patient interaction.
As new data is received, either from claims or the patient, it is added to existing patient data and analyzed for targeted and actionable opportunities to improve care. When an issue is identified, the user receives an alert in the PHR, which they are directed to through e-mail notification. In addition, the issue is communicated to the treating physician. When clinical alerts are sent to both the patient and the physician, both parties receive information they need to make informed decisions and to collaborate intelligently and productively.
Dynamic PHRs integrate in real time with clinical decision support technologies designed to aggregate data to compare with thousands of medical rules that represent incontrovertible standards of care. This allows for discrepancies to be highlighted between the care that a patient is actually receiving and the care that the patient should be receiving as reflected in the evidence-based literature.
Let's say a patient uses his PHR and enters that he is taking acetaminophen. The dynamic PHR immediately can tell the patient that the over-the-counter drug, in the context of an abnormal liver function test, is not recommended. Other examples of alerts include potential misdiagnoses, potential adverse drug interactions, absence of therapeutically beneficial drugs, missing lab tests and reminders for preventive exams, such as mammograms and colonoscopies.
On another occasion, the system might spot a patient who indicates in her PHR that she's taking a particular prescription that might have a side effect on the kidneys - and also finds claims data that the patient is being treated for kidney disease and is taking other prescription medications in preparation for a kidney transplant -- the system would send an alert to the doctor. The physician - and then the patient - would be notified that the combination of drugs could increase the chances of a new kidney being rejected. It is these types of potential medical missteps that a dynamic PHR can help physicians avoid, while guiding patients about staying healthier.
A prominent new enhancement to PHR technology is integration with disease management and wellness programs. This provides users with an interactive tool that can instantaneously issue evidence-based, patient-specific, clinical alerts when potential medical issues are identified. Bi-directional data sharing enables the two programs to complement one another in several ways:
- Member-derived data is captured via either the PHR or a disease management nurse, and the information is aggregated with claims data and analyzed by clinical decision support technology.
- PHRs can be leveraged as a vehicle to encourage compliance with alerts generated from the member data and the decision support platform.
- A clinically intelligent PHR has the ability to recognize and notify users who qualify for specific disease management programs by sending customized enrollment invitations.
Additionally, PHRs can be integrated into value-based insurance design to enable members to see customized messages about co-pay reductions for essential medications that may be available to them for certain classes of drugs. This messaging is in addition to members receiving letters at home and the treating physicians receiving letters about the potential co-pay reduction.
The dynamic PHR provides company associates with an evolving, comprehensive picture of their health. Medical claims data and member-derived information are combined and analyzed against the latest findings in evidence-based literature to identify patient-specific, actionable opportunities to improve care. These are typically adding a treatment, stopping a treatment or suggesting a procedure that hasn't been conducted. When opportunities are identified, members receive personalized alerts via their PHR and their physicians are notified.
The dynamic PHR further supports the doctor-patient relationship by giving patients the ability to grant their doctors permission to view their PHR online and to print out portions to bring with them to doctor appointments. With individualized alerts, easy-to-use tools, Spanish language capability and integration with the company's existing health management programs would help associates and their dependents take an active role in their health.
For company employees, the system provides members with links to information about topics like chronic illnesses.Members also have access to live health coaches to help manage chronic conditions.
Consumers are wondering if PHRs can guarantee the level of privacy and protection of their personal information. Third-party vendors can act as business associates of their covered entity clients. This makes them contractually required to comply with HIPAA, which includes the following obligations:
- To not use or further disclose the PHR other than as permitted by the contract or as required by law;
- To use appropriate safeguards to prevent unauthorized use or disclosure of the PHR;
- To report to the covered entity any unauthorized use or disclosure of which it becomes aware;
- To ensure that any agents, including subcontractors, to whom it provides PHR agree to the same restrictions and conditions that apply to the business associate; and
- On termination of the contract, return or destroy all PHRs in its possession, or, where that is not possible, extend the protections of the contract for as long as the information is retained.
When selecting a vendor for a PHR, find out what its policies around privacy and protection are.
As PHRs evolve, we will see vendors adding new features that will further enhance the experience for patients and physicians. One example is a calendar in which patients can enter appointments with doctors and then receive reminders for those appointments. Pre-populated intake and immunization forms for visits to new doctors and schools /camps are other enhancements. Links to educational resources may be provided so that the patient can access general information about a range of health issues.
The addition of the Spanish language feature is imperative because the U.S. Census Bureau reports more than 28 million Americans speak Spanish at home. With a click of the mouse, members can easily change their entire PHR from English to Spanish and vice versa.
The adoption of dynamic personal health records is a vital step in changing the current, fragmented state of our health care system. By blending clinical intelligence and data analytics, the newest generation of PHRs can enhance managed care and help achieve its goals of improved quality, lowered costs, empowered consumers and improved communication between patients and physicians.
