Personal Health RecordsThe impact on patient’s health care

Introdução à MedicinaTurma 1127 Novembro 2009

Personal Health Records - PHR

An electronic application through whichindividuals can access, manage and share theirhealth information in a private, secure andconfidential environment;

It is based on the Internet, personal computersor other gadgets;

Personal Health Records - PHR

It differs from electronic health records –computerized platforms for managing detailedmedical information that are capable of beingshared within across different health caresettings - because the main manager is thepatient himself, instead of health careprofessionals or health institutions; [1]

Personal Health Records - PHR

They are used by the individual person for selfcare and record keeping, matching general’spopulation growing demand to play an activerole in the management of their own health care.[2]

Potential functions of electronic

PHRs

• Eg.: Medical history, previous prescriptions, testresults.

Access to user's electronic clinical record (summary or detailed)

• Eg.: clinics, health care service providers, tests, dates, non-prescribed treatments, scanned documents.

Personal health organizer or diary

• Eg.: care plans, graphing of symptoms, passive biofeedback, tailored instructive or motivationalfeedback or decision aids.

Self management support

[3,4]

Potential functions of electronic

PHRs

• Eg.: Patient organizations or virtual peer networks.

Links to sources of support

• Eg.: Email or other active reminders for scheduled appointments, immunization, routine screening and preventative care.

Personal Health Reminders

• Eg.: By self report or objective monitoring through electronic devices (fixed or portable).

Capture of symptom or health behavior data

[3,4]

Potential functions of electronic

PHRs

• Different health care professionals’ access to medical history.

Heath information exchange.

• Decrease in face-to-face appointments.

Telehealth

• Better patient understanding of their diagnosis and treatment options, selection of higher quality providers.

Self management support

[3,4]

BackgroundNeed for clinical history of the patient for more

accurate diagnosis;

Reliable source of information for thephysician; [5]

Clinical record of an individual from birth to hislast visit to the doctor;

Platform that allows the patient to control andaccess his own health records; [7]

Record’s universality;

Perceived as the tool to empower consumers tobecome active decision-makers of theirhealthcare; [2, 8]

They can help prevent medical mistakes andimprove doctor/patient relationship; [9]

They raise concerns about privacy [10], facilityof use [11] and precision of the healthinformation provided by the patient. [12]

Paper-basedhealthrecords

Electronichealthrecords

FactorsPrivacy

Patient’s safety

Doctor/patientrelationship

Efficiency

Quality of care

[4]

Personal

Personal

[6]

Justification

PHRs are becoming an increasingly importantresearch subject in medical informatics;

The PHRs in use or in development todaysupport a myriad of different functions,advantages and disadvantages and consequentlyoffer different value propositions; [4]

Justification

The increased mobility of both the populationand their health care providers and complexityof care delivered make PHRs a valuable additionon the providing of health care.

They appear as the solution to the need for atrustworthy source of essential patient data inorder to ameliorate the providing of health care[1, 13].

Research question"Does the use of PHR improve the health of their

users?"

Aims

Study the impact on patient’s health of PHR:

Better health status;

Less exacerbations;

Less visits to the doctor;

Better medical decisions.

MethodsStudy Design: Systematic Review

Analysis Unit

Articles that evaluate the impact of PHR.

Original ones.

Methods

Methods

Title

Abstract

Medline

ISI

Scopus

Methods

Data collection methods

Methods

"Medical Records Systems, Computerized"[Mesh] AND ("PHR*" OR "personal health records" OR "personal medical records" OR "Medical transcription" OR "Patient access to records" OR "Attitude of health personnel" OR "Patient education" OR "public opinion" OR "Patient participation" OR "Patient satisfaction" OR "Child health services" OR "Disease management" OR "cooperative behaviour" NOT ("EMR―[ti] OR "Electronic Medical records―[ti]))

1256 articles. 74 review.

MeSH Terms

Variables

Number of patients using the PHR;

Evolution

Countries

Type of institutions involved

Diseases of patients

Patient age and gender

Methods

Planned statistical analysis

SPSS

Methods

References• 1. Tang, P., et al., Personal health records: definitions, benefits, and strategies

for overcoming barriers to adoption. Journal of the American Medical Informatics Association, 2006. 13(2): p. 121-126.

• 2. Ball, M., N. Carla Smith, and R. Bakalar, Personal health records: empowering consumers. Journal of Healthcare Information Management—Vol. 21(1): p. 77.

• 3. Pagliari, C., D. Detmer, and P. Singleton, Potential of electronic personal health records. British Medical Journal, 2007. 335(7615): p. 330.

• 4. Johnston, D., et al. A framework and approach for assessing the value of personal health records (PHRs). 2007: American Medical Informatics Association.

• 5. George, J. and P. Bernstein, Using electronic medical records to reduce errors and risks in a prenatal network. Current Opinion in Obstetrics and Gynecology, 2009. 21: p. 000-000.

• 6. Akber, A. and T. Gough, TeleHealth paradigm for Kuwait's healthcare. Logistics Information Management, 2003. 16(3/4): p. 229-245.

• 7. Ferreira, A., et al., Why facilitate patient access to medical records. Studies in health technology and informatics, 2007. 127: p. 77.

• 8. Raisinghani, M. and E. Young, Personal health records: key adoption issues and implications for management. International Journal of Electronic Healthcare, 2008. 4(1): p. 67-77.

• 9. Ludwick, D. and J. Doucette, Adopting electronic medical records in primary care: lessons learned from health information systems implementation experience in seven countries. international journal of medical informatics, 2009. 78(1): p. 22-31.

• 10. Markle Foundation, The Personal Health Working Group final report. Connecting for health: a public-private collaboration [appendix 2]. New York, NY: Markle Foundation.

• 11. Wright, A. and D. Sittig, Encryption characteristics of two USB-based personal health record devices. Journal of the American Medical Informatics Association, 2007. 14(4): p. 397-399.

• 12. Lober, W., et al. Barriers to the use of a personal health record by an elderly population. 2006: American Medical Informatics Association.

• 13. Wuerdeman, L., et al. How Accurate is Information that Patients Contribute to their Electronic Health Record? 2005: American Medical Informatics Association.

• 14. Tang, P. and D. Lansky, The Missing Link: Bridging The Patient-Provider Health Information Gap. Health Affairs, 2005. 24(5): p. 1290-1295.