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ePHR Home
John is a fictional IT executive for a large integrated delivery system. As John sits in his office, studying his attorney's interpretation of the recent legislative action intended to stimulate Health Information Technology adoption, Dr. Hill appears at his door. She has just finished up the annual checkup with Gary Smith, one of her long-term patients, who started the interview by presenting her with a USB memory stick. Mr. Smith wanted Dr. Hill to download the stick with information he had accumulated on an internet-based Personal Health Record ... and at the end of the examination, to upload the results of Dr. Hill's current exam. Dr. Hill and John enter into a vigorous conversation centered around whether the Medical Group, or hospital currently have a policy and/or processes to support Mr. Smith's request - which to him, seems to be a rather simple one. John agrees to do a little research (starting with an excellent position paper by HIMSS), and meet with Dr. Hill and her colleagues the following week. It seems, as a starting point, that the memory stick is related to, or part of an ePHR. John starts by jotting down a few questions ...
- What is a personal health record - Lots of vendors, lots of definitions, lots of approaches. But ... Congress just defined a goal to have a personal health record for everyone in the country by 2014, via the Stimulus bill. Who owns the definition of what it is, and what are the options?
- How does PHR relate to my EMR? - We have a pretty big commitment to EMR. How can we use that?
- Medical Records Issues - HIPAA formalized the environment of privacy and security. But is a patient obligated to protect her own confidentiality - or can institutions simply make it clear that any confidentiality breaches are as a result of her actions, and not theirs. What might Medical Records professionals or providers might find valuable (or threatening) in all that important data being copied onto a portable device?
- Physician Issues - Physicians are people, too ... and susceptible to many different points of view. Clearly, physicians accept CD's of diagnostic images that walk into their office in a patient's purse or pocket. Let's see what values physicians expect and structure our policies around them. For PHR-on-a-Stick, do we need a full history of all inpatient and ambulatory activity, or is it "good enough" to hold current medical condition, allergies and medications?
- Technology Issues - Some providers see any externally-generated device attached to their computers as a really bad idea. (Click here for one example). Another impediment to a physician accepting a memory stick would be data accessibility and format. Of course, our IT brethern will ask some other questions, like whether the stick contains an application, or just data.
- Operational Implications - Let's assume that Dr. Hill and John have agreed to accept Gary's data via memory stick, and even to share the results in a similar fashion. The next patient who walks in has a similar request, except that she wants to use Google Health. The next patient wants Microsoft Health Vault. The next ... gosh, this is turning into a real job for somebody to support all the patient requests, isn't it? Of course, once we agree to fulfill the requests, we are probably obligated to some level of diligence in maintaining that data (some other provider might rely on it, after all). Is this a super sized shadow chart?
- Payor Issues? - If a payor wants a copy of your medical records today, is the physician obligated to provide it? Those medical records release forms everybody signs apply to the provider. Since well before HIPAA, providers have been keenly aware of confidentiality of your records. If we as patients and consumers are more cavalier, does it matter? Do consumers have rights, which could be impinged upon to the benefit of of insurance shareholders and the detriment of patients? What are payors doing with ePHR?
- What is the legal environment around PHR - Legality is always among the first questions that health care professionals ask. Still ... even though the issues are open, can providers afford to be policy-silent? HIMSS does a good job of isolating many of the questions in this section.
- What should we tell our patients Since an ePHR is a patient-centric tool, a sophisticated provider should have materials and information at hand to share with patients who ask about it! The trick will be to keep it simple ... there is a lot of vendor "noise" shouting for attention!
After a few Google searches, our IT executive is left scratching his head. There is certainly a lot of data about PHR's. It looks like a classic Tar Baby which could consume a lot of John's time. How can he justify the time to study the topic adequately, much less develop policies, interfaces and organizational implications .... when neither he nor Dr. Hill are sure about the medical value of supporting Mr. Smith's request? There's the stimulus bill, which clearly rewards technology adoption ... there's the status of John's EMR implementation ... there's a list of projects that already exceed the capacity of John's IT staff to deliver.
John begins to lay out the elements of a PHR Policy. The trick will be in getting all this data into something "pamphlet sized" to communicate the relevant information easily. Medicare has a pilot program, which although it is payor based, has some nice features to emulate. Perhaps he could start there ...
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Last modified at 3/30/2011 8:31 AM by Jay Fisher
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