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ANNUAL CONFERENCE. INDIANA ASSOCIATION for HEALTHCARE QUALITY May 1, 2008 Personal Health Record and Quality. THE MEDICAL RECORD. Provider Medical Record is their property and maintains their business aspects Only licensed and authorized individuals document in the MR Privacy.

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May 1, 2008

Personal Health Record

and Quality

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  • Provider Medical Record is their property and maintains

    their business aspects

  • Only licensed and

    authorized individuals

    document in the MR

  • Privacy

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  • Media is Paper, electronic or hybrid

  • Electronic EHR/EMR are usually proprietary

  • Facilities do not share data between

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Regional Health Exchange Organization (RHIO)

  • RHIO share information from those facilities that are shared within their connectivity

  • Interoperability is the main problem

  • Currently used only in emergency situations

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  • Some facilities with EHR/EMR allow patient access to see information

  • via patient portals but do not allow them to add to


  • Patient may be tracking

    home activities but not

    remember to provide

    physicians the information

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  • General public more informed

  • Patients research their disorders

  • Millions of health websites

    • WebMD, NLM, disease sites, etc

  • Patients want to be engaged in their own care

  • Consumer empowerment

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Consumer Empowered

  • Consumers know and control of their financial information but do not control or know about health information

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Reported data can now publicly viewed

  • Medical Errors

  • Patient Safety Concerns

  • Mortality

  • Quality Indicators (Core Measures)

  • Pricing

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CURRENTLY Consumer Role

HCPs ask patients

to provide their

health details

at the initial

patient visit

or during an


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Problem with Current System

  • Based on recall of patient at that time

    • Medications

    • Surgery Dates

    • Sicker patients have more to recall

    • Elderly

  • Updates to the HCPs record are only based on encounters with that particular HCP or facility

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  • Incomplete or incorrect patient information can impede HCPs ability to provide quality care

  • Decentralized Patient Information

    • Patients see more than one HCP

    • Mobile society

    • Select in-network provider

      • New Insurance

      • Provider leaves network

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Quality Concern

  • Missing or incorrect information could result in an incorrect Diagnosis

  • An incorrect diagnosis can result in and incorrect Treatment plan

  • An incorrect treatment plan could result in poor patient outcome

  • Medication Reconciliation clarification

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Potential Solution

  • Personal Health Record

    • Shared during initial visit

    • Used to update HCP records during subsequent visits

  • Win-Win

    • HCP has complete information

    • Patient is more involved

    • Patient receives better care

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  • Not based on memory

  • Contains additional information

    • Over the counter medication

    • Herbals

    • Exercise habits

    • Preferences, such as a living will

    • Home Monitoring

    • Lifestyle activities/habits

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A collection of life-long information about a person’s own health, or the health of someone they care for, such as a parent or child that is needed by individuals to make health decisions. The person actively owns, manages and maintains the PHR which comes from healthcare providers and the individual. The PHR is separate from and does not replace the legal record of any provider.

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  • Patient empowerment

  • Improved patient-provider relationships

  • Enhanced patient safety:

    • Comprehensive health information in one location

    • Allergies, medications, and care plans in a PHR are available to each provider.

  • Health information privacy (Endsley et al., 2006, p. 60).”

  • Cost savings

  • The PHR is owned by the patient

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  • Paper – notebook

  • Electronic

    CD-Rom, Memory stick, network

  • Web-based

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  • Tethered – PHR which is linked to a facility and populated by the facility data and housed on their system

  • Untethered – PHR which can be transmitted or submitted anywhere

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Current PHR trend for data

Consumer initiated


Insurer–based on billing data

Employer-based on billing data

Medicare- based on billing data

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Patient identification

Providers data

Insurance data

Family history

Patient history





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The AHRQ has provided general education on their website for consumers to learn of the need for the PHR and it’s use

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The American Health Information Management Association is conducting a consumer education program

AND has forms for paper or electronic PHR available for consumers to use

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Harris Interactive Study (2004)

  • n = 2,500

  • 67% or 1,675 are concerned about privacy/security

  • 42% or 903 keep PHRs

  • 58% or 1,597 don’t keep PHRs

    Those who keep a PHR: (n = 903)

  • 86% are on paper

  • 14% are electronically

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Harris Interactive (Cont)

Likelihood to start a PHR for those who don’t keep a PHR (n=1,597)

40% Likely

39% Not very Likely

20% Not at all Likely

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Health issues and Aging Population

  • Over 65 population will nearly triple – over 70 million

  • More than 6 of every 10 Boomers will be managing >1 chronic disease

  • More than 1 out of every 3 Boomers will be clinically obese (21 Million)

  • 1 of every 4 Boomers will be livin with diabetes (14 M)

  • Nearly 1 out of every 2 Boomers will be living with arthritis

  • 8 times more knee replacements will be performed than in 2007

  • 62% of 50 to 64 yr report having at lease 1 of 6 chronic conditions (hypertention, Hi Cholestrol, arthritis, diabetes, HD, or Cancer)

    Amer Hosp Assocation and First Consulting Group. “When I’m 64: How Boomers Will Change Health Care” AHA Washington DC 2007

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ERA of Virtual Caregiving?

  • Health Technology will move into home

  • Remote monitoring, wearable devices and communication links

  • Technologies will keep people out of hospital, or avoid need to come to clinic

  • Less invasive surgical options w/ new tech

  • But service demand exceeds supply of caregivers

    AHA and First Consulting Group. 2007

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As patients begin using:

  • Education of providers on importance and use of PHR

  • Education on retention and dating of PHR

  • Connectivity and interoperatability to the EHR/EMR

  • Home monitoring devices integration with PHR

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Continuity of Care Record (CCR)

EMR and PHR comparisons for

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Nursing Initiative Workgroup

  • Consumer Empowerment/Personal Health Record Collaborative 

  • The Consumer Empowerment/Personal Health Record Collaborative was formed to: 

  • Establish efforts to develop health information literacy with the public and healthcare consumers.

  • Work with Personal Health Record (PHR) advocates and developers to optimize PHRs as they relate to nursing.