The Tech Doctor: What You Need to Know About PHRs

New technology can be a boon for you, but it can also be good for your patients, too. For those of you hoping to offer a new electronic widget to your patients, a personal health record (PHR) may be just the thing.

The PHR has a number of pluses: In most cases there is no cost to you or your patient; little, if any, installation; and a nice stream of patient care benefits ranging from better disease management to 24-hour access from anywhere in the world. Also, for those practices that have not made the leap to digitizing paper records, recommending a PHR to patients does not require having an EMR. Finally, for those of you eligible for pay for performance or other quality programs, a PHR can help patients self manage and help you qualify for bonuses.

Sold? Good - let’s take a quick look at the PHR landscape.

There are three basic flavors:

• Standalone PHRs. These were designed to be a sophisticated medical record keeper for patients the same way that Quicken functions as a financial record keeper. They are available as hosted systems (meaning they are accessed via the Internet) or for installation on a patient’s home computer. For the most part, all data is entered manually by the patient. Standalone PHRs may include some basic prompts and reminders to help patients keep track of preventive care tests or manage a chronic illness. These systems are fine for patients who don’t mind the manual entry and are motivated self-care managers. The primary limitation is that they are not well suited for the collection of provider generated data. That’s a big limitation.

• EMR-powered PHRs. They consist of a secure Internet-based window into the provider’s EMR, allowing a patient to see lab results, prescribed medications, and other discrete data such as allergies and problem lists (progress notes are usually not included). Additionally, these PHRs often include other features such as secure e-mail messaging, the ability to request appointments, and access to Web-based patient education materials.

The win for patients is portability. The record is securely accessible from any computer with Web access, which is nice for patients who are traveling and get sick. Other good points are good data quality and virtually no data entry (since you are basically viewing your doctor’s record). The downside, however, is EMR-powered PHRs only contain information within the provider’s EMR and are not really designed for patients to enter their own data or proactively manage their care.

To offer this type of PHR, you need an EMR that features a patient portal. The portal services are typically sold on an annual per provider subscription basis with prices ranging from $300-$500/provider/year. Some practices offer free access to the portal; others charge anywhere from $25-$100/year/per patient.

• Connected PHRs. This is the most ambitious Web-based PHR model, which is capable of receiving data inputs from a variety of sources: ranging from EMRs at primary-care and specialist offices to pharmacies and labs. At the same time, these systems feature many of the self-directed care aspects of the standalone PHRs. Their objective is to create a PHR that minimizes the need for data entry, is comprehensive, but still offers patients control of their records. This is it. A prominent example of a connected PHR is Google Health.

At a simple level, Google Health is a basic Web-based PHR with the capability to manually build your own health record, like the standalone PHRs we described above. However, Google Health is also designed to both import and export data. Microsoft’s Health Vault is a variation of this model.

As with most grand visions, the devil is in the details - and the details in this case are all about connectivity; establishing the secure “pipes” into and out of the PHR, so that it can send and receive data from third parties, like a family practice’s EMR.

Although connectivity standards help, these connections get built one at a time. As a result both Google and Microsoft are establishing partnerships with national lab companies like Quest and pharmacies like Walgreens and CVS. Since providers (and the data they hold) are highly fragmented, you’ll see Google and Microsoft partnering with large provider organizations to provide a connected PHR for patients in a given region.

Payers, like Aetna are jumping into the mix with connected PHRs for their members, using claims data as the primary source of clinical information. Their motivation is simple: improved patient self-care equals healthier patients and lower costs.

What if you happen to live in area where these electronic connections don’t exist? You basically are left with a PHR that puts the burden on the patient for data entry. The reality is that for many of us the connected PHR is not very connected.

So where does that leave us?

Even though the ideal connected PHR is still in the process of being built, personal health records will be very much a part of the new healthcare landscape in which consumers will be expected to better manage their own care and providers will be expected to help them. Now is a good time to get ahead of the curve.

Bruce Kleaveland is president of Kleaveland Consulting, a management consulting firm focused on healthcare IT. He can be reached via kelllie.rowden-racette@cmpmedica.com.

This article originally appeared in the February 2009 issue of Physicians Practice.