Personal Health Records Farrokh Alemi, Ph.D. Personal Health Records

Can PHR’s Transform Health Care Why not? Can PHR’s Transform Health Care This lecture describes what is personal health care and how it can transform the delivery system and why has it not been as effective until now.

PHR Identity Problem list Medication The common components of PHR include Identification Sheet, Problem List, Medication Record and related drug drug interaction system,

PHR History & Physical Progress Notes Consultations History and Physical, Progress Notes, Consultation,

PHR Physician’s Orders Imaging Reports Lab Reports Physician’s Orders, Imaging and X-ray Reports Lab Reports, Immunization Record, Consent and Authorization Forms

Consents & Authorizations PHR Immunization Records Consents & Authorizations Billing Immunization Record, Consent and Authorization Forms, billing resolutions

PHR Email Reminders Scheduling Ability to email your doctor (mostly answered by nurses), prevention and wellness reminders such as weight loss programs, and scheduling appointments

Tethered HL7 CCD CDA ASTM CCR PHR may be tethered to a specific electronic health record company or be independent; allowing input and exchanges from multiple sources. The Health Level Seven (HL7) Continuity of Care Document (CCD) and Clinical Document Architecture (CDA) and the American Society for Testing and Materials (ASTM) Continuity of Care Record (CCR) are different sets of standards that enable how a PHR can receive information from multiple sources.

Tethered Google Health is an example of an independent PHR. GE Patient Portal is an example of a tethered system.

Would you be interested in having a personal health record Would you be interested in having a personal health record? In knowing what is your immunization data. In having your lab results at hand. In showing up in an emergency room and having your entire record available? In case of disaster, you can lose so much but you will not lose your health records.

By 2014, Stage 2 Meaningful use requires electronic health record companies to have 10% of their patients use their personal health record or their patient portal. Given lack of interest on behalf of the patients, this seems an impossible task. Health care providers stand to lose millions of EHR incentives if they do not meet the proposed guideline.

No Interest Google discontinued their personal health record. Patients are allowed to use the system till 2013 and after that even the data will no longer be available.

If it’s not fun, if it’s not social, why would they do it? Why not? Not trustworthy Not social If it’s not fun, if it’s not social, why would they do it? Adam Bosworth Google Health was not trustworthy: Consumers are not willing to trust corporations like Google or Microsoft with their personal health data. Google Health was not fun or social: Adam Bosworth, the original leader of Google Health and now founder at Keas, told TechCrunch TV a few weeks ago: “My sense is that neither [Google Health nor Microsoft HealthVault] are dramatically successful. In Google’s case, it’s partly because they haven’t really pushed to see what people would want. They basically offered a place to store data. Our data shows people don’t really want a place to store data, per se. They want to do something fun and engaging. If it’s not fun, if it’s not social, why would they do it? Yes, they want to be healthy, but they need more than that. They need the encouragement and even the pressure of friends. They need the constant pressure, constant reminders.” Quoted from 10 Reasons why Google Health failed by Brian Dolan on Mobile Health News See http://mobihealthnews.com/11480/10-reasons-why-google-health-failed/ Quoted from 10 Reasons why Google Health failed by Brian Dolan on Mobile Health News

Why not? No doctors involved No insurance companies Poor marketing, poor service, etc. Google Health did not involve doctors: GH was too bottom-up, according to at least one former In order to get ongoing and broad adoption of something in healthcare, one needs to lead with the clinicians. Google Health did not involve insurance companies The participation of insurance companies was also not widespread. They refused to share data or saw no incentives to do so. A host of other reasons can also be added such as poor marketing and poor service, but these are the reasons why any business may fail. Quoted from 10 Reasons why Google Health failed by Brian Dolan on Mobile Health News See http://mobihealthnews.com/11480/10-reasons-why-google-health-failed/

It didn’t help manage their health. Why not? Not Useful Enough John Moore It didn’t help manage their health. Google Health was not useful to consumers: Ultimately, I think John Moore of Chilmark Research hits on the biggest reason of all: It didn’t solve any pressing problems for consumers. “Can it help them better manage their health and/or the health of a loved one? Will it help them make appointments? Will it saved them money on their health insurance bill, their next doctor visit? Can it help them automatically get a prescription refill? These are the basics that the vast majority of consumers want addressed first, and Google Health was unable to deliver on any of these.” Quoted from 10 Reasons why Google Health failed by Brian Dolan on Mobile Health News See http://mobihealthnews.com/11480/10-reasons-why-google-health-failed/ Quoted from 10 Reasons why Google Health failed by Brian Dolan on Mobile Health News

What could make a personal health record more useful What could make a personal health record more useful? How could we make it more social?

Pharmacogenetics Clearly personal health records should take advantage of what is most personal of all, one’s DNA and genetics. Let patients know what works for them based on their specific genetics. Let them contact their physicians and ask for alternatives to their treatment.

Outcome Based Prescribing Check in large data warehouses for cases similar to the patient and see what has worked for them and how combination of patient’s medications can be optimized.

Symptom Diary Allow patients to collect their symptoms over time and present their experiences to their doctor at next visit. Closely monitor symptoms between visits. Out of site is no longer out of mind.

Social Community It could help patients if they could exchange notes with other patients in the same conditions. It could help if patients can ask questions between visits and get answers publicly. It could help if patients can see what others are saying about their physicians.

Next? The coming years will establish how personal health records will be delivered and to whom. It is now up to you to make a difference and lead the effort.