1. © 2012 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Birds of a Feather PHR HL7 - Phoenix Tuesday, Q5 EHR/PHR WG John Ritter, Elaine Ayres, Tim Mckay

2. © 2012 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Agenda Introduction and Welcome High-level display of the new PHR-S FM functions for nutrition and physical activity The PHR and Mobile Health Nutrition, PHR, EHR, and Mobile Devices -- The Future is Now! Q&A, Status, Issues, and Next Steps 01/01/2011 2

3. © 2012 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Description of the Nutrition and Diet Information Section Nutrition is related to health and wellness as well as chronic diseases. People want to record and monitor their food and nutrient intake including any nutritional supplements because they are trying to manage their weight, maintain their fitness level, or demonstrate progress towards the goals in their nutrition care plan. 01/01/2011 3

4. © 2012 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Examples of Nutrition & Diet Information Food and nutrient intake records Liquid nutrition supplements (nutraceuticals) Enteral and parenteral feedings Vitamin, mineral and herbal supplements History of breastfeeding Diet recommendations provided by a Registered Dietitian Tracking information such as weight, height, and Body Mass Index (BMI) Food allergies and intolerances Physical activity records 01/01/2011 4

5. © 2012 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Criteria 1 1a. The system SHALL provide the ability for the PHR Account Holder to manage information regarding the PHR Account Holder's nutrition and/or diet. 1b. The system SHALL provide the ability for the PHR Account Holder to manage concerns (either self-generated concerns or concerns that were expressed by others) that relate to the PHR Account Holder's nutrition and/or diet. 01/01/2011 5

6. © 2012 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Criteria 2 2a. The system SHOULD provide the ability for the PHR Account Holder to capture his or her nutrition and diet information (specifically, current intake of foods and/or nutrients). 2b. The system SHOULD provide the ability for the PHR Account Holder to capture his or her nutrition and diet information (specifically, past history of intake of foods and/or nutrients (e.g., anorexic during teenage years; vegetarian from age 5 to 10). 2c. The system SHALL provide the ability for the PHR Account Holder to import diet and nutrition -related data from a provider's EHR system or from other sources (e.g., diet-related instructions from a provider; diet-related orders; or diet-related information that appears on an assessment). 01/01/2011 6

7. © 2012 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Criteria 3 3. PHR system SHOULD allow for entry and tracking of nutritional supplements, multivitamin and herbal products as discrete data or lists. Question – should this be merged with other medication functionality? 01/01/2011 7

8. © 2012 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Other Criteria Analyze drug-herb interactions and render a notification or alert Analyze and render nutritional information by calculating nutrient values for items or total daily intake summaries Exchange food intake information and/or nutritional analysis data with third-party applications Capture, maintain, and render physical activity information including total workout data Capture, maintain, and render educational information 01/01/2011 8

9. © 2012 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Use Case 1 The PHR-S maintains a food and nutrition history list that may be followed by the PHR Account Holder and referenced by his or her providers and Registered Dietitians. Copies of the PHR food and nutrition history list may be kept by their providers in their EHRs. 01/01/2011 9

10. © 2012 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Use Case 2 The PHR-S maintains a list of nutrition and diet-related information including food intake records, nutrient analysis summary records, energy balance data and nutrition care recommendations. This list may be followed by the PHR Account Holder and referenced by his or her providers including a Registered Dietitian 01/01/2011 10

11. © 2012 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. The PHR and Mobile Health The PHR/Mobile Gap Analysis Sub-group was established to determine the extent of changes needed in the PHR-S Functional Model to accommodate the use of mobile devices within the model. Scope:  Review recently balloted PHR-S functional model to determine how the introduction of mobile devices as actors within the model may result in changes to the model.  Make specific recommendations to the PHR-S functional model in terms of additional conformance criteria and/or creation of a mobile-specific profile for the PHR-S. 01/01/2011 11

12. © 2012 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. PHR/Mobile: Completed Work The team has generated a bulleted list of issues to use in determining the need for changes to the PHR-S. Items fall into three overlapping categories  Device characteristics (location services, camera, accelerometer, screen size)  Device context (location of use, BYOD, destination vs. conduit)  User actions (shared devices, device misplacement)

13. © 2012 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. PHR/Mobile: Next Steps Review the PHR-S Chapter 3 conformance criteria to determine need for new/updated criteria. Consider the need for a mobile-specific PHR-S profile in light of the Chapter 3 review.

14. © 2012 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. The PHR and Mobile Applications 01/01/2011 14 Mobile optimized page vs. mobile application 85% of US adults own a cell phone – of those 53% own smart phones

15. © 2012 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. What if……… Your smart phone is your PHR?  Utilize various applications  Collect data (or information) from various apps and transfer to the mobile PHR  PHR then provides reminders, suggestions or calculations  PHR enables transfer to other systems 01/01/2011 15

16. © 2012 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. How Many Apps? According to MobileWalla (this morning)  13,110 Health Apps  475 Diet and Nutrition Apps  3534 Exercise and Physical Activity Apps  574 PHR Apps!! My Fitness Pal has over 30 million users 19% of all smart phone users have a health app and of those exercise, diet and weight apps are the most popular (Pew Internet) 11/12 01/01/2011 16

17. © 2012 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Mobile Phones Phones – texting reminders like Text4Baby Low and Middle Income Countries (LMIC)  Often mobile phone only source of information  Use for notifications  Use for reminders 01/01/2011 17

18. © 2012 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Smart Phones Weight Management Use Case  Establish a goal for weight and body mass index in the weight management app Record weight data on a weekly basis NOTE: may use a smart scale to provide weight data directly to app  Record daily food intake in a “diet” app Monitor daily caloric intake  Collect data in PHR (or PHR app)  PHR provides educational information on weight loss tips and behavior modification 01/01/2011 18

19. © 2012 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Smart Phones Shopping Use Case  A Diabetes management app develops a shopping list with suggested foods  An embedded bar-code reader captures all of the foods purchased  A list of foods purchased is recorded and sent to the PHR  The Registered Dietitian reviews the list of food purchased as a way to monitor compliance 01/01/2011 19

20. © 2012 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Smart Phones Vitamin/Mineral/Herbal Supplement Use Case  A supplement tracking app records use of vitamins, mineral and herbal supplement use  The list of compounds used is added to the PHR  The PHR sends the list to the EHR  Prior to upcoming surgery, patient notified to discontinue herbal supplement use based on adverse impact on anesthesia 01/01/2011 20

21. © 2012 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Smart Phones Physical Activity Use Case  Physical activity app measures daily exercise routines  Point of care testing for blood glucose tracks daily blood sugar levels  Data is transferred to PHR  PHR correlates and graphs relationship of exercise in managing blood glucose levels 01/01/2011 21

22. © 2012 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. Smart Phones Allergy and Intolerance Use Case  Junior eats some nuts at home and develops a rash around his mouth  Mom takes a picture with her phone and sends to her PHR app  Mom heads to the emergency room where an allergy to nuts is added to Junior’s allergy list  The allergy list is then updated in the PHR and includes the associated reaction photo 01/01/2011 22

23. © 2012 Health Level Seven ® International. All Rights Reserved. HL7 and Health Level Seven are registered trademarks of Health Level Seven International. Reg. U.S. TM Office. In Closing…. Q and A Status of project Next steps 01/01/2011 23