Personal Health Records: A Vital Element of Patient-Centered Care

Providers and patients have been slow to adopt the use of personal health records.

An evidence-based study published in September 2013 in the Journal of Patient Safety estimated between 210,000 and 440,000 patients per year received hospital care that resulted in preventable harm that contributed to their deaths.¹ That frightening analysis makes medical errors the third leading cause of death behind heart disease and cancer at 611,105 and 584,881, deaths, respectively.² The article concluded that this epidemic should be addressed, in part, by “fully engaging patients and their advocates during hospital care, systematically seeking the patients’ voice in identifying harms…”¹

Personal health records (PHRs) can help address some of these concerns. Simply stated, a PHR is a repository of historic medical and health care information specific to a particular patient. In its simplest form, a PHR could be accomplished using a paper-based archive of an individual’s medical history; however, the digital revolution brings with it many advantages to the capabilities of PHRs.

Digital PHR solutions can be stored on localized devices (computers, hard drives, etc) or can be cloud-based. Regardless of the format, a PHR can provide a valuable repository and resource for an individual’s relevant health care information. As such, a PHR would contain the patient’s contact information and physical metrics, as well as a range of health care data including, but not limited to:

• Family history
• History of illnesses, accidents, surgeries, and hospitalizations
• Vaccinations
• Listing of allergies and known drug reactions
• Blood and laboratory results
• Prescription records
• Imaging reports
• Miscellaneous notes (eg, exercise, alcohol, or smoking history) relevant to the patient’s health

Digital PHRs go beyond being a simple, yet valuable archive of historical medical information. A digital PHR solution, coupled with analysis through computational processing and connectivity to large databases, has the potential to provide health care professionals with a breadth and depth of timely insights previously not available. With such capability, digital PHRs can help assess a person’s health profile, identify potential issues with drug interactions, assess comorbidities, compare care plans, and highlight health gaps and recommend treatment plans, which can be referenced to the health care professional’s expertise.

Additionally, many digital PHRs offer improved communications between the patient and the medical staff through e-mail and include convenient functionalities, such as the ability to set alerts based on deviations in patient metrics for blood pressure (BP) or blood sugar. Many of these platforms allow for scheduling appointments, receiving reminders, and requesting prescription refills. All of these advantages can significantly improve response time, provide comfort and convenience to patients, and eliminate trips to meet face to face with the physician. Furthermore, in the case of a medical emergency, access to a PHR can provide the emergency responder with valuable information to quickly assess a situation and determine treatment.

Although there is no legal mandate that compels a consumer or patient to store their personal health information in a PHR, having such information available in 1 place could be a significant time-saver and provide valuable information to caregivers. Realizing the advantages of PHRs, dozens of large and small companies have developed PHR solutions. Somewhat surprisingly, though, and despite the ostensible benefits outlined above, PHR solutions have been slow to be adopted by patients.

Even Google experienced a slow patient adoption rate for a PHR solution they introduced in 2008. Google Health was a free service that allowed the public to create their own PHRs and enter data either manually or automatically by signing in to their provider’s online electronic health record (assuming the provider was one of the organizations that allowed data sharing with Google Health). Once the history was entered, Google Health would then provide the person with possible interactions between drugs and health conditions. Due to a lack of widespread adoption, Google discontinued the service in 2013.

Microsoft also launched its own web-based PHR solution, HealthVault, in 2008. The solution offers a multitude of functionalities, including allowing an individual to track their medications, health history, vital metrics (eg, BP), fitness, and allergies, and to store their imaging files. The service is available as a free mobile app.

Apple is also now participating as a data collection point for fitness and health data. Its product, “Health,” allows for the ingestion of data from a variety of wearable fitness devices—including devices that monitor heart rate, calories burned, BP, blood sugar, and cholesterol levels—and displays that information graphically in a dashboard.

The many benefits to having a digital PHR solution include:

• All medical records are consolidated and stored in 1 place.
• The records can be readily backed-up.
• Consolidating various file types, thereby allowing storage of x-rays, magnetic resonance imaging, and ultrasound results and video in 1 location.
• Access to patient health information that is easily searchable and navigable. Having access to the patient history helps the clinician make better treatment recommendations and plans.
• The files are easily sharable, allowing patients to share their history with a new physician or caregiver. Additionally, patients can submit their data to the electronic health record of a health care provider.
• Electronic PHRs allow for analysis through comparison of both an individual’s history with current best medical practices and care plans and their medications against a database of drug interactions. This helps reduce errors in diagnosis and treatment plans.
• Patient illnesses and outcomes can be tracked over time, and health care professionals can be alerted to deviations in status.
• Two-way communication between the patient or caregive, and the health care professional is improved via e-mail or messaging. Scheduling and reminders are also easily accomplished with some PHRs, thereby saving significant travel, wait, telephone, and one-on-one time. Such capability greatly eases the process for questions and answers, and provides a historical reference.

Challenges

Perhaps not surprisingly, privacy remains the chief concern regarding digital PHRs. Hacking into networks is not uncommon. The threat of accessing and revealing highly personal information, including history of disease, surgical procedures, medications, and physiological disorders, is a real issue. Such a breach of confidentially is not only limited to hackers, but anyone with even peripheral access to the records, such as is the case when access is granted to providers in support of primary caregivers. Record maintenance is another challenge, as the systems require updating with each new medical or health-related incident.

Conclusion

Significant progress has been made with PHR platforms as a result of the digital technology revolution. Computers allow for the rapid analyses of conditions, treatments, and medications; data storage has decreased in cost to the point where it is essentially free; user interfaces have evolved to be increasingly intuitive and easy to use; and Internet connectivity is ubiquitous and fast.

Despite these advantages, obstacles remain to its widespread adoption, including the issues of security and accepted standards for data exchange between a provider’s medical records and a patient’s PHR. However, there is no doubt that these hurdles will be resolved in time.

Beyond the convenience of having an individual’s medical records archived in 1 accessible and readily (and securely) shareable location, next-generation PHRs promise to significantly improve on current patient outcomes. As PHR solutions improve and are connected to vast diagnostic and drug information databases, as well as to data on aggregated patient populations, autonomous software will allow for rapid diagnoses and treatment recommendations. All of this will greatly assist medical providers, speed diagnostic times, eliminate errors, and dramatically improve patient outcomes.

As is the case with any technological innovation that promises to impact the world, the existing practice will likely persist until the benefits clearly outweigh both the disadvantages and human inertia. However, once that tipping point is reached, widespread PHR solution adoption will ensue and usher in a new era in health care.

Thomas Triumph, MBA, is a hands-on technology executive who helps large organizations act more nimbly in the market and small companies scale. Leading marketing and business development, he has launched numerous technology products and led cross-functional teams, including participating in 2 technology revolutions: less-invasive medical devices and the Internet/software. Tom founded a consumer electronic company and has worked for leading companies to help launch and lead medical device products, software, software as a service (SaaS) models, Internet companies, professional consulting services, and a 25-ton hovercraft built entirely from composite materials.

References

• James JT. A new, evidence-based estimate of patient harms associated with hospital care. J Patient Saf. 2013;9(3):122-128. doi: 10.1097/PTS.0b013e3182948a69.
• Leading causes of death. Centers for Disease Control and Prevention website. www.cdc.gov/nchs/fastats/leading-causes-of-death.htm. Updated February 6, 2015.