A personal health record (PHR) is a universal tool that consists of a comprehensive database of an individuals health documents. Personal health records are available in a variety of platforms, such as paper, the internet, personal computers, and portable devices. This paper describes the contents included in a personal health record as well as the steps to putting together a personal heath record. The advantages of having a personal health record can be a life saver. Patients can control their own health records and play a proactive role in better managing their personal health care information. Several concerns remain an issue with personal health records, issues such as security and privacy, costs, and lack of standardization.
Have you ever wondered what to do with all your immunization records or old medical records you collected over the years and have stuffed away in a multiple places throughout your home? That is because until recently, individuals didn’t have a place to properly store their personal medical records. Everyone has a different system of how they maintain their personal health records, from an old shoe box, to “the special drawer” or the over stuffed file folder. There are several problems associated with these kind of record keeping practices. First of all, they are not safe or secure in the event of theft or fire. Secondly, it is difficult to manage your health from a file folder. Papers documents collected over a persons lifetime can be enormous, especially in the event of a long term illness. It is a daunting task to gather up all your paper documents saved over the past several years and present them in one big disorganized pile to a health care
worker and expect them to sort it out.
Because of the demands in healthcare and on healthcare workers, there has been an recent surge in the area of personal health records development. Several companies and
researchers have developed simple and creative ways for individuals to maintain their personal health records, in addition to easily integrating their records into clinical healthcare systems. A personal health record is a way that individuals can gather all there medical information and place it into one safe and secure place. Personal health records are a gathering of an individuals medical data from several different sources and making them readily accessible in one or another format when needed. Sources where one might collect medical information are: clinics, multiple doctors offices, laboratories, pharmacies, radiology departments, hospitals, insurance companies, and the military, etc. Not to confuse anyone, but a personal health record or a electronic personal health record is not the same as a electronic health record. A personal health record is used by an individual and they control who can see or use the information in it. Other people, such as their doctor, may be able to add information to it. An electronic health record is used and controlled by health care providers. Electronic health records may be stored at a doctor’s office, a hospital, an insurance company, or an employer. (“NIH Medicine Plus,” pgs. 16-17) Electronic health records are legally mandated notes on the care provided by clinicians to patients. There is no legal mandate on personal health records.(Wikipedia, n.d) Creating an comprehensive personal health record can be life saving for several reasons. One reason being, in the case of an emergency, medical personal need accurate up to date data in order to provide an individual with the most proficient care available. For example, for the first time in history at any mass gathering, many of the people’s personal electronic health records were instantly, securely available to medical personnel at the world-famous Indy 500 motor race. The Indianapolis Motor Speedway’s Clarian Emergency Medical Center had access to those
records, thanks to the Indiana Network for Patient Care (INPC). The data
include admission and discharge notes, lab test results, and other critical information. A personal electronic health record is medical information about an individual that is stored in secure digital form on a computer or a network of computers. The goal of many in the health-care field is to have that information available instantly to health professionals wherever you are—even at The 500. (“NIH Medicine Plus,” pgs. 16-17)
Putting together a personal health record is a great way to take control of your health. A Personal health record is initiated and maintained by an individual. From using something as simple as a notebook, a file folder, or buying a program or using a password protected website, creating a personal health record is becoming more readily available than ever before. Web sites such a Google Health or Microsoft Health Vault are just a few of the many web based companies cashing in on the personal health record market. Most of these web sites provide secure password protected access to some health insurers, pharmacies, and providers so you can request and upload your records, saving yourself some work. Some of the tools found on these web sites can help track and record your progress towards your health goals, such as weight loss and nutrition. Keeps track of doctor visits and information to share with your doctor, such as blood sugars, cholesterol, and blood pressure since your last appointment. Electronic personal heath record websites help to diminish the hassle of scheduling appointments, submitting insurance claims, ordering prescriptions or refills by automatically doing it for you. Additional tools include monitoring devices such as a pacemaker check or blood sugar/insulin calculator to ordering prescriptions.
Flags recent medication or discharge instructions from your last visit. Costs may vary depending on the type of personal health record being used.
Using a computer based personal health record can be as easy as checking your e-mail. Personal health records are offered by a variety of sources—employers, insurers, healthcare organizations, and companies that aren’t in the healthcare arena. Kaiser Permanente said in April that more than 3 million of its 8.6 million members use its My Health Manager system to access their records, make appointments, look at lab results, and order
prescriptions.(Hobson, 2009) PHRs can contain a diverse range of data and may include information such as: 1.Name, birth date, blood type
3.Primary caregiver(s)/phone number
4.Medicines, dosages, and how long taken, including over the counter and herbal remedies 5.Allergies/adverse drug reactions
6.Date of last physical
7.Dates/results of tests and screenings
8.Major illnesses/surgeries/procedures and their dates/hospitalizations 9.Chronic diseases
10.Family illness history
12.laboratory test results
14.Activities of daily living
15.Health insurance information
16.Spiritual or Religious Preferences
What not to include in your personal health record:
1. your social security number
2. home address
3. telephone number
Use caution when placing your personal information on the internet. Using information that identifies you too closely can lead to identity theft, even medical identity theft. Medical identity theft is when someone steals your insurance information and makes medical appointments in your name and orders prescription medications. Reports cite 200,000 cases of medical identity theft each year. (Torrey, 2010)
One advantage to using a web-site for posting your PHR is having the ability to access your medical records from almost anywhere, anytime, as well as helping keep your records updated and current. Using a PHR helps to eliminate duplicate tests, which saves both time and money. In addition,
instead of waiting for the usual 7-10 days for lab results to be mailed to you, systems can automatically upload the information to the PHR once they become available. Not only does this help with patient satisfaction, but is an enormous savings on mailing and handling costs. One of the obstacles and concerns of creating a personal health record is security and
privacy of individuals records. Many consumers wonder whether their health information is kept private and secure in an electronic health record system. There are several PHR web providers that would love nothing better than to sell your information to advertisers. Although there are several good programs, consumers need to use caution when selecting an online program. Most companies use encrypted programs to protect unwanted and unauthorized access to an individuals personal health records.
Many individuals continue to use paper records for their personal health records. However, with the invention of modern computer record keeping programs, paper records may not be as effective for the care of individuals with chronic illnesses. Some individuals have a long history of medical problems and have accumulated volumes of paper medical records. Paper records are not readily available at multiple locations at once and often present with an inconsistently of information. An individual with a chronic illness may benefit from transferring their paper records into an electronic personal health records program, which will aid in improving their continuity of care and efficiency. Many personal health care programs offer services that will help guide individuals on the how to of scanning and uploading their paper records into the program. Another benefit to using an electronic program is having your personal information formatted into a standard reporting structures for charting and sharing information and making it easier and faster for healthcare workers to review medical history and treat an individual. For example, a doctor can order a test for a patient and have the results transmitted to a their PDA and in turn can review the patients medical information and order further tests, medications and treatments at their convenience. This not only saves time for the patient, but
frees the doctor from making frequent trips to the various locations to see patients or review results of tests. The results are then immediately uploaded into the patients personal health records. (Mohammod, 2009) For example, a newly diagnosed insulin dependent diabetic may have concerns with the dosages of their insulin and sliding scales plus managing their diet. Tools included in some of the personal health record programs will smooth the progress of mapping out a diabetics progress as well as offering a plethora of educational sites and suggestions and feedback, including alerts being sent to the physician or nurse if their blood sugar enters into a dangerous zone.(SentinelNewsService, 2009)
Nursing related issues and Personal health records are becoming more challenging then ever before. As progress towards digitizing healthcare evolves, nurses are caught in between the paper documentation to electronic documentation chaos. Nurses must play an proactive role in educating themselves to the variety of personal health record information that is readily available for their patients. Many patients are unaware of the services available to them and a healthcare provider must often help inspire their patients along their personal journey of creating a personal health record. Moreover, a nurse that is proactive with helping patients with their personal health records, will also encourage a patient to healthy behaviors, by teaching patients how to use tools to keep track of their health progress, such as weight loss and diet control. Encouraging a patient to keep better track of their healthcare records will be invaluable for patients with chronic illnesses. Providing up to date information in one document to a health care provider not only saves time and money, but assists the health care provider in providing safer and improved quality of care as well as a better way of communicating with their providers. As a nurse, it can
be very frustrating taking a health history on a patient with a chronic illness with a long list of medications. Often, patients are poor historians or don’t remember the name of a drug or dosage. Nurses can spend well over an hour just gathering information about the patients history before they can begin to treat the patients problem. It is always a welcoming sign of
relief when a patient produces an itemized list of all their medications and dosages as well as their past medical history. The time spent gathering all the patients information could be better spent on giving more personal care to the patient as well as the other patients in the nurses care.(Sensmeier, 2010, p. 47-50)
Physicians have their own issues and concerns related to personal health records. First of all, most physicians are mostly interested in providing safe, resourceful and revenue producing care. Physicians are slow to adapt to change and it is difficult to convince a physician to use a service for something that may not produce results for many years. Personal health records are in their infancy stages and are only a hand full of individuals are utilizing the services. Physicians as well other medical personal may not be educated on personal health records and are not obligated to review or edit or manage these type of records. However, once a document from a patients personal health record is imported into an Electronic medical record, the physician is then responsible for reviewing such data. Physicians are then responsible for maintaining the accuracy of the data exported to the patients personal health record. Another concern is the issue of compensation. How are physicians going to be compensated for their time spent on training, implementation, updating and creating documents for PHR? Also, covering the costs associated with the hiring of new staff that will be needed to head such a plan, as well as purchasing the
required equipment and software that will be used to interface with larger networks?(“American College for Physicians,” 2006, p. 1-2)
Personal health records have a direct impact on the role of the nursing informatics specialist. One of the roles of a nursing informatics specialist is reviewing, analyzing and coordinating new applications across departments and determine how the new applications will best fit into a healthcare system effectively. One of the biggest concerns of any healthcare system is cost, the cost of a new program or application must be carefully scrutinized by the nursing informatics specialist as well as other personal within the healthcare system before being accepted into the system. Several questions that arise from the nursing informatics specialist may include:
3.Broad-spectrum cohesiveness throughout the system
4.Better workflow processes
7.Implementation and Development
9.Troubleshooting and training
A key concern to most healthcare systems is the inevitability of employing such systems. Healthcare systems will eventually be forced into implementing such programs. The future of healthcare is rapidly becoming more digitalized and will be dictated by the consumers demands and systems that can better accommodate such demands. The next generation of computer savvy consumers and evolving healthcare technologies is on the forefront of nursing informatics specialists agendas.
Nursing informatics specialists are scrambling to keep up with technology and developing savvy ways of keeping up with current trends in healthcare. Currently, there is very little data related to the purchasing costs of commercial PHR applications which presents a problem to the NIS. Not only is PHR a cost concern problem, but anytime a new product as enormous as PHR applications are lingering over a health care systems head, it becomes a system wide concern because the future is so unpredictable and health care systems can’t afford to spend millions of dollars on the implementation of such systems and then the system becomes obsolete within a year after implementation. A nursing information specialist’s input is critical in healthcare systems decision making process.
Every day you hear of a new process or a new policy related to healthcare. Nursing information specialists are fairly new to the healthcare scene and
are instantaneously being propelled into unfamiliar and never heard of areas of healthcare. A NIS must hold on tight to their game hat and be prepared to handle the roller coaster ride of the unpredicted future of healthcare technology. (Shah, Kaelber, Adam, Pan, Middleton & Johnston, 2008)
The standardization of personal health records is an ongoing concern among consumers and the healthcare industry. There are many standards, open specifications, and efforts toward standardization of PHR information, and services. Many organizations are actively working to improve and support the exchange of medical record information.(“Records for Living,” 2010)
Because there is not set standard among PHR vendors and health care organizations, the present recommendation is to adopt data content and exchange standards that are based upon standards accepted for EHRs, as a way of improving the interoperability of the systems. In addition, it is important for consumers to understand the privacy policies and practices of PHR vendors and health care organizations and who may have secondary access to their personal information. Also, these agencies should address any language barrier issues preventing the consumer from fully understanding the agencies practices related to security and privacy. Since HIPPA does not cover all PHR systems, consumers should be provided a complete outline of the uses of their PHR data and not covered entities should voluntarily adopt to strict privacy policies and practices. No health information provided to a PHR agency should be used without the expressed consent or authorization of the consumer. (US dept. of Health and Human Services, 2010)
President Bush and Secretary Leavitt have put forward a vision that, in the Secretary’s words, “would create a personal health record that patients, doctors and other health care providers could securely access through the Internet no matter where a patient is seeking medical care.” (US dept. of Health and Human Services, 2010) Before those famous words can be put into effect, there first, must be a global standardization and recognized language. Currently,
there is no uniform definition of “personal health records”, therefore making
collaboration and policy-making difficult. The following aspects of PHRs can vary:
1.what information is allowed on a PHR
2.secure and reliable sources of the information
3.features and functions offered
4.custodian of the record
5.storage location of the contents
6.authorized access to records and security standards
Additionally, organizations will continue to discover gaps during the development phases of PHR, by collecting data and information, agencies can make recommendations and respond with appropriate action.
Providing readily accessible, safe and reliable data through secure systems of communication will help to better serve consumers, patients, healthcare workers and federal and public agencies, and others far more effectively. However, there is a general concern for the underserved populations. There are several areas of the country that do not have access to such systems or have the resources or funds to purchase such systems. Also, there are educational barriers to consider in relation to health literacy issues which could limit the use of PHR systems in these underserved populations. With so many people out of work and living on welfare, there are far greater concerns than having a PHR. Many people are only concerned with their basic survival and having enough resources to provide a meal or heat to their families. The government would need to provide assistance to the underserved if this was required of them.
In conclusion, as a nurse and a potential consumer, I am in favor of a electronic personal heath record and do think the pros of such systems outweigh the cons, especially in the case of
the chronically ill. I do, however have many concerns with PHRs. As a nurse, it would be difficult to rely on data presented in a electronic personal health record unless I was able to verify the information with a physician
treating the individual or a family member. I can see how easily an individual may inadvertently enter the wrong medication into their personal health record. A simple slip of the key may change a medication entered as a diabetes drug Amaryl instead of an Alzheimer’s medication called Reminyl. Pharmaceutical companies are working hard to prevent medications from being named something similar to other drugs currently on the market, but there have been several reported deaths due to medication errors.
It should be required that a government monitoring agency be in charge of overseeing the content being entered into PHRs as well as protecting consumers from becoming the victim of targeted marketing scams or identity theft. Too often we hear of these things happening to unknowing victims and unfortunately most of these victims are the elderly, which will more than likely be one of the biggest consumers of this kind of service. The government will also need to set standards for protecting consumers, otherwise, if consumers are being victimized on these kind of systems, PHR could potentially suffer harm and loose the trust of consumers. The widespread adoption of PHRs will not happen until consumers are confident with their personal records being adequately protected.
I think it is important to get consumers and patients more involved in their own healthcare. And one of the first steps is learning how to create their own personal health record. Not only can they learn to create their own PHR, but they could get there family and friends involved as well. Using an Internet-based PHR system allows for multiple individuals, such as family members and caregivers to contribute patient information from multiple locations. For
example, a sibling that lives out of town may have the access to update their parents health information and also share the information with another sibling who lives out of town and both collaborate on the information provided. This allows for continuity of care in the event of an illness and the sibling is not directly available to be at their parents bedside.
The personal health record will play a key role in motivating the consumer
or patient to a safer, more efficient form of healthcare. Because personal health records are still in their infancy stages, there remains a great deal of concern for the safety and security for the users personal information. Once these concerns are addressed and “idiot- proofed”, consumers and health care facilities may buy into it.
Personal health care records are designed to help individuals better organize their health care records by placing all their documents into one easily accessible format. This kind of application can be a life saver. Having all of a patients up to date information available for healthcare personal to review in one easy to read format may make the difference between life and death in some cases. Quickly identifying drug allergies, medications, health history is all a part of the vital information needed in the case of any emergency. There is a myth among most consumers, most consumers believe that emergency rooms should have access to their medical records in the event of a crisis and the truth is, they don’t. Many patients see several doctors from a variety of locations and emergency rooms don’t have immediate access to all of a patients medical information. A personal health record not only allows you to share information with health care providers at multiple locations, it also empowers the consumer or patient to better manage their own health goals. Building a health record takes a considerable amount of time and effort. You have to collect all your past medical documents and manually enter them into a PHR platform of your choice. After that, it is as simple as scanning or faxing in a document or entering the information manually into a system after each visit to the doctor, or test, which keeps your medical records current and updated.
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