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AAOS Now

Published 4/1/2009
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Toya M. Sledd, MPH, MBA

Personal health records: The patient’s EMR

Consumers are keeping track of their own medical records

When you hear the words “Microsoft” or “Google,” you may think of Bill Gates, personal computers, and Web search engines—not health care. But now these companies are joining health insurers such as Blue Cross Blue Shield, Humana, and WellPoint in offering personal health records (PHRs) to consumers and beneficiaries. And soon, patients may be tracking their health histories and bringing their PHRs, which are not the same as their physicians’ electronic medical records (EMRs), along to your office.

The development of PHRs was triggered in 2004 when President Bush announced that all citizens would have access to EMRs in 10 years. Federal agencies, including the Department of Veteran Affairs, the Department of Defense, and the Centers for Medicare & Medicaid Services (CMS), are encouraging the use of PHRs.

CMS has already conducted several pilot programs to enable beneficiaries to access and use PHRs provided through participating health plans. In January 2009, CMS launched another pilot program in Arizona and Utah to determine how to transform claims data into an individual’s PHR.

Although concerns about security and integration with EMRs have slowed adoption, many consumers are beginning to take an active role in the shared decision-making process. The latest survey conducted by the Markle Foundation found that 60 percent of respondents supported the creation of a secure online personal health record service that would allow them to check and refill prescriptions, get test results, communicate with their doctors via e-mail, and check for mistakes in their medical records; more than 70 percent of respondents believed that PHRs would improve healthcare quality.

What is a PHR?
A PHR is an electronic record of an individual’s health information controlled by the individual, enabling him or her to manage, track, and participate in his or her own health care. PHRs differ from EMRs in that EMRs typically contain information collected and maintained by a healthcare provider, including the patient’s health history, physical examination results, physician dictations, and laboratory results.

The American Health Information Management Association recommends that a standardized PHR should be able to be used by different providers in different care settings and should include the following common data elements:

  • demographic information
  • medications (prescription and nonprescription)
  • immunizations
  • allergies
  • hospitalizations, surgeries, and medical devices

The sidebar “What’s out there now?” includes information on a variety of PHRs currently available to consumers. This is not an exhaustive list, and none of these products is endorsed by the AAOS.

What about patient privacy?
Some PHRs can have negative consequences for the privacy of consumers who authorize the PHR vendor to maintain their health records. According to the World Privacy Forum, federal rules for health providers and insurers do not protect records maintained by many PHR vendors. Google™ Health, for example, is not regulated by the Health Insurance Portability and Accountability Act because the data is not stored on behalf of healthcare providers. Many PHR vendors have stated that they are committed to protecting user privacy and have strict data security policies. Potential users should extensively investigate these policies before selecting a product.

What can you do?
Continue to encourage your patients to take responsibility for their health. Help your patients identify a core set of data relevant for their navigation within the healthcare settings. The use of PHRs could be valuable in removing communication barriers between the patient and physician, reducing the occurrence of medical errors, and reducing overuse of the healthcare system (duplicative testing).

Toya M. Sledd, MPH, MBA, is the clinical quality improvement coordinator in the AAOS medical affairs department. She can be reached at sledd@aaos.org

What’s out there now?
Here are just a few of the personal health record products currently being marketed to consumers.

Google™ Health—Launched in March 2007, Google™ Health (https://www.google.com/health) is an application and a data platform for consumers to gather, store, and manage their personal health information. Individuals can store data on existing and previous medications, lab results, allergies, medical devices, and health education information; they can also access wellness programs for tracking diet and exercise and applications to detect potential medication interactions.

iHealthRecord—This secure, confidential, interactive PHR (www.ihealthrecord.org), which now integrates with Google™ Health, stores personal information and helps the consumer better understand medical conditions and medications. Users can grant or revoke access privileges for their physicians or other healthcare providers.

Microsoft® HealthVault—Launched in 2007, this health application platform (www.healthvault.com) allows users to collect, store, view, share, and transfer health-related information online. HealthVault also provides a privacy-enhanced and security-enhanced foundation that can be used to store and transfer information among a variety of providers’ health services and health devices.

myPHR—Sponsored by the American Health Information Management Association, myPHR educates consumers about the benefits of maintaining a personal health record. The site (www.myphr.com) defines a personal health record, provides a step-by-step guide on accessing health information and compiling and keeping a personal health record, and explains privacy rights.