Tuesday, February 05, 2008

Personal Health Record

In addition to EMR (electronic medical record) and EHR (electronic health record), the latest three letter acronym in this area is PHR - or, personal health record. These are described in a February 4th article from the Associated Press. What's intriguing about PHRs is that they are patient-driven.

Everyone has heard of computer tax preparation software. Well, why not a health record created and maintained, not my doctors or hospitals, but by patients. Hmmmmm...... The article does take a shot at doctors for being slow to accept electronic records (although I do agree that docs have been slow to adapt certain technologies).
Doctors have been slow to switch from error-prone paper records to digital ones, so the trend promises to empower patients to take matters into their own computers.
From the front lines of American health care, I do admit that - every day - I have people bring in their blood sugar log or blood pressure log. They keep track of it on excel or other spread sheet program. Not only do patients print this out and bring it to their visit with them, they also bring color graphs which they print out on their ink jet printers. Quite impressive.

Plus, some of these devices, like home blood pressure monitors and blood sugar machines - they have a memory. So, that my patients can show me their trends for the past few hours, past few weeks, and even past few months. What would stop them from inputting this into their computer to further their personal health record.
While large hospital and insurance networks are making the switch, few private doctors have. And even then, software differences mean one doctor's system can't always share information with another's.

Hence the patient-driven trend. More than 100 vendors, from insurers to free Web sites, offer individuals or families the option of creating PHRs — records that they control.

The programs range from very simple electronic diaries to more comprehensive programs that link directly with doctors or hospitals for direct downloading of formal e-charts.
Computer vendors are taking the lead from pharmaceutical companies - direct to consumer advertising. With hospitals and now patients utilizing computer technology for health records, the community based primary care doc (ie - me) will be forced to make the huge financial investment to implement some kind of electronic record (this computer program will probably not be compatible with either the hospital system or multiple patient systems - then what?).

By the way, there is no doubt that electronic records make things more convenient for the hospital, the patient, the pharmacy, the insurance company, the regulatory agency, and others. But how about the physician? I believe the jury is still out on that one. Plus, if you treat electronic records like pharmaceuticals (Ek!), what is the number needed to treat for one person to benefit? There's an interesting question....


Kirsten said...

I'm all for medical records getting with the 80s and going electronic. My doctor's office uses them, but only within their office. It kinda helps that they are the largest healthcare provider in southern Nevada, so if I need to go to their urgent care facility in the middle of the night I don't have to tell them the basics.

I've seen some PHR sites but so far only worksheets that I can print out. I'd be interested in a free database style program, especially some templates that can be used in MS Office.

Jessica said...

I know my insurance company just introduced a website that has nurses on it to aks questions 24/7... I know cause they called me right off the back since I'm listed as havng a chronic condition although the nurse had never heard of Hemicrania Continua... so not much help. They also have a place where you can keep track of your own health records... I would guess this is similar to what you described in the post. Though I have not personally looked at it yet.

Do you think that as a dr this kind of thing would be help full to you?

Kb said...

As a patient and a Mom of a special needs, nonverbal child with a seizure disorder I am for the implantable chip. I know it sounds mean but a few years ago he had a seizure at school. (A little boy pushed him down and he hit his head on the hard floor)The teacher was so rattled she could not give much information and the EMTs spent more time calming her down. My son seizes for up to 20 minutes and has stooped breathing. He was transported to the ER and I drove/ flew from work to meet them at the hospital. Because it was considered a trauma incident we were taken to a special room and treated very with kid gloves. After explaining to the nurse that we were used to this and not going to fall apart they allowed is into the room. My son had been given heavy doses of Ativan (which is normal for him) and was almost asleep. As we walked the Er doc said to his team, "This child is mentally retarded this is probably his baseline behavior." The tiger momma in me wanted to slap him but I said loud and clear, "This is NOT his baseline he has been sedated to stop the seizures!" The thought of someone not knowing what is going on with my child because he can't talk keeps me up at night. I am all for electronic records and chipping.

Anonymous said...

Just out of curiosity, Dr. A., in what ways do electronic records NOT make it easier for the physician? I would've thought one definite benefit for the doctors would be the fact they can print out patient instructions and hand them over, thus guaranteeing their patients will remember what they are supposed to be doing and follow those instructions more readily.

This seems like it's been especially handy when the system has been preprogrammed with some of the most commonly used ones. My doctor can even quickly access and print things like back stretches for me -- a sharp contrast to before, when she had to go spend 20 minutes hunting through a pile of printed pamphlets. It also means she can clearly and instantly find and read notes made by other doctors, as well as three years worth of emails I've sent a variety of doctors as well, reporting on my progress, questions, issues, etc.

But this is all stuff I see on MY end that makes it APPEAR like things are easier for the doctor now that we've gone electronic. You make it sound like they actually aren't. In what way? Is it just because of the typing/inputting? Or is there something else you're losing by going electronic?