My semester-long research project in HSCI 2109 is about the advent and use of a very interesting innovation in health care: the Personal Health Record). This presentation is a mid-semester check-in with my fellow students to educate them about some key definitions, stakeholders, barriers, and recommendations I have gathered around system development and implementation of PHRs. This is a topic I am very interested and invested in so I would be happy to discuss it with anyone who is interested!

1. PERSONAL HEALTH RECORDS
A Facilitated Discussion by Mark Silverberg
HSCI 2109 - Trends and Innovations in Healthcare - GW Spring 2013

2. TOPIC INTRODUCTION
Electronic Health Record Personal Health Record
includes patient information
contains the encounter data
they have received from their
Definition between a health provider
providers plus data they enter
and the patient
themselves
Maintained
Provider or Payer Patient
by
Personal Health Records (PHRs) are an Innovation in Health Care
• The topic of PHRs is a perfect example of how information technology has the
potential to enrich the health care experience
• PHRs have the potential to catalyze patient engagement which has been shown
to cut costs and improve outcomes through both preventative medicine and
chronic disease management (PCMH model)

3. KEY STAKEHOLDERS
• Patients stand to gain insight into their own health and improved
outcomes if their PHR provides the right functionality. Security breaches
would, however, put patients’ own information at risk (however they
already at risk due to EHR use which is beyond the patient’s control)
• Providers can benefit by having a more knowledgeable and informed
patient. Some providers could see this as a larger burden and more
work. Providers can benefit from government incentives in some cases.
• Payers benefit when their costs are
reduced. PHRs do this by letting patients
manage chronic diseases and encouraging
preventative measures; may pay for PHRs
• IT service providers can benefit
economically from building products and
providing services but must comply with
security regulations such as HIPAA Retrieved 4/6/2013 from http://www.deloitte.com/view/en_BE/be/industries/
life-sciences-and-health-care/life-sciences-and-health-care-in-belgium/

4. BARRIERS TO ADOPTION
Providers
• Attitudes including lack of buy-in (Anoshiravani 2011)
• Practitioner difficulty with technology (Miller 2004)
• High up-front costs for IT (Miller 2004)
Patients
• Lack of information, motivation (Goel 2011)
• Negative attitudes towards technology, security concerns (Goel 2011)

5. FACILITATORS OF PROGRESS
Technology
• Advancements in technology continue to make PHRs more viable
through secure data exchange and improved user experience design
Payers
• Due to the savings and subsequent improved
profit margin, payers may continue to subsidize
PHRs for their patients to encourage healthy
(and cost-saving) behavior and choices
Government leverage on providers
• Regulations including some Meaningful Use measures require
providers to make patient portals available to patients in order to
receive incentives. It is thought this will be the first step to get
patients used to managing their care and holistic health online.

6. SUSTAINABILITY & ECONOMICS
• A PHR is controlled by a patient but it can be hosted by any trusted party
• Some receive a PHR through their employer, payer, provider, or health
club.
• There are free and paid options in the marketplace for patients to
choose from. Popular examples include Microsoft HealthVault and
NoMoreClipboard.
• Implementation costs for PHRs vary greatly. There are some open-
source software packages which can be used to significantly reduce
costs.
• Providers are economically incentivized by the
government (Center for Medicare and Medicaid
Services) to implement EHRs and PHRs.

7. COST AND BENEFITS
FOR INDIVIDUALS AND SOCIETY
• With correctly implemented and supported PHRs,
improved health outcomes and reduced costs can be
achieved; a few examples include:
• reminding and urging patients to receive preventative medicine such as
flu shots and colonoscopies (Lau 2012)
• allow patients to ask medical professionals non-urgent questions
without calling or coming into the office (Detmer 2008)
• facilitate chronic disease management using online, mobile, and device-
connected tools (Urowitz 2012)
• connect patients to cost-saving telemedicine providers
• A 2008 article from the Journal of the American Health Information
Management Association (JAHIMA) noted that “widespread use of PHRs
could save the US healthcare industry between $13 and $21 billion a year.”

8. IMPORTANT CONSIDERATIONS
There has been a lot of credible research performed on the topic of PHRs.
Future researchers and system implementors should take advantage of the
existing wealth of knowledge including these suggestions:
• Good user interfaces not only make for a more enjoyable experience but also
increase data quality (Kim 2004)
• Most popular features were usually found to be medication overview and lab
results sections followed by the treatment appointments feature (Ros 2012)
• Patients are most likely to engage with the PHR technology if the practitioner
who explains it to them ‘buys into’ the pitch (Lee 2006)
• Organizational change management cannot be underestimated (Bonander
2010); it may be as or more important than the technology itself (Day 2012)

9. RECOMMENDATIONS
• Having a PHR puts the
patient in a position to
more effectively monitor
and impact their own
health. Doing so can help
more than just the patient.
• PHR system developers and
implementors must keep patient
and practitioner needs and “Having a Personal Health
feelings in mind throughout Record keeps me in control
the process of my family’s healthcare.”
Retrieved 4/6/2013 from
https://www.mymediconnect.net/