In an integrated healthcare world, a personal health record (PHR) provides a secure, patient-accessible destination for clinicians to deliver information to patients from an EHR or EMR. In a less-connected system, a PHR could become another silo of information or a dead-end repository of questionable clinical value. Much depends on how they're used and by whom. And the question still remains: Will people embrace them?
The demise of Google Health's personal health record (PHR) illustrates some of the hindrances to widespread adoption in healthcare—including wary physicians, patient privacy questions, a lack of patient engagement, quality information and integration issues. Still, clinical IT leaders who figure out a way around these obstacles are harnessing PHRs to get more information and boost patient satisfaction.
But, make no mistake, the end of Google Health's PHR should not be confused with the end of PHRs in general. Consider:
- Even before Google Health's sunset date was announced, the Bolivar, Mo.-based Citizens Memorial Healthcare, a five-facility healthcare organization serving nine counties across Missouri, had already planned to connect to Microsoft HealthVault as another PHR option. That should be ready to go live by the end of this year, says Denni McColm, CIO at Citizens Memorial.
- Sisters of Mercy Health System in Chesterfield, Mo., has seen an exponential increase in PHR users within three months. Following a marketing campaign in November 2010, the provider which serves communities across Arkansas, Kansas, Missouri and Oklahoma, saw a spike in PHR usage, from 10,000 to 140,000 users, according to Chris Davis, MD, physician informaticists at the Center for Medical Informatics.
If PHRs are providing an easy means for patients to access their records, pay bills, schedule appointments and/or refill medications in some organizations, what's the problem? There are several: First, patients can be as reluctant as physicians when it comes to using a PHR to engage in their own care. In fact, a mere 7 percent of survey respondents reported having ever used a PHR in a 2011 IDC Health Insights poll.
"The leading reason for not using a PHR was not being exposed to the idea [50.6 percent in 2011]," wrote Lynne A. Dunbrack, MBA, in the IDC report, released in March. The report, "Vendor Assessment: When Will PHR Platforms Gain Consumer Acceptance," was based on responses from approximately 1,200 consumers.
These results almost mirrored those of a 2006 survey from the same organization, where 7 percent of respondents reported ever having used a PHR. Close to 52 percent cited the main reason for not using one being because they weren't exposed to the concept (50.6 percent in 2011 and 51.9 in 2006).
Most PHRs are modules of hospital or physician websites (25 percent total) and health plan websites (21.4 percent), according to the 2011 report. Introducing patients to a PHR isn't the only challenge, either: Among the 7 percent who reported using a PHR in 2011, fewer than half (47.6 percent) are still using one to manage their family's health, the report notes.
For providers, the jury is out on the reliability of PHRs, says Matthew Wynia, MD, MPH, director at the Institute for Ethics and Center for Patient Safety at the American Medical Association in Chicago. Wynia and colleagues found that only 14 percent of 856 responding physicians reported using PHRs daily, in findings published in the February edition of Health Affairs .
"Many physicians are a little wary of using data sources they don't know," says Wynia. "In our research, [we found that] 79 percent of the physicians were concerned that a PHR might contain incorrect information. This was a prevalent concern among physicians, both willing and unwilling to use PHRs."
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Citizens Memorial initially had physicians who were reluctant to use them, but they were asked to give the PHR and portal a try, McColm says. "The piece the physicians interact with most is the portal, which they don't even realize, because it is so integrated," she says. Also, patient messages are present in the same way if the physicians came from the portal or a phone call. Likewise, medication refill requests are the same if they came from a pharmacy or from the portal. At Citizens Memorial, no providers have requested to disengage from either the portal or PHR.
Via the PHR, Citizens Memorial had some providers concerned about patients getting