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When is the PHR the
LHR ?
PRESENTED
B Y:
Joan Beach
CHW Privacy Official
The Privacy Symposium
Sixteenth Annual National HIPAA Summit
August 20, 2008
Cambridge, MA
When is the PHR the LHR?
The Personal Health Record
What is a Personal Health Record (PHR)?
•
A personal health record (PHR) is a confidential and
easy-to-use tool for managing information about your
health. A PHR is usually an electronic file or record of
your health information and recent services, such
as allergies, medications, personal medical facts,
and doctor or hospital visits that can be stored in
one place, and then shared with others, as you see
fit. You control how the information in your Personal
Health Record (PHR) is used and who can access it.¹
•
Email messages
¹ Available at http://www.medicare.gov/PHR/Overview.asp
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When is the PHR the LHR?
What Components are valid?
•
Continuity of Care Record - CCR ¹
Problems
Encounters
Family History
Functional Status
Social History
Plan of Care
Allergies/Alerts
Payers
Medications
Medical Equipment
Immunizations
Advanced Directives
Vital Signs
Health care providers
Results
Non-professional caregivers
Procedures
¹Developed by American Society for Testing and Materials (ASTM)
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When is the PHR the LHR?
•
Standardized Format – HL7 Reference
Information Model (RIM)
–
Continuity of Care Document (CCD)
•
–
•
Similar to CCR with an additional Identifier
Agreement reached to work with ASTM (XML) to
combine CCR & CCD
Common Platform Components (CPC)¹
–
–
Functional Requirements (Elements)
Technical Requirements (Architectures)
¹Availabe at www.PojectHealthDesign.com
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When is the PHR the LHR?
User Community
• Consumers
– Increased Mobility
– Computer and Internet Acceptance
• Graying of America
• Insurance Companies
– Kaiser Permanente – My Health Manager
• https://members.kaiserpermanente.org/kpweb/toc.do?theme=myhealthmana
ger_members
– Aetna – SmartSource (CareEngine)
• https://www.aetna.com/member/
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When is the PHR the LHR?
Vendors
• Google Health – Sharing Information
– “Google Health contains a directory of third-party websites
that are capable of securely sending information to Google
Health. These websites (which may include your medical
provider) may give more information about certain
conditions or extend the functionality of Google Health in
other ways. By creating a link to these websites, you give
them permission to send you information such as
medical records, prescription histories, or test reports.
– You can approve access for some of these websites to
view your health information. If a website accesses your
health information and stores a copy of your information,
that copy will be governed by that website’s privacy policy.
Others at that facility – like an on-call doctor – may be able
to view your information. Google is not responsible for the
content, performance, or privacy policies of third-party
websites. “
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When is the PHR the LHR?
Vendors, cont.
– Microsoft HealthVault PHR - http://www.healthvault.com
• Connection with Hospitals
– iHealth Record - http://www.ihealthrecord.org/
• Allscripts
• Google Health
• Regulatory Agencies
– Medicare PHR Recommendation -myPHR.com
(AHIMA) - http://myphr.com/
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When is the PHR the LHR?
Value of the PHR
• To Consumers
PLUS
Desire for Control of Healthcare
MINUS
Don’t forget the healthcare
professionals knowledge is still key
Establish & Maintain Goals
Manage who is allowed Access (family
members, providers, insurers)
Relationships change. No
assurances information was not
saved by others or printed into hard
copy. Use discretion when
permitting access.
Allows for Accumulation or a variety of
healthcare resources
Increase exposure of PHI to thirdparties. Awareness of data security
is key.
Test Results available
Providers & Insurers must participate
Centrally located
Limited access to Internet regularly
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When is the PHR the LHR?
Value of the PHR
• To Providers
PLUS
MINUS
Reduce Unnecessary OV
New Task- Email
Reduce Phone Calls
24/7 Expectation
Prescription Refills
Ongoing Family History
Requires Frequent Review for new
details
Appointment Management
Requires Practice Management
Application
Integrated Record
Validation of Health Status
Required:” Can I trust the
information as fact?”
Data Retention requirements: “ What
happens when the Patient
disassociates?”
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When is the PHR the LHR?
Value of the PHR
• To Insurers¹
PLUS
Reduction in Medical Errors
MINUS
All parties involved in care must
participate in PHR
Key to prevention and maintenance
of chronic conditions
Conduit to provide wellness and other If access cannot be limited to
program announcements
specific health information
individual privacy rights in jeopardy
Portability from one insurer to another Fear of premium adjustment
¹ http://www.ahip.org/search/default.aspx
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When is the PHR the LHR?
Value of the PHR
• To Regulatory Agencies¹
PLUS
MINUS
Availability of records during a
Disaster
Standards for accumulating
information must be followed or
value is diminished
Resource for Public Health –
Background information related to
certain disease categories
Fear governmental agencies will
have “too much” information about
individuals
Development of Health Risk Appraisal Consumer concerns may be used
for consumer health management
for purposes of Research without
consent
¹ http://www.insurance.ca.gov/0400-news/0100-press-releases/0070-2008/release040-08.cfm
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When is the PHR the LHR?
Proxy PHR Users
• Determination Requirements
– Varies from State to State
– Documentation is not always required
– Verification prior to communicating
• Ownership of Relationship
– Consumer is the ultimate owner
• Maintaining current relationship access
– Insurers, Providers may share Responsibility if integrated
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When is the PHR the LHR?
Electronic Messaging within the PHR
• Patient to Provider / Provider to Patient
– Secure Messaging capabilities (iHealth)
• Encrypted
• Patient education for appropriate use – non-urgent only
– Clinic vs. Acute Care Setting
– Establish Reporting Periods
• Patients with chronic conditions can report to the provider on a
pre-arranged schedule
– Prompt Response is key
• Billable Services
– Patient Education
• Must understand when a communication becomes a “Visit”
• Ability to Refuse
– Insurance Verification
– Patient Pay – Accounts Receivable Management
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When is the PHR the LHR? – EXAMPLE LHR
Data Viewing Source Systems
ADT Demographics
(IDXtend/ FlowCast)
Laboratory
(Cerner Classic)
Pathology
(PathLogics )
Pharmacy
(Extreby)
Radiology
I
n
t
e
r
f
a
c
e
Partial Electronic
Health Record
Clinical System Repository
CIS
ALLSCRIPT/
TouchWork
(RadNet Emageon PACs)
Transcription
H&P, OP Reports,
Consultations, Clinic Notes
(MedQuist)
Paper Documentation /
Optical Archiving
Front Cover Summary/Med List
Handwritten Clinic Notes
Handwritten Progress Notes
Handwritten Nurses Notes/ Orders
Handwritten Ancillary Notes
Laboratory-Anatomical
Laboratory-Clinical
Diagnostic Imaging
Other Handwritten Documentation
Hospital Records
Consents
Advance Directives
Outside Record
Online
Data
Entry
Current State= CIS
On-Line Clinical
Documentation
E-Sign
CPOE
Assessment
Nursing Notes
Vital Signs
Ancillary Notes
Physician Clinic Notes
Hybrid
Legal Health Record
H-LHR
Paper/ Optical Imaging
ALLSCRIPT/
TouchChart
Stand Alone Applications
Home Health
(Misys)
Elysium
(Data Repository)
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When is the PHR the LHR? – EXAMPLE LHR + PHR
Data Viewing Source Systems
ADT Demographics
(IDXtend/ FlowCast)
Laboratory
(Cerner Classic)
Pathology
(PathLogics )
Pharmacy
(Extreby)
Radiology
I
n
t
e
r
f
a
c
e
Partial Electronic
Health Record
Clinical System Repository
CIS
ALLSCRIPT/
TouchWork
Online
Data
Entry
Current State= CIS
On-Line Clinical
Documentation
E-Sign
CPOE
Assessment
Nursing Notes
Vital Signs
Ancillary Notes
Physician Clinic Notes
(RadNet Emageon PACs)
Transcription
H&P, OP Reports,
Consultations, Clinic Notes
(MedQuist)
Paper Documentation /
Optical Archiving
Front Cover Summary/Med List
Handwritten Clinic Notes
Handwritten Progress Notes
Handwritten Nurses Notes/ Orders
Handwritten Ancillary Notes
Laboratory-Anatomical
Laboratory-Clinical
Diagnostic Imaging
Other Handwritten Documentation
Hospital Records
Consents
Advance Directives
Outside Record
Hybrid
Legal Health Record
H-LHR
iHealth
Health Profile
Prescription Requests
Email Messages
Validation
Paper/ Optical Imaging
ALLSCRIPT/
TouchChart
Stand Alone Applications
Home Health
(Misys)
Elysium
(Data Repository)
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When is the PHR the LHR?
Concerns
• Technology Compatibility
– Not all EMRs are Built the Same!
• Once a patient “connects” with a provider information
is considered “available”.
• Knowledge of information that is not utilized elevates
risk for liability
– PHR includes allergies not included in the clinicians chart
– Clinician accepts PHR connection
– Prescribed medication causes and adverse event
• AB1298
– Who is responsible when a Breach occurs
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When is the PHR the LHR?
Ongoing Dialog
• “World Wide Web” = World Wide Access
• Ownership = Does it mean Responsibility for Data
Security? Confidentiality? Integrity? Availability?
• Do Consumers perceive the PHR as a value added
experience?
“When consumers are comfortable with an activity, such as
they were with searching for cause and treatment
information, their perceived effectiveness is higher, their
trust is higher and their likelihood to exhibit desired
behavior is higher—all by significant margins. Sites that
expect end users to perform activities that are less
familiar than healthcare information searching are going
to have to be simpler and easier to use.”¹
¹”The Consumer Experience of Online Healthcare” available at: www.changesciences.com
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When is the PHR the LHR?
Conclusions
• No Clear Standard
– Entities must analyze value to current business
– Model of the LHR “Hybrid”
• Keep it Simple
– Consumer Awareness of liability
– Manage partnerships : How many PHR flows can a Covered
Entity manage?
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