1. Personal Health Records LIS 4785 Introduction to Health Informatics Fall 2015 Week 5-2 Instructor: Dr. Sanghee Oh

2. PHR Use

3. PHRs An electronic application used by patients to maintain and manage their health information in a private, secure, and confidential environment. PHRs: – Are managed by ___________. – Can include information from _______________, including health care providers and patients themselves – Can help patients securely and confidentially ________ and _________ health information, such as diet plans or data from home monitoring systems, as well as patient contact information, diagnosis lists, medication lists, allergy lists, immunization histories, and much more – Are separate from, and ____________________ of any health care provider – Are ____________________ that simply allow patients to view provider information or communicate with providers

4. American Health Information Management Association (AHIMA) www.myphr.com A tool that you can use to collect, track and share past and current information about your health or the health of someone in your care. – This information can save you the money and inconvenience of repeating routine medical tests. – Even when routine procedures do need to be repeated, your PHR can give medical care providers more insight into your personal health story. Take an active role in monitoring your health and healthcare by creating your own PHR. PHRs are an inevitable and critical step in the evolution of health information management (HIM).

5. PHR Elements Identification sheet Problem list Medication record History and physical Progress notes Consultation Physicians’ orders Imaging and X-ray reports Lab reports Immunization Record Consent and Authorization Forms Operative Report Discharge Summary

6. PHR Selection Criteria _______________________

7. Paper-based PHR Forms AHIMA provides paper-based PHR forms for individual management of health information. – Health information form for adult: http://www.myphr.com/PHR_Forms/adultform.pdf http://www.myphr.com/PHR_Forms/adultform.pdf – Health information form for child: http://www.myphr.com/PHR_Forms/childform.pdf http://www.myphr.com/PHR_Forms/childform.pdf – Authorization form: http://www.myphr.com/PHR_Forms/Sample_Authorization.p df http://www.myphr.com/PHR_Forms/Sample_Authorization.p df

8. PHR Providers Employ Sponsored Insurance Sponsored Provider Sponsored Independent product – HealthVault – Healthy Circles – MedHelp – The 65 Best Health & Fitness Apps of 2014 – http://greatist.com/fitness/best-health-fitness-apps http://greatist.com/fitness/best-health-fitness-apps

9. PHR Challenges According a survey of the PHR use in 2011: – Only seven percent of Americans had used online personal health records, and less than 3.5 percent used them with any frequency. _________________________

10. 5 Reasons Why Google Health Failed Too little, too soon 1.Consumers, for the most part, just weren't interested or didn't even know what a personal e-health record is. 2.Consumers who are aware of PHRs tend to use physician, hospital, and even health-plan portals to keep track of their records. 3.Lack of provider relationships and other data sources. 4.Google lacked other communication and convenience features that patients look for when dealing with their health information electronically. 5.Privacy and security concerns by consumers, whether warranted or not.

11. Evidence-Based Medicine

12. Evidence-based Medicine Evidence-based medicine (EBM) is the process of systematically___________, ___________ and _______ _______________ to aid the delivery of optimum clinical care to patients. “The conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients” (Sackett et al., 1996). The practice of EBM is the integration of ___________________ with the best available _________________ from systematic research (Sackett et al., 1996).

13. A shift in the culture of health provision away from decisions based on opinion, past practices and precedent, toward a system that better utilize science, research and evidence to guide decision making

14. Benefits EBM offers the surest and most _________________ to determine and maintain consistently high quality and safety standards in medical practice; EBM can help _______________________ of transferring ________________ into ________________; EBM has the potential to _____________________ significantly. EBM allows providing more ____________, _________ medical interventions resulting in better health outcomes for patients. Greater _______________ in the quality of care

15. Clinical Decision Support System (CDSS) Computer software that presents users with a knowledge base patient-specific data, and related information at the point of care to enhance healthcare provision and management – Clinical guidelin e – Clinical protocol – Organizations’ structure, culture, and reward systems

16. Challenges _______________________of EBM research into everyday practice is a major challenge. – There are substantial gaps between __________________ and __________________________. Clinical practice is _______________ than trials. No time, to competence ______________ of what works ________________________________ are important.

17. EBP Process Steps ASSESS the patient: Start with the patient -- a clinical problem or question arises from the care of the patient 1.___________________________ – Construct a well built clinical question derived from the case 2.___________________________ – Select the appropriate resource(s) and conduct a search 3.___________________________ – Appraise that evidence for its validity (closeness to the truth) and applicability (usefulness in clinical practice) 4.___________________________ – Return to the patient -- integrate that evidence with clinical expertise, patient preferences and apply it to practice 5.___________________________ – Evaluate your performance with this patient

18. Types of Clinical Questions _________________

19. – Questions of treatment in order to achieve some outcome. May include drugs, surgical intervention, change in diet, counseling, etc. _________________ – Questions of identification of a disorder in a patient presenting with specific symptoms. _________________ – Questions of progression of a disease or likelihood of a disease occurring. _________________ – Questions of negative impact from an intervention or other exposure.

20. Therapy – “In a population at risk for H1N1 influenza, does a new H1N1 vaccine (versus no vaccine) decrease disease rates?” Diagnosis – “In patients with a history of recent chest pains, does stress echocardiography versus cardiac catheterization diagnose coronary artery disease?” – “In patients with whom acute appendicitis is suspected, does CT scan, as compared with exploratory laparotomy, diagnose appendicitis? Prognosis – In patients with coronary heart disease, does an episode of CHF lead to reduced overall quality of life? Etiology/Harm – “In previously healthy children, does vaccination with MMR vaccine increase the risk of autism?” – “In adults, does cell phone use (versus no cell phone use) increase the risk of brain cancer?”

21. How to ask clinical questions PICO ______________ and _______________________ that is most appropriate to answer the question type.

22. EBM and HIT The concept of EBM is a strong commitment to the establishment of robust clinical information systems to help realized EBM commitments. – _____________________________ research-based knowledge in decision making – Developing HIT systems for _______________________ for __________________________________ the use of evidence – Promoting and facilitating ____________________________.