Articles
8/9/2009 CNN Health care's big money wasters More than $1.2 trillion spent on health care each year is a waste of money. Members of the medical community identify the leading causes. That's half of the $2.2 trillion the United States spends on health care each year, according to the most recent data from accounting firm PricewaterhouseCoopers' Health Research Institute. What counts as waste? The report identified 16 different areas in which health care dollars are squandered. But in talking to doctors, nurses, hospital groups and patient advocacy groups, six areas totaling nearly $500 billion stood out as issues to be dealt with in the health care reform debate. Too many tests Doctors ordering tests or procedures not based on need but concern over liability or increasing their income is the biggest waste of health care dollars, costing the system at least $210 billion a year, according to the report. The problem is called "defensive medicine." "Sometimes the motivation is to avoid malpractice suits, or to make more money because they are compensated more for doing more," said Dr. Arthur Garson, provost of the University of Virginia and former dean of its medical school. "Many are also convinced that doing more tests is the right thing to do." "But any money that is spent on a patient that doesn't improve the outcome is a waste," said Garson.
6/2009 Personal health record: A tool for managing your health A personal health record makes it easy to gather and manage your medical information in one accessible and secure electronic location. If you're like most people, you have a number of health concerns and visit multiple doctors and pharmacies. Keeping track of it all is challenge. With a personal health record, you can gather — and manage — all that information in one, easily accessible location. What is a personal health record? A personal health record is simply a collection of information about your health. If you have a shot record or a box of medical papers, you already have a basic personal health record. And you've probably encountered the big drawback of paper records: You rarely have them with you when you need them. Electronic personal health record systems — often called PHR systems — remedy that problem by making your personal health record accessible to you anytime via a Web-enabled device, such as your computer, phone or PDA. Personal health records are not the same as electronic health records (EHR) or electronic medical records (EMR), which are owned and operated by doctors' offices, hospitals or health insurance plans. Unfortunately, not many doctors' offices use these systems yet and those that do often limit your access to and control of your medical record. What information goes into a personal health record? You decide what you put in your personal health record. In general, though, it needs to include anything that helps you and your health care providers manage your health — starting with the basics: Your primary care doctor's name and phone number Allergies, including drug allergies Your medications, including dosages Chronic health problems, such as high blood pressure Major surgeries, with dates Living will or advance directives You can also add information about what you're doing to prevent disease, such as: Results of screening tests Cholesterol level and blood pressure Exercise and dietary habits Health goals, such as stopping smoking or losing weight What are the benefits of a personal health record? Having a personal health record can be a lifesaver, literally. In an emergency you can quickly give emergency personnel vital information, such as a disease you're being treated for, medications you take, drug allergies, and how to contact your family doctor. A personal health record not only allows you to share information with your care providers but also empowers you to manage your health between visits. For example, a personal health record enables you to: Track and assess your health. Record and track your progress toward your health goals, such as lowering your cholesterol level. Make the most of doctor visits. Be ready with questions for your doctor and information you want to share, such as blood pressure readings since your last visit. Manage your health between visits. Upload and analyze data from home-monitoring devices such as a blood pressure cuff. And remind yourself of your doctor's instructions from your last appointment. Get organized. Track appointments, vaccinations, and preventive or screening services, such as mammograms. Are there any drawbacks to personal health records? Building a complete health record takes some time. You have to collect and enter all your health information. Plus, you have to keep your record current by updating it each time you see a doctor, fill a prescription, have a test or go to the hospital. Why isn't there an easier way? Because doctors and hospitals have been slow to adopt information technology. So only a minority of doctors' offices and hospitals can send information electronically to your personal health record. Even if your doctor can send information to your personal health record, you need to review whatever is sent. The process of transferring health data electronically is still in its infancy — and it isn't always perfect. For instance, information drawn from insurance billing records is sometimes incomplete or imprecise. Will the information be kept private? Perhaps the most common concerns about personal health records are about privacy and security. To address these concerns, reputable PHR systems follow industry best practices, such as making their privacy policies public and submitting to monitoring by independent organizations. Also, 2009 legislation directs the federal government to strengthen rules governing the security of health information held by PHR systems and related entities. Where do I start? As with any decision about your health, do a little research before you jump in. When you're evaluating your options, consider these questions: Is the system easy for me to use? Can I enter all the information I want to track? How will my information be kept private? Will information be added to my record from outside sources, such as insurance or doctors' offices? How and what will be added? Can I correct or delete information in my record? Can I share information with my doctor and other caregivers? Can I upload data from home-monitoring devices, such as a peak flow meter or blood pressure cuff? What will it cost? Are there any special fees? Will it help me manage my health by providing information and advice? Can I create an account for my whole family and manage information for my family members? Putting it all together. As important as it is to gather your health information in one spot, you won't achieve the full benefits unless you proactively use the information to manage your health. To help you to do that, Mayo Clinic has created Mayo Clinic Health Manager, which is powered by Microsoft HealthVault. "Mayo Clinic Health Manager extends the capabilities of traditional personal health records and uses your information to provide customized recommendations, so you can better manage your health and your family's," explains Sidna Tulledge-Scheitel, M.D., a primary care physician at Mayo Clinic and medical director of Mayo Clinic Global Products and Services. Mayo Clinic Health Manager generates reminders and recommendations specific to each family member's life stage and health status. And as you enter more personal health information, Mayo Clinic Health Manager delivers more specific and customized recommendations. So, for example, Mayo Clinic Health Manager might recommend getting a pneumococcal immunization and annual influenza immunization if you have asthma. Go ahead, take control. Are your ready to take the next step in managing your health — and your family's? If so, drop the paper shuffle and give technology a go. Create your electronic personal health record and start seeing what it can do for you. Original Article:http://www.mayoclinic.com/health/personal-health-record/MY00665 Raisinghani MS, et al. Personal health records: Key adoption issues and implications for management. International Journal of Electronic Healthcare. 2008;4:67. Personal medical records. National Library of Medicine's MedlinePlus. http://www.nlm.nih.gov/medlineplus/personalmedicalrecords.html. Accessed April 16, 2009. Konrad W. A halting start to electronic health records. New York Times, April 18, 2009. http://www.nytimes.com/2009/04/18/health/18patient.html. Accessed April 18, 2009. Tulledge-Scheitel S (expert opinion). Mayo Clinic, Rochester, Minn. April 21, 2009. My personal health record? MyPHR.com. American Health Information Management Association. http://www.myphr.com/what/why_keep.asp. Accessed April 17, 2009. Conn J. FTC takes on bigger role to protect PHR privacy. Modern Healthcare.com. http://www.modernhealthcare.com/article/20090417/REG/304179997/1153. Accessed April 17, 2009. Tang PC, et al. Personal health records: Definitions, benefits, and strategies for overcoming barriers to adoption. Journal of American Medical Informatics Association. 2006;13:121. Helping consumers select PHRs: Questions and considerations for navigating an emerging market. American Health Information Management Association. http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_032260.hcsp?dDocName=bok1_032260. Accessed April 28, 2009. Survey of health care consumers, 2009. Deloitte Center for Health Solutions. Accessed April 28, 2009. Tang PC, et al. Your doctor's office or the Internet? Two paths to personal health records. New England Journal of Medicine. 2009;360:1276.
12/2008 Electronic Records Are Key to Health-Care Reform BusinessWeek reader William Yasnoff says Obama must make electronic medical records a top priority in his economic stimulus plan By William A. Yasnoff, M.D., PhD The current worldwide financial crisis is transforming the problem of rising U.S. health-care costs into a dire threat to our entire economy, making health-care reform an increasingly urgent priority. Any potential approach to restructuring health care must include universal electronic medical records so that both patient care and policy decisions are fully informed. In his weekly address to the nation on Dec. 6, President-elect Barack Obama made a commitment to this goal as part of his economic recovery plan. But what exactly needs to be done to achieve this?
Today, each person's medical records are scattered among all the places where care has been given—leaving no one with a complete copy. Amazingly, no health-care institutions are responsible for ensuring that complete records are available for each person when care is needed. As the President-elect stated, both the quality and safety of health care could be greatly improved if complete electronic medical records were immediately available to physicians. Efficiency would also increase through, for example, the elimination of unnecessary duplicate tests and imaging procedures. Of course, any system of electronic medical records requires stringent privacy protections to prevent unauthorized access or use.
Health record banks can address our health information needs by providing each person with an electronic "account" where copies of all their medical records could be deposited, stored, and retrieved. A health record bank account would operate much like today's familiar checking account. But instead of depositing money, your medical providers would deposit copies of your new records after each care episode (which they must do at your request under the Health Insurance Portability & Accountability Act, or HIPAA). Privacy First
Just as you control the funds in your checking account, you would retain sole authority over access to any portion of your medical records in a health record bank. Normally, you would make the complete records available to your own doctors and to health-care personnel treating you in an emergency. You would have access to your records yourself (including the ability to add information if you wished) and would be able to see exactly who else has accessed your records and when. With your permission, your information could be aggregated with others' data into anonymized reports for public health officials, medical researchers, and policymakers.
Health record banks would be required to protect your privacy by guaranteeing that you fully control who sees any portion of your records, and to safeguard your information using the same computer security techniques applied today to protect classified military information. There would also be regular independent privacy and security audits (analogous to auditing requirements for financial banks). Health record banks would be privately financed, owned, and operated, and governed either by community nonprofits or via regulation. Multiple competitive health record banks are entirely feasible to provide choices for consumers.
A health record bank account would cost no more than $1 per month—and the health-care savings from the availability of the information would be many times that amount! Some employers may elect to cover this cost as part of their health plan, particularly for beneficiaries with chronic diseases where improvements in quality of care and cost savings from having complete electronic medical records would be even more substantial and immediate. Health-Care Cost Savings
Of course, successful health record bank operation depends on all medical records being electronic. Today, however, fewer than 20% of physicians use electronic medical record systems in their offices, primarily because most of the financial benefits of these systems accrue to others. Financial incentives for electronic medical record systems from health record banks could promote universal adoption and solve this problem, thereby achieving the President-elect's goal.
The Obama Administration's strategy for achieving universal electronic medical records should include policies that facilitate and encourage health record bank development including: (1) statutory privacy protection of medical information; (2) requiring physicians to supply a no-cost electronic copy of newly generated medical information at the time of service (which could be directed to a health record bank account); and (3) making health record bank account fees (up to $12 per year) a covered benefit for all federal health beneficiaries (federal employees, Medicare, Medicaid, Defense Dept., Veterans Administration, Indian Health Service, etc.).
This latter policy would only create expenditures when a health record bank account is actually opened and used—and having the account would ensure health-care savings of at least 10 times the covered cost. Taking these actions to develop a system of health record banks represents an inexpensive yet critical first step in health-care reform that could simultaneously save money, save lives, and protect individual privacy.
As I commented on the story, "Wal-Mart Launches E-Health Program," HIPAA's privacy rule actually allows disclosure of private medical information without consent to anyone for "treatment, payment, or health-care operations" (TPO), thereby eliminating privacy. While this HIPAA provision at first appears to be quite reasonable, the decision about whether a specific disclosure is for TPO is made solely by the entity that holds the information with no notice to the patient, no possibility for review or appeal, and no requirement for keeping records of the disclosures. The current system is anticonsumer—and certainly not in the spirit of President-elect Obama's goals to improve the U.S. health-care system.
William A. Yasnoff, M.D., PhD, is an Arlington (Va.)-based physician and computer scientist. He is currently managing partner of National Health Information Infrastructure (NHII) Advisors, a health information technology consulting firm. He previously served as senior advisor, NHII, U.S. Health & Human Services Dept. from 2002-2004.
December 19, 2008 MayoClinic.com - Mayo Clinic Staff. Personal health record: A tool for managing your health. A personal health record makes it easy to gather and manage your medical information in one accessible and secure electronic location. http://www.mayoclinic.com/health/personal-health-record/MY00665. 6/24/2009 Cayton H. Introduction to "Better Information, Better Choices, Better Health: Putting Information at the Centre of Health." Department of Health, UK. December 16, 2004. Cayton H. Supporting the Patient. Speech at the NHS Alliance Fifth Annual Conference: 'Hearing the Patient's Voice—Supporting the Patient.' October 18, 2003. Available at:
DeLenardo C. Grand River Hospital's Internet-Based Solutions Empower Patient Managed Care. Healthcare Quarterly Vol. 7, No. 3, 2004. Available at: http://www.longwoods.com/hq/HQ73-2004/HQ73GRH.pdf
Detmer D, Singleton P, MacLeod A, Wait S, Taylor M & Ridgwell J. The Informed Patient: Study Report. Cambridge University Health. March 2003.
Dodd B. An independent 'Health Information Bank.' British Journal of Healthcare Computing. Vol. 14, No. 8, October 1997.
Earnest M, Ross S, Wittevrongel L, Moore L & Lin C. "Use of a Patient-Accessible Electronic Medical Record in a Practice for Congestive Heart Failure: Patient and Physician Experiences." JAMIA. Vol. 11, 2004:410-417.
Gordon, Ann B. Information Therapy Helps Improve Care. The Quality Indicator. December 2003. Available at: http://www.qiphysician.com/common/pdfs/QIPHY1203.pdf
IHealthRecord FAQs. Available at: http://www.ihealthrecord.org/faq.html
Kim M & Johnson K. Personal Health Records: Evaluation of Functionality and Utility. JAMIA Vol. 9, 2002:171-180.
Kirshner M. The Role of Information Technology and Informatics Research in the Dentist-Patient Relationship. Advances in Dental Research. Vol. 17, December, 2003:77-81.
Mandl K, Szolovits P and Kohane I. Public Standards and Patients' Control: How to Keep Electronic Medical Records Accessible but Private. British Medical Journal Vol. 322, February 3, 2001:282-287. Available at: http://bmj.bmjjournals.com/cgi/content/full/322/7281/283
Markle Foundation. Connecting for Health: A Public-Private Collaborative. The Personal Health Working Group Final Report. July 1, 2003. Available at: http://www.markle.org/downloadable_assets/final_phwg_report1.pdf
Medem, Inc. First of Its Kind, Secure, Online Personal Health Record Available to Every American at No Cost. Press Release. May 9, 2005. Available at: http://biz.yahoo.com/prnews/050509/dcm027.html?.v=10
National Programme for Information Technology (NPfIT), National Health Service, UK. HealthSpace. Information Sheet.
National Health Information Infrastructure (NHII), U.S. Frequently Asked Questions. Available at: http://aspe.hhs.gov/sp/nhii/FAQ.html Ramsaroop P & Ball J. The "Bank of Health"—A Model for More Useful Patient Health Records. MD Computing. Vol. 17, No. 4, July/August 2000:45-48. Ross S & Lin C. The Effects of Promoting Patient Access to Medical Records: A Review. JAMIA. Vol. 10, No.2, Mar/Apr, 2003:129-138. Taylor H, Ed. Two in Five Adults Keep Personal or Family Health Records and Almost Everybody Thinks This is a Good Idea. HarrisInteractive® Health Care News. Vol. 4, No. 13, August 10, 2004. Wang M, Lau C, Matsen FA III & Kim Y. Personal Health Information Management System and its Application in Referral Management. Vol. 8, No. 3, September 2004:287-297. Available at: http://icsl.ee.washington.edu/projects/emedicine/phims-ieee-tbme2004.pdf. Also see project summary at: http://icsl.ee.washington.edu/~clau/ Winkelman W, Leonard K & Rossos P. Patient-Perceived Usefulness of Online Electronic Medical Records: Employing Grounded theory in the Development of Information and Communication Technologies for Use by Patients Living with Chronic Illness. JAMIA. Vol. 12, 2005:306-314. Winkelman W & Leonard K. Overcoming Structural Constraints to Patient Utilization of Electronic Medical Records: A Critical Review and Proposal for an Evaluation Framework. JAMIA. Vol. 11, 2004:151-161. =========================================================== 2009.08.06 Should health records be online? Cloud-based medical records systems have been implemented in the US, but would they be an improvement on UK plans? Written by Tom Young When even Conservative Party MPs seem unable to agree among themselves about plans for electronic medical records, it demonstrates the challenges involved in delivering what is a key goal for the NHS. Former Tory frontbencher David Davis last week came out in strong opposition to the storing of personal health records in cloud-based services. The party has floated the idea as a policy twice this year, once in a speech by David Cameron in April and last month in a story based on anonymous quotes given to The Times newspaper. The Tory proposal would be to use services such as Google Health or Microsoft HealthVault to keep personal health records online, rather than storing them on a central, state-run database that Cameron often refers to erroneously as the “NHS supercomputer”. Davis hates the idea because he believes that Google has a bad privacy record. “We are still a long way from being able to give personal data to any company, let alone Google,” he said, while highlighting the “massive weaknesses” in a central database as well. The online concept comes from the US, where there is no state health system and healthcare is fragmented. A record stored in the cloud could be accessed by any clinician anywhere in the country quickly and easily with the patient’s permission. The offerings from Microsoft and Google were only launched in 2007 and they sit alongside a number of packages from smaller vendors. Universal electronic records are a key part of President Barack Obama’s health reform plan, though it is still unclear what form they will take. The trend in healthcare is towards giving patients greater access and control over their own health information, according to Abdul Roudsari, head of health informatics at City University. “It means doctors cannot hide evidence from patients, as in the case of Harold Shipman, and should lead to greater trust between patients and clinicians,” he said.
The NHS “spine” system gives less control to patients than cloud-based services, but still provides more control than has previously existed by allowing patients to decide who can and cannot see their records. But there are dangers in allowing patients greater access to their own records. Some information could be detrimental to the health of the patient if they see it at the wrong time or in the wrong way and could be open to misinterpretation – which is even more likely with a cloud-based system that is not overseen by health professionals. And allowing patients to input their own health information unsupervised by a clinician could produce inaccurate data. A study by Stanford University published in 2006 found that proper education – both online and offline – offers a solution. “Reinforcement of the need to maintain the quality and accuracy of personal health record information can occur as educational experiences unfold during the primary and secondary school years,” says the report. But both Google and Microsoft automatically import health data from a number of sources so that when a patient has an operation, their record is updated automatically by the health company, thus making inaccuracy less likely. There are advantages to a cloud-based systems – alerts to upcoming appointments, the rapid issue of test results, and reminders on treatment programmes could all be more accessible to patients. But such records are still less likely to be accurate and are more dispersed than those held on a database, making them less useful for medical research – one of the key aims of electronic health records. However, the relative benefits of a cloud-based system could be a moot point regardless of the Tory plans, according to one supplier involved with the NHS National Programme. “It is very unlikely that the Conservatives will ditch the spine system, so cloud systems would only really be used to keep personal health information such as diet and allergies up to date,” he said. “Why ditch the ready-made network we already have?” An NHS Direct web site called Healthspace already allows patients to do exactly this – essentially serving the same purpose as the Google and Microsoft systems and rendering them redundant, according to the supplier. What they say about storing health records on Google: Tory leader David Cameron: “People can store their health records securely online, they can show them to whichever doctor they want. They’re in control, not the state.” Former Tory frontbencher David Davis: “What was proposed was both dangerous in its own right, and hazardous to the public acceptability of necessary reforms to the state’s handling of our private information.” Peter Fleischer, Google’s global privacy counsel: “Mr Davis’s argument is based on something of a straw man, given that Google Health, our health records product, is only available in the US, and we have no immediate plans to bring it to other countries.” ======================================================= August 06, 2009 Electronic health records facing a tough sell to doctors Filed Under (EHR, Health IT, Hospital) by admin
BY CHRISTOPHER WEAVER KAISER HEALTH NEWS Dr. David Blumenthal, the Obama Administration’s national coordinator for health information technology, can recall the day he became a true believer in the potential of electronic health records. He was about to order a lung scan when the computer in his Boston hospital alerted him to a similar image already in the file. The patient was spared an unnecessary dose of radiation and the health care system was spared the cost of an unnecessary test.
Such experiences, he said, “suggest… how small victories… can lead us to be better physicians, higher quality physicians.” That thinking is informing his actions as head of the Office of the National Coordinator, which wants doctors to use electronic medical records as part of a broader effort to modernize the health care system. Blumenthal’s office, along with two advisory panels, reported Thursday on their progress in developing the framework for the $33 billion health information technology initiative. The undertaking, which began with the February passage of the stimulus bill, has required that they define key terms, such as “meaningful use,” that will guide doctors as they adopt electronic health records. They are also setting the minimum requirements physicians will have to meet in order to receive financial incentives. For Blumenthal, the most difficult challenge will be to convince doctors that participating is worth it. Even with assistance from the federal government, physicians will have to spend big money on the digital transition. And the return on their investment is murky. Blumenthal must show doctors how this program is good for them by identifying goals for improvements, and ultimately, savings in their practices. With the stimulus law, Congress laid out two goals — improving the quality of health care and lowering costs. Lawmakers also offered some specific guidance on how to proceed. They wanted the funds to be used to create, for instance, platforms for e-prescribing and for the coordination of care — not simply to buy new software. But other than those few stipulations, Congress left Blumenthal in charge. On Thursday, in a key step, the Health Information Technology Policy Committee — one of the panels — reached consensus on the definition of meaningful use. A multipage documents lays out 28 specific objectives. For example, physicians would have to track and report measures such as the percentage of diabetic patients with controlled hemoglobin A1c levels, or women older than 50 who have had recent mammograms. Their systems also should help prevent dangerous drug interactions, provide clinical decision support and track at least some efficiency measures, such as how often the doctor prescribes generic drugs instead of more expensive brand name alternatives. In addition, the systems should show an ability to exchange health information with other providers or health systems where possible and make electronic records available to patients. The Centers for Medicare and Medicaid Services will use this definition and set of objectives as it drafts its proposed rule, due out in December, for the stimulus health IT funding. This approach reflects Blumenthal’s emphasis on quality as well as his belief that better outcomes lead to healthier patients, fewer errors and hospitalizations, and lower health care costs. He argues the resulting quality improvements would automatically achieve Congress’ other goals of increasing efficiency and reducing the costs of health care. “The question is, is it more efficient to treat high blood pressure than not?” he said at a June meeting. “It saves so much money in avoiding strokes and heart attacks, kidney failure and complications from diabetes.”
On these points, “Blumenthal has his head screwed on right,” said David Merritt, a health policy analyst at Newt Gingrich’s Center for Health Transformation. Doctors would be eligible for the stimulus dollars beginning in 2011 — in the form of increased Medicare and Medicaid payments — only after they install the systems and achieve these meaningful uses. Eventually, in addition to the fact that they are tracking the measures, doctors may have to show actual improvements in their clinical performance to get the money. And if doctors don’t take those carrots, they face a stick: without systems in place by 2015, their Medicare and Medicaid payments would be lowered as a penalty. But Blumenthal’s other, and maybe even more difficult, challenge is to demonstrate to doctors how this program is good for them. “We really need to be able to sell this…,” said Neil Calman, a family doctor in New York, during the June meeting of the advisory panel. “It’s really critical that we show efficiency is achieved.” There is a financial reality that makes this proposition difficult: While preventing hospitalizations, medical errors and duplicate tests would cut into America’s more than $2 trillion of annual health spending, the savings would go to the insurers, policy holders and taxpayers who pay the bills, but not individual physicians. “Office-based physicians in particular may see no benefit if they purchase and install such a product - and may even suffer financial harm,” even as their expenditures spare the government about $13 billion, in addition to other savings across the health system, the Congressional Budget Office predicted in a report March 10. Already that reality has discouraged many doctors from making the hefty investment in e-health. As of last summer, only about 13 percent of physicians were using even basic electronic records, according to a New England Journal of Medicine study. According to a PricewaterhouseCoopers report, Rock and a Hard Place, the average three-physician practice could spend as much as $300,000 to buy e-health software, cover training costs, and pay for upgrades over two years. But doctors are limited to no more than $44,000 in additional Medicare and Medicaid payments over the life of the program, and they have to buy the technology up front. Dr. Ted Epperly, the president of the American Academy of Family Physicians, uses electronic records in his own practice in Boise, Idaho. He values them for what they do for his patients, not for his bottom line. Yet, he said, “This money is going to, in good faith, get most physicians on their way there.” Above article published on http://www.newjerseynewsroom.com/healthquest/ electronic-health-records-facing-a-tough-sell-to-doctors
Definition
The term “personal health record” is not new. The earliest, English-language article indexed by PubMed that mentions the term is dated June 1978;[1] however, search results from PubMed also reveal that most scientific articles written about PHRs have been published since 2000.
The PHR is an ill-defined concept that has been developing over several years.The term has been applied to both paper-based and computerized systems; however, current usage usually implies an electronic resource. In recent years, several formal definitions of the term have been proposed by various organizations.[2] [3] [4] Although each definition is unique, most of the definitions agree that the PHR is a computerized application that stores an individual's personal health information.
It is important to note that PHRs are not the same as EHRs (electronic health records). The latter are software systems designed for use by health care providers. Like the data recorded in paper-based medical records, the data in EHRs are legally mandated notes on the care provided by clinicians to patients. There is no legal mandate that compels a consumer or patient to store her personal health information in a PHR.
PHRs can contain a diverse range of data but usually include information about:
* allergies and adverse drug reactions,
* medications (including dose and how often taken) including over the counter medications and herbal remedies,
* illnesses and hospitalizations,
* surgeries and other procedures,
* vaccinations,
* laboratory test results,
* and family history.
In addition to storing an individual's personal health information, some PHRs provide added-value services such as drug-drug interaction checking or electronic messaging between patients and providers.
[edit] PHR Platforms
One of the principle distinguishing features of a PHR is the platform by which it is delivered. The types of platforms include: paper, personal computers, the internet, and portable devices.
Paper-based PHRs: Personal health information is recorded and stored in paper format. Printed laboratory reports, copies of clinic notes, and health histories created by the individual may be parts of a paper-based PHR. This method is low cost, reliable, and accessible without the need for a computer or any other hardware.
Paper-based PHRs may be difficult to locate, update, and share with others. Paper-based PHRs are subject to physical loss and damage, such as can occur during a natural disaster. Paper records can also be printed from most electronic PHRs.
PC-Based PHR: Personal health information is recorded and stored in personal computer-based software that may have the capability to print, backup, encrypt, and import data from other sources such as a hospital laboratory. The most basic form of a PC-based PHR would be a health history created in a word-processing program. The health history created in this way can be printed, copied, and shared with anyone with a compatible word processor.
PHR software can provide more sophisticated features such as data encryption, data importation, and data sharing with health care providers. Some PHR products allow the copying of health records to a mass-storage device such as a CD-ROM, DVD, smart card, or USB flash drive.
PC-based PHRs are subject to physical loss and damage of the personal computer and the data that it contains.
Internet-Based PHR: Personal health information is accessed and edited via a Web browser. The data is stored on a remote server. Internet-based PHRs may have the capability to print information, backup data, import data from other information systems, and share information with health care providers.
Internet-based PHRs are subject to physical loss and damage of the Web server. Internet-based PHRs may be vulnerable to unauthorized access via Internet or other data connections. Internet-based PHRs have the advantage of being accessible from any location with an Internet connection with a suitable Web browser. By using the internet, the PHR is enabled to be interactive, and to evolve with medical literature and the medical history of the patient and his or her family.
Mobile SmartPhone-based mPHR: Mobile Personal health information is recorded and stored in personal mobile Smart Phone-based application that may have the capability to print, backup, encrypt, and import data from other sources such as a laboratory, clinics Electronic Health Record or Web based PHRs. Health history such as medications, immunizations and allergies may be stored in the application.
Portable-Storage PHR: Personal health information is recorded and stored on a portable-storage device such as a CDROM, DVD, smart card, or USB flash drive and SmartPhones such as the iPhone or Android Phone. Some portable-storage PHRs provide features such as history editing, data encryption, data importation, and data sharing with health care providers.
Portable-storage PHRs are subject to physical loss and damage of the storage device. One of the disadvantages of portable-storage PHRs is that many computers at physician offices and hospitals cannot read and update these PHRs.However,the new generation portable personal health record manager can be used as a free standing application without the need for specialized software.
[edit] Sponsors of PHRs
PHR programs are structured in the same basic way a consumer credit report is structured, in that consumers may obtain a PHR from various sponsoring organizations. Some PHRs are marketed directly to the consumer by the product vendor. The direct-to-consumer PHRs often require the consumer to pay a fee for registering a new account. Other PHRs are offered by health care organizations such as hospitals. Frequently, these hospital-based PHRs are integrated with other information systems owned by the health care delivery organization such as its EHR or laboratory information systems. Recently, PHRs are being offered to people by employers and health insurance companies, however it is unclear if the PHR is transportable or transferable if a person switches jobs or insurance companies.
[edit] See also
* Health care
* Health informatics
* electronic health record
[edit] Bibliography
Books
1. Agarwal R, Angst CM. Technology-enabled transformations in U.S. health care: early findings on personal health records and individual use,” In Galletta G, Zhang P, (Eds.), Human-Computer Interaction and Management Information Systems: Applications (Vol. 5). Armonk, NY: M.E. Sharpe, Inc., pp. 357–378. 2006.
2. Lewis D, Eysenbach G, Kukafka R, Stavri PZ, Jimison H. Consumer health informatics: informing consumers and improving health care. New York: Springer. 2005.
Journal Articles
1. "Computerisation of personal health records". Health visitor 51 (6): 227. Jun 1978. PMID 248054.
2. "Recordkeeping systems: personal health records". J Am Med Rec Assoc. 55 (12): 42. Dec 1984. PMID 10310901.
3. "Concepts of the Health Vault". http://www.munnecke.com/papers/D03.doc. 1999 Paper by Tom Munnecke describing an architecture for the Personal Health Record
4. "[Personal medical records and identification card, synchronized information systems]" (in French). Rev Infirm. (106): 45–6. Dec 2004. PMID 15672518.
5. Swain, M (Apr 2005). "Information prescriptions (Ix): bringing internet-based health content into the treatment process; patients to your site". Internet Healthc Strateg. 7 (4): 4–8. doi:10.1016/0148-9062(76)91830-1. PMID 15929640.
6. "Report on attitudes about personal health records". Internet Healthc Strateg. 6 (9): 10–1. Sep 2004. PMID 15526437.
7. "New-age PHR comes with decision-support, multiple opportunities for DM". Dis Manag Advis. 12 (12): 140–2, 133. Dec 2006. PMID 17225631.
8. Kupchunas WR (2007). "Personal health record: new opportunity for patient education". Orthop Nurs. 26 (3): 185–91; quiz 192–3. doi:10.1097/01.NOR.0000276971.86937.c4. PMID 17538475.
9. "Readers' perspective. Personal health records will be widely used within five years, supplanting the need for regional health information organizations". Health Data Manag. 15 (10): 8. Oct 2007. PMID 17941305.
10. Ackerman MJ (2007). "The personal health record". J Med Pract Manage. 23 (2): 84–5. PMID 17974083.
11. Adler KG (2006). "Web portals in primary care: an evaluation of patient readiness and willingness to pay for online services". J Med Internet Res. 8 (4): e26. doi:10.2196/jmir.8.4.e26. PMID 17213045. PMC: 1794005. http://www.jmir.org/2006/4/e26.
12. Burrington-Brown J, Fishel J, Fox L, et al. (Jun 2005). "Defining the personal health record. AHIMA releases definition, attributes of consumer health record". J Ahima. 76 (6): 24–5. PMID 15986557.
13. "Practice brief. The role of the personal health record in the EHR". Journal of AHIMA / American Health Information Management Association 76 (7): 64A–64D. Jul 2005. PMID 16097127.
14. Albright B (Feb 2007). "Prepping for PHRs. The growing trend of consumer empowerment includes the speedy rise of personal health records". Healthc Inform. 24 (2): 44, 46. PMID 17370879.
15. "The value of personal health records. A joint position statement for consumers of healthcare". J Ahima. 77 (9): 24. Oct 2006. PMID 17111904.
16. "The value of personal health records. A joint position statement for consumers of healthcare by the American Health Information Management Association and the American Medical Informatics Association". J Ahima. 78 (4): 22, 24. Apr 2007. PMID 17455841.
17. Atkinson NL, Massett HA, Mylks C, Hanna B, Deering MJ, Hesse BW (2007). "User-centered research on breast cancer patient needs and preferences of an Internet-based clinical trial matching system". J Med Internet Res. 9 (2): e13. doi:10.2196/jmir.9.2.e13. PMID 17513284.
18. Bakker A (Mar 2004). "Access to EHR and access control at a moment in the past: a discussion of the need and an exploration of the consequences". Int J Med Inform. 73 (3): 267–70. doi:10.1016/j.ijmedinf.2003.11.008. PMID 15066557.
19. Ball MJ, Gold J (2006). Banking on health: Personal records and information exchange. 20. pp. 71–83. PMID 16669591.
20. Ball MJ, Smith C, Bakalar RS (2007). "Personal health records: empowering consumers". J Healthc Inf Manag. 21 (1): 76–86. PMID 17299929.
21. Black D (Mar 1992). "Personal health records". J Med Ethics 18 (1): 5–6. PMID 1573654.
22. Burrington-Brown J, Friedman B (Oct 2005). "Educating the public about personal health records". J Ahima. 76 (9): 94–5. PMID 16274211.
23. Cimino JJ, Patel VL, Kushniruk AW (Dec 2002). "The patient clinical information system (PatCIS): technical solutions for and experience with giving patients access to their electronic medical records". Int J Med Inform. 68 (1-3): 113–27. doi:10.1016/S1386-5056(02)00070-9. PMID 12467796. http://linkinghub.elsevier.com/retrieve/pii/S1386505602000709.
24. Clarke JL, Meiris DC, Nash DB (2006). "Electronic personal health records come of age". American Journal of Medical Quality 21 (3 Suppl): 5S–15S. doi:10.1177/1062860606287642. PMID 16621927.
25. Conn J (2006). "Personal and (maybe) confidential. Questions over privacy, formats and definitions remain, but personal health records are on the way". Mod Healthc. 36 (27): 28–31. PMID 16898550.
26. Cooke T, Watt D, Wertzler W, Quan H (May 2006). "Patient expectations of emergency department care: phase II--a cross-sectional survey". CJEM. 8 (3): 148–57. PMID 17320008. http://caep.ca/template.asp?id=C47E9E43681744CC95052E4A44FFCEBE.
27. D'Alessandro DM, Dosa NP (Oct 2001). "Empowering children and families with information technology". Arch Pediatr Adolesc Med. 155 (10): 1131–6. PMID 11576008. http://archpedi.ama-assn.org/cgi/pmidlookup?view=long&pmid=11576008.
28. Denton IC (Sep 2001). "Will patients use electronic personal health records? Responses from a real-life experience". J Healthc Inf Manag. 15 (3): 251–9. PMID 11642143.
29. Earnest MA, Ross SE, Wittevrongel L, Moore LA, Lin CT (Sep 2004). "Use of a patient-accessible electronic medical record in a practice for congestive heart failure: patient and physician experiences". J Am Med Inform Assoc. 11 (5): 410–7. doi:10.1197/jamia.M1479. PMID 15187074.
30. Edlin M (2006). "Implementing personal health records". AHIP Coverage 47 (2): 14–6, 19. PMID 16700448.
31. Einbinder JS, Bates DW (2007). "Leveraging information technology to improve quality and safety". Yearbook of medical informatics: 22–9. PMID 17700900.
32. Endsley S, Kibbe DC, Linares A, Colorafi K (May 2006). "An introduction to personal health records". Fam Pract Manag. 13 (5): 57–62. PMID 16736906.
33. Fowles JB, Kind AC, Craft C, Kind EA, Mandel JL, Adlis S (Apr 2004). "Patients' interest in reading their medical record: relation with clinical and sociodemographic characteristics and patients' approach to health care". Arch Intern Med. 164 (7): 793–800. doi:10.1001/archinte.164.7.793. PMID 15078650.
34. Foxhall K (Mar 2007). "Now it's personal. Personal health records may be next on deck for the certification process". Healthc Inform. 24 (3): 30. PMID 17427793.
35. Friedman RH (2006). "Medicaid information technology architecture: an overview". Health Care Financ Rev 28 (2): 1–9. PMID 17427840.
36. Gawthorn EC (Jun 1983). "Personal health records (PHR)". Aust Fam Physician. 12 (6): 466–8. PMID 6626044.
37. Greene J (2007). "The personal health record: a key to improving health care for seniors". AHIP Coverage 48 (5): 46–8, 51–2, 55. PMID 17941574.
38. Halamka JD, Mandl KD, Tang PC (2008). "Early experiences with personal health records". J Am Med Inform Assoc. 15 (1): 1–7. doi:10.1197/jamia.M2562. PMID 17947615.
39. Hassol A, Walker JM, Kidder D, et al. (Nov-Dec 2004). "Patient experiences and attitudes about access to a patient electronic health care record and linked web messaging". J Am Med Inform Assoc. 11 (6): 505–13. doi:10.1197/jamia.M1593. PMID 15299001.
40. Hess R, Bryce CL, Paone S, et al. (Oct 2007). "Exploring challenges and potentials of personal health records in diabetes self-management: implementation and initial assessment". Telemed J E Health. 13 (5): 509–17. doi:10.1089/tmj.2006.0089. PMID 17999613.
41. Honeyman A, Cox B, Fisher B (2005). "Potential impacts of patient access to their electronic care records". Informatics in Primary Care. 13 (1): 55–60. PMID 15949176. http://openurl.ingenta.com/content/nlm?genre=article&issn=1476-0320&volume=13&issue=1&spage=55&aulast=Honeyman.
42. Iakovidis I. Towards personal health record: current situation, obstacles and trends in implementation of electronic healthcare record in Europe. Int J Med Info. Oct 1998. 52(1-3); 105-15.
43. Jeffs D, Harris M (Aug 1993). "The personal health record. Making it work better for general practitioners". Aust Fam Physician. 22 (8): 1417–9, 1421, 1424–7. PMID 8379881.
44. Jeffs D, Nossar V, Bailey F, Smith W, Chey T (Jun 1994). "Retention and use of personal health records: a population-based study". J Paediatr Child Health. 30 (3): 248–52. doi:10.1111/j.1440-1754.1994.tb00627.x. PMID 8074911.
45. Johnson S, Mayor P (Apr 2002). "A patient-held record for cancer patients from diagnosis onwards". Int J Palliat Nurs. 8 (4): 182, 184–9. PMID 12048447.
46. Joshi P, Jones KV, Hanson RM, Alperstein G, Fasher B (Oct 1993). "Personal health records". J Paediatr Child Health 29 (5): 400–1. doi:10.1111/j.1440-1754.1993.tb00549.x. PMID 8240876.
47. Jossi F (Feb 2006). "Personal health records". Healthc Inform. 23 (2): 52, 54. PMID 16597007.
48. Kardas G, Tunali ET (Jan 2006). "Design and implementation of a smart card based healthcare information system". Comput Methods Programs Biomed. 81 (1): 66–78. doi:10.1016/j.cmpb.2005.10.006. PMID 16356586.
49. Kim E, Mayani A, Modi S, Kim Y, Soh C. Evaluation of patient-centered electronic health record to overcome digital divide. Conf Proc IEEE Eng Med Biol Soc. 2005. 2;593-6.
50. Kim MI, Johnson KB (Mar-Apr 2002). "Personal health records: evaluation of functionality and utility". J Am Med Inform Assoc. 9 (2): 171–80. doi:10.1197/jamia.M0978. PMID 11861632. PMC: 344574. http://www.jamia.org/cgi/pmidlookup?view=long&pmid=11861632.
51. Kim MI, Johnson KB (May 2004). "Patient entry of information: evaluation of user interfaces". J Med Internet Res. 6 (2): e13. doi:10.2196/jmir.6.2.e13. PMID 15249262. PMC: 1550597. http://www.jmir.org/2004/2/e13.
52. Kimmel Z, Greenes RA, Liederman E (Nov-Dec 2005). "Personal health records". J Med Pract Manage. 21 (3): 147–52. PMID 16471387.
53. Klein-Fedyshin MS (2002). "Consumer Health Informatics--integrating patients, providers, and professionals online". Med Ref Serv Q. 21 (3): 35–50. doi:10.1300/J115v21n03_03. PMID 12238015.
54. Kupchunas WR (2007). "Personal health record: new opportunity for patient education". Orthop Nurs. 26 (3): 185–91; quiz 192–3. doi:10.1097/01.NOR.0000276971.86937.c4. PMID 17538475.
55. Kun LG. Homecare and disease prevention: reviewing a decade of evolution - privacy still the biggest hurdle. Conf Proc IEEE Eng Med Biol Soc. 2006;1:4685. Medline
56. Lafky DB, Tulu B, Horan TA. A user-driven approach to personal health records. Communications of the Association for Information Systems. Jun 2006. 17(46).
57. Lee M, Delaney C, Moorhead S (Oct 2007). "Building a personal health record from a nursing perspective". Int J Med Inform. 76 Suppl 2: S308–16. doi:10.1016/j.ijmedinf.2007.05.010. PMID 17616432.
58. Lin CT, Wittevrongel L, Moore L, Beaty BL, Ross SE (Aug 2005). "An Internet-based patient-provider communication system: randomized controlled trial". J Med Internet Res. 7 (4): e47. doi:10.2196/jmir.7.4.e47. PMID 16236699. PMC: 1550679. http://www.jmir.org/2005/4/e47.
59. Lober WB, Zierler B, Herbaugh AL, Shinstrom SE, Stolyar A, Kim EH, Kim Y. Barriers to the use of a Personal Health Record by an Elderly Population. AMIA Annu Symp Proc. 2006. 514-8.
60. Lowes R (Feb 2006). "Personal health records: What's the status now?". Med Econ. 83 (4): TCP13–4, TCP16. PMID 16573223.
61. Lu SC (2007). "CCR exchange: building a patient-driven web-based healthcare community around an emerging personal health record standard". Stud Health Technol Inform. 127: 58–64. PMID 17901599. http://booksonline.iospress.nl/Extern/EnterMedLine.aspx?ISSN=0926-9630&Volume=127&SPage=58.
62. Masys D, Baker D, Butros A, Cowles KE (Mar-Apr 2002). "Giving patients access to their medical records via the internet: the PCASSO experience". J Am Med Inform Assoc. 9 (2): 181–91. doi:10.1197/jamia.M1005. PMID 11861633. PMC: 344575. http://www.jamia.org/cgi/pmidlookup?view=long&pmid=11861633.
63. McSherry B (Aug 2006). "Access to confidential medical records by courts and tribunals: the inapplicability of the doctrine of public interest immunity". J Law Med. 14 (1): 15–9. PMID 16937777.
64. Moen A, Brennan PF (2005). "Health@Home: the work of health information management in the household (HIMH): implications for consumer health informatics (CHI) innovations". J Am Med Inform Assoc. 12 (6): 648–56. doi:10.1197/jamia.M1758. PMID 16049230.
65. Morales Rodriguez M, Casper G, Brennan PF (Apr 2007). "Patient-centered design. The potential of user-centered design in personal health records". J Ahima. 78 (4): 44–6; quiz 49–50. PMID 17455846.
66. Morrissey J (Nov-Dec 2005). "What does the public think? For consumers to adopt PHRs, they need reasons that hit home". J Ahima 76 (10): 42–4. PMID 16333943.
67. Neame R (Feb 2000). "Creating an infrastructure for the productive sharing of clinical information". Top Health Inf Manage. 20 (3): 85–91. PMID 10747439.
68. Nelson R (Sep 2007). "The personal health record". Am J Nurs. 107 (9): 27–8. doi:10.1097/01.NAJ.0000287504.92887.de (inactive 2008-10-21). PMID 17721144.
69. Nobel JJ (Nov-Dec 2005). "Health plan sponsored personal health records: a tool for information driven quality improvement". AHIP Coverage 46 (6): 14–6, 18, 20–5. PMID 16450491.
70. O'Flaherty S, Jandera E, Llewellyn J, Wall M (Nov 1987). "Personal health records: an evaluation". Arch Dis Child. 62 (11): 1152–5. PMID 3688919.
71. Odom-Wesley B (Nov-Dec 2000). "Envisioning the personal medical record". J Ahima 71 (10): 39–45. PMID 11185857.
72. Pagliari C, Detmer D, Singleton P (Aug 2007). "Potential of electronic personal health records". BMJ 335 (7615): 330–3. doi:10.1136/bmj.39279.482963.AD. PMID 17703042.
73. Poon EG, Wald J, Schnipper JL, et al. (2007). "Empowering patients to improve the quality of their care: design and implementation of a shared health maintenance module in a US integrated healthcare delivery network". Studies in health technology and informatics 129 (Pt 2): 1002–6. PMID 17911866. http://booksonline.iospress.nl/Extern/EnterMedLine.aspx?ISSN=0926-9630&Volume=129&SPage=1002.
74. Pyper C, Amery J, Watson M, Crook C, Thomas B (2002). "Patients' access to their online electronic health records". J Telemed Telecare. 8 Suppl 2: 103–5. doi:10.1258/135763302320302244. PMID 12217158.
75. Pyper C, Amery J, Watson M, Crook C (Nov 2004). "Access to electronic health records in primary care-a survey of patients' views". Med Sci Monit. 10 (11): SR17–22. PMID 15507869. http://www.medscimonit.com/fulltxt.php?ICID=11808.
76. Ralston JD, Revere D, Robins LS, Goldberg HI (May 2004). "Patients' experience with a diabetes support programme based on an interactive electronic medical record: qualitative study". BMJ 328 (7449): 1159. doi:10.1136/bmj.328.7449.1159. PMID 15142919.
77. Rahul Shetty: Portable Digital Personal Health Record : To Bridge the Digital gap in Medical Information Storage of Individuals with Personal Health Records in Flash Drives. The Internet Journal of Health. 2007. Volume 5 Number 2.
78. Rhoads J, Metzger J (Jan-Feb 2007). "Personal health records: prospects and challenges for health plans". AHIP Coverage 48 (1): 50, 53. PMID 17315559.
79. Rocha RA, Romeo AN, Norlin C (2007). "Core features of a parent-controlled pediatric medical home record". Stud Health Technol Inform. 129 (Pt 2): 997–1001. PMID 17911865. http://booksonline.iospress.nl/Extern/EnterMedLine.aspx?ISSN=0926-9630&Volume=129&SPage=997.
80. Roop L (Feb 2007). "Technology. Big business charges ahead with personal health records". Hosp Health Netw. 81 (2): 17. PMID 17373527.
81. Ross SE, Lin CT (Mar-Apr 2003). "The effects of promoting patient access to medical records: a review". J Am Med Inform Assoc. 10 (2): 129–38. doi:10.1197/jamia.M1147. PMID 12595402. PMC: 150366. http://www.jamia.org/cgi/pmidlookup?view=long&pmid=12595402.
82. Ross SE, Moore LA, Earnest MA, Wittevrongel L, Lin CT (May 2004). "Providing a web-based online medical record with electronic communication capabilities to patients with congestive heart failure: randomized trial". J Med Internet Res. 6 (2): e12. doi:10.2196/jmir.6.2.e12. PMID 15249261. PMC: 1550594. http://www.jmir.org/2004/2/e12.
83. Ross SE, Todd J, Moore LA, Beaty BL, Wittevrongel L, Lin CT (May 2005). "Expectations of patients and physicians regarding patient-accessible medical records". J Med Internet Res. 7 (2): e13. doi:10.2196/jmir.7.2.e13. PMID 15914460. PMC: 1550642. http://www.jmir.org/2005/2/e13.
84. Sachinopoulou A, Leppänen J, Kaijanranta H, Lähteenmäki J (2007). "Ontology-based approach for managing personal health and wellness information". Conf Proc IEEE Eng Med Biol Soc. 2007: 1802–5. doi:10.1109/IEMBS.2007.4352662. PMID 18002328.
85. Sax U, Kohane I, Mandl KD (May-Jun 2005). "Wireless technology infrastructures for authentication of patients: PKI that rings". J Am Med Inform Assoc. 12 (3): 263–8. doi:10.1197/jamia.M1681. PMID 15684133.
86. Schneider JH (Aug 2001). "Online personal medical records: are they reliable for acute/critical care?". Crit Care Med. 29 (8 Suppl): N196–201. doi:10.1097/00003246-200108001-00009. PMID 11496043. http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0090-3493&volume=29&issue=8&spage=N196.
87. Schoenberg R, Safran C (Nov 2000). "Internet based repository of medical records that retains patient confidentiality". BMJ 321 (7270): 1199–203. doi:10.1136/bmj.321.7270.1199. PMID 11073513. .
88. Sittig DF (Apr 2002). "Personal health records on the internet: a snapshot of the pioneers at the end of the 20th Century". Int J Med Inform. 65 (1): 1–6. doi:10.1016/S1386-5056(01)00215-5. PMID 11904243. http://linkinghub.elsevier.com/retrieve/pii/S1386505601002155.
89. Smith SP, Barefield AC (Oct-Dec 2007). "Patients meet technology: the newest in patient-centered care initiatives". Health Care Manag (Frederick). 26 (4): 354–62. doi:10.1097/01.HCM.0000299254.29678.50 (inactive 2008-10-21). PMID 17992110.
90. Sprague L (Nov 2006). "Personal health records: the people's choice?". NHPF Issue Brief. (820): 1–13. PMID 17146910.
91. Smolij K, Dun K (Dec 2006). "Patient health information management: searching for the right model". Perspect Health Inf Manag. 3: 10. PMID 18066368.
92. Tang PC, Ash JS, Bates DW, Overhage JM, Sands DZ. Personal health records: definitions, benefits, and strategies for overcoming barriers to adoption. Journal of Medical Informatics Association. Mar 2006. 13(2); 121-126.
93. Tang PC, Lansky D (Sep 2005). "The missing link: bridging the patient-provider health information gap". Health Affairs. 24 (5): 1290–5. doi:10.1377/hlthaff.24.5.1290. PMID 16162575.
94. Tobacman JK, Kissinger P, Wells M, et al. (Jul 2004). "Implementation of personal health records by case managers in a VAMC general medicine clinic". Patient Educ Couns. 54 (1): 27–33. doi:10.1016/S0738-3991(03)00184-8. PMID 15210257.
95. Tracy CS, Dantas GC, Upshur RE (Sep 2004). "Feasibility of a patient decision aid regarding disclosure of personal health information: qualitative evaluation of the Health Care Information Directive". BMC Med Inform Decis Mak. 4: 13. doi:10.1186/1472-6947-4-13. PMID 15361257.
96. Ueckert F, Goerz M, Ataian M, Tessmann S, Prokosch HU (Jul 2003). "Empowerment of patients and communication with health care professionals through an electronic health record". Int J Med Inform. 70 (2-3): 99–108. doi:10.1016/S1386-5056(03)00052-2. PMID 12909161. http://linkinghub.elsevier.com/retrieve/pii/S1386505603000522.
97. Waegemann CP (May 2005). "Closer to reality. Personal health records represent a step in the right direction for interoperability of healthcare IT systems and accessibility of patient data". Health Manag Technol. 26 (5): 16, 18. PMID 15932068.
98. Weingart SN, Rind D, Tofias Z, Sands DZ (Jan-Feb 2006). "Who uses the patient internet portal? The PatientSite experience". J Am Med Inform Assoc. 13 (1): 91–5. doi:10.1197/jamia.M1833. PMID 16221943.
99. Winkelman WJ, Leonard KJ (Mar-Apr 2004). "Overcoming structural constraints to patient utilization of electronic medical records: a critical review and proposal for an evaluation framework". J Am Med Inform Assoc. 11 (2): 151–61. doi:10.1197/jamia.M1274. PMID 14633932.
100. Winkelman WJ, Leonard KJ, Rossos PG (May-Jun 2005). "Patient-perceived usefulness of online electronic medical records: employing grounded theory in the development of information and communication technologies for use by patients living with chronic illness". J Am Med Inform Assoc. 12 (3): 306–14. doi:10.1197/jamia.M1712. PMID 15684128.
101. Wright A, Sittig DF (Feb 2007). "Security threat posed by USB-based personal health records". Ann Intern Med. 146 (4): 314–5. PMID 17310061.
102. Wolter J, Friedman B (Nov-Dec 2005). "Health records for the people. Touting the benefits of the consumer-based personal health record". J Ahima. 76 (10): 28–32, quiz 35–6. PMID 16333941.
103. Woolf SH, Krist AH, Johnson RE, et al. (Mar-Apr 2006). "A practice-sponsored Web site to help patients pursue healthy behaviors: an ACORN study". Ann Fam Med. 4 (2): 148–52. doi:10.1370/afm.522. PMID 16569718.
104. Wright A, Sittig DF (2007). "Encryption characteristics of two USB-based personal health record devices". J Am Med Inform Assoc. 14 (4): 397–9. doi:10.1197/jamia.M2352. PMID 17460132.
105. Wright A, Sittig DF (Feb 2007). "Security threat posed by USB-based personal health records". Ann Intern Med. 146 (4): 314–5. PMID 17310061.
106. Zeng-Treitler Q, Kim H, Goryachev S, Keselman A, Slaughter L, Smith CA (2007). "Text characteristics of clinical reports and their implications for the readability of personal health records". Stud Health Technol Inform. 129 (Pt 2): 1117–21. PMID 17911889. http://booksonline.iospress.nl/Extern/EnterMedLine.aspx?ISSN=0926-9630&Volume=129&SPage=1117.
Conference Proceedings
1. Angst CM, Agarwal, R, Downing, J. An empirical examination of the importance of defining the PHR for research and for practice,” Proceedings of the 41st Annual Hawaii International Conference on System Sciences. Jan 2008.
2. Cimino JJ, Li J, Mendoca EA, Sengupta S, Patel VL, Kuhniruk AW. An evaluation of patient access to their electronic medical records via the World Wide Web. AMIA Symposium. Sep 2000.
3. Dorr D, Bonner LM, Cohen AN, et al. (2007). "Informatics systems to promote improved care for chronic illness: a literature review". J Am Med Inform Assoc. 14 (2): 156–63. doi:10.1197/jamia.M2255. PMID 17213491.
4. Iakovidis I. From electronic medical record to personal health records: present situation and trends in European Union in the area of electronic healthcare records. Medinfo. Sep 1998. 9(1 suppl); 18-22.
5. Ross S, Lin CT (2003). "A randomized controlled trial of a patient-accessible electronic medical record". AMIA Annu Symp Proc.: 990. PMID 14728493.
6. Stroetmann KA, Pieper M, Stroetmann VN. Understanding patients: participatory approaches for the user evaluation of vital data presentation. ACM Conference on Universal Usability; Proceedings of the 2003 Conference on Universal Usability . Nov 2003. 93-97.
7. Wuerdeman L, Volk L, Pizziferri L, et al. (2005). "How accurate is information that patients contribute to their Electronic Health Record?". AMIA Annu Symp Proc.: 834–8. PMID 16779157.
Other
1. America’s Health Insurance Plans. Consumer and provider focus groups on PHR. Unpublished. Jan 2005.
2. Angst CM, Agarwal R, Downing J. An empirical examination of the importance of defining the PHR for research and for practice. Robert H. Smith School Research Paper. May 2006. RHS-06-011.
3. California Health Care Foundation. National consumer health privacy survey 2005. Nov 2005.
4. Canedy JT. SimplyWell PHR. AHIC Consumer Empowerment Workgroup Meeting 7/23/06. Jul 2006.
5. Connecting for Health. Americans want benefits of personal health records Jun 2003.
6. Connecting for Health. The personal health working group. Jul 2003.
7. Connecting for Health. Connecting Americans to their Healthcare final report: working group on policies for electronic information sharing between doctors and patients. Jul 2004.
8. Connecting for Health. Connecting Americans to Their Health Care: A Common Framework for Networked Personal Health Information. Dec 2006.
9. Department of Health and Human Services. Standards for privacy of individually identifiable health information. Federal Register. Dec 2000. Billing Code 4150-05M; 82461-82829 (45 CFR Parts 160-164).
10. Detmer D, Steen E. Learning from abroad: lessons and questions on personal health records for national policy. AARP. Mar 2006.
11. Haslmaier EF. Health care information technology – getting the policy right. Web Memo – Heritage Foundation. Jun 2006. No. 1131.
12. Markle Foundation. Attitudes of Americans regarding personal health records and nationwide electronic health information exchange: key findings from two surveys of Americans. Oct 2005.
13. Miller RH, Sim I. Physicians' use of electronic medical records: barriers and solutions. California HealthCare Foundation. Mar 2004. 116-126.
14. Skewes JL. Shared Health, Inc. AHIC Consumer Empowerment Workgroup Meeting 7/23/06. Jul 2006.
15. Taylor H. Two in five adults keep personal or family health records and almost everybody think this is a good idea. Harris Interactive. Aug 2004.
[edit] References
1. ^ "Computerisation of personal health records". Health Visitor 51 (6): 227. Jun 1978. PMID 248054.
2. ^ Connecting for Health. The Personal Health Working Group Final Report. July 1, 2003.
3. ^ American Health Information Management Association. The Role of the Personal Health Record in the EHR. July 25, 2005.
4. ^ America's Health Insurance Plans. What are Personal Health Records (PHRs)? December 13, 2006.
[edit] External links
* MyPHR - Directory of PHR products that are currently available on the market - sponsored by The American Health Information Management Association * Video Interview of MIT Professor Peter Szolovitz about early developments of the Personal Health Record |
