Personal Health Records In Action: Google Health and Microsoft HealthVault
Personal Health Records (PHRs) offer an interesting way for patients to access an electronic health record, or at least selected portions of it. While there are many to choose from, tech giants Google and Microsoft each have PHR offerings, and the Journal of the American Medical Informatics Association recently published a study that trialed both these systems. The authors pull 4 main learning points from their experience.
But first some background
PHRs generally fall into two categories: Tethered or stand alone. Roughly speaking a stand alone variety can be separate from any other paper or electronic record and filled with patient-entered data, or have some varying level of interconnectedness with a clinical EMR (electronic medical record). As its name suggests, a tethered system is fed by an electronic medical record and is essentially a patient portal into clinical data gathered by a provider or payer.
In 2008 researchers at the Military Health System launched MiCare, a one year pilot project aimed at giving service personnel greater access to their EHRs. The clinicians were practicing out of a major 400-bed tertiary care center in Washington State. They enrolled 250 participants, and gave them option of choosing Google Health or Microsoft’s HealthVault PHR system, tethered to their military EHR. 169 chose HealthVault, and 81 opted for Google Health.
The PHRs provided data on: Lab results, allergies, medications, radiology reports, appointments, medical procedures medical problems, consultation reports, inpatient notes, outpatient encounter notes.
After extensive surveying, debriefing and analysis, including the table of comments from users shown below (Table 4), the researchers extrapolated four key learning points. There were technical findings as well, which you can read about in the paper itself.
1. Speed (and therefore data) Matters. Since most participants wanted all possible data to show up in their PHR, the initial default was to transfer all possible data to the PHR. Problem: The amount of data transferred was such that it slowed the system to a point that was unacceptable to many users. Solution: Let patents decide what data they wanted to transfer to their own PHR.
2. Immediacy versus Perspective. Patients wanted access to information such as lab test results as soon as they were available, yet clinicians wanted a 7-day lag time between when results were ready and when they appeared in the PHR. This would give them time to interpret results, and have a chance to communicate directly with the patient. Solution (sort of): Test results related to sensitive issues such as sexually transmitted disease or pregnancy would be communicated by the clinician to the patient, and only appear in the PHR if the patient requested it.
This raises a couple of interesting issues tied to the perceived purpose of the PHR. If it is supposed to allow a patient access to their medical information, does it make sense to have them receive it after their clinician? On the other hand, should I learn that I’ve tested positive from a dread disease from a new entry in my PHR? Is the PHR supposed to provide a reasonably complete view of my health, or an edited one that allows me to pick and choose what is listed: Diabetes, yes, gonorrhea, no. For an ‘out of network’ provider that may be using a PHR to get a glimpse at a patient history, this could lead to problems (more on that in #4).
3. Workflow matters. Providers complained that the interface between EMR and PHR was not fully automated, which necessitated an additional step for them. This seems like a no brainer: A tethered PHR has to automatically feed from an EMR without additional inputs from the clinician if it expects to live a long, healthy, functional life. Another interesting point: If patients choose what information is appears in their PHR, then it may be of limited utility as a communication tool for clinicians, who may not be sure exactly what information each patient has access to via the PHR. “Results of your blood panel look fine, and are available in your PHR. If you have enabled ‘view my test results.’”
Maybe that’d work.
4. Giving control to patients can have unintended consequences. When patients can choose what information is shared via their PHR, it may not provide a holistic view of their health. What if you don’t mention your mental health condition to your cardiologist who prescribes a drug contra-indicated for patients with your condition? In addition to these possible scenarios, could giving patients ultimate power over their health information ultimately degrade provider trust and acceptance of such systems? The answer to that likely depends on who you ask.
Photo Credit: Google Health, HealthVault.