As healthcare stakeholders weave their way toward the President's vision of providing every American with an electronic medical record by the year 2014, a growing number are taking the intermediate step of creating personal health records (PHRs).
Although PHRs lack a common definition and data set, stakeholders from every corner agree they have the potential to flip the healthcare paradigm for consumers.
When the Institute of Medicine released its landmark quality report in 2001, it identified 10 "design rules" for improving care: six of those depend upon directly involving patients in their care. PHRs are an essential way to encourage such involvement.
"We're definitely on the front end of the journey," explains C. Martin Harris, MD, chief information officer for the Cleveland Clinic, which offers its MyChart PHR.
Employers and the federal government have recently started getting in the PHR game:
Many consumers have maintained paper PHRs in file folders for years. In a July 2004 Harris Interactive online poll, 42% of respondents said they kept personal health records, nearly nine out of 10 in paper form. Unfortunately, paper records are fragile, and electronic PHRs are still on a slow track with content that varies depending on who maintains them.
A handful of provider groups, such as the Cleveland Clinic, and integrated systems, such as Kaiser Permanente, are making patient-friendly versions of their electronic medical records available. These provider-sponsored PHRs provide a depth of information. Unfortunately, because they are provider-specific, they lack information about treatment or medications a patient may be receiving from other providers.
The Kaiser Permanente and Cleveland Clinic PHR services enable patients to schedule appointments and renew prescriptions, which encourages patient use. Kaiser Permanente's My Health Record began rolling out in 2005 and so far has 1.3 million member accounts-about 25% of the total membership age 13 and up. In the Northwest region, where the service first began, the penetration is about 40%.
PHRs maintained by health plans are based on aggregated claims data. Plan-sponsored PHRs provide a broad range of information and enable patients to track their medical encounters across multiple providers. Plans are in a unique position to provide care coordination, notes WellPoint Chief Medical Officer Sam Nussbaum, MD.
"We have that central clearinghouse capability that no other entity has," he says.
For example, claims data might show that a patient visited 10 different doctors who prescribed 10 different medications, some of which might have dangerous interactions. A plan-sponsored PHR, such as the one offered by WellPoint could alert the member of a potential risk.
That said, plans can't provide members with complete information about all those encounters. In many cases a health plan's record may show a patient visited a doctor and he ordered a test but will not indicate the results of the test or what the doctor advised the patient to do. Similarly, although claims data may show a prescription for a medication was filled, it may not include specific dosage information.