We’re more than halfway through the semester and I can honestly say that this course has been very enlightening so far. Over the first half of the semester, my preconceived notions about health informatics especially in the Philippines was basically shattered, and I am discovering that there is so much more to learn from this course than what I initially thought.
That being said, let us now dive into this week’s topic – personal health records.
The question we were asked was…
“What features are considered critical or most useful by users of Personal Health Records?”
In last week’s blog, I discussed electronic health records (EHR). In researching for that topic, it was only then that I realized that EHRs are not synonymous with electronic medical records (EMRs). I also learned that automated health records (AHRs) and computer-based patient records (CPRs) are also different. Now we will be adding patient health records (PHRs) to the mix.
According to HealthIT.gov, a personal health record or PHR is an “electronic application used by patients to maintain and manage their health information in private, secure and confidential environment.” The key phrase here is “used by patients”, since that is the main distinguishing feature of the EHR from the AHR, CPR, or EMR (Ideally in EHRs, there should be a component where patients can manage their data as well). Through PHRs, a patient can be more involved or proactive in the management of his own health since it allows him to enter, view and modify health data into the application. Aside from being a static repository of data, the more advanced PHRs have decision-support capabilities that assist patients in managing their conditions. They have the potential for to help analyze a patient’s health profile, identify health threats or deviation from normal at an earlier time which leads to prevention or early intervention, or provide improvement opportunities based on analysis of drug interactions, gaps in current medical care, and identification of medication errors. When the PHR is also made accessible to the clinician or health care provider, it facilitates communication between provider and patient for continuous exchange of health data.
With the rapid developments in technology also come numerous attempts at personal health record softwares or systems. However, PHRs have not received the same attention as EHRs and EMRs. There are several issues that arise when it comes to its adoption, and I believe that the two main issues are:
- Quality of data – Since in PHRs patients are mostly the ones who enter the data, then how accurate are the data? Are they entered using medical or laymen terminology? Are the diagnoses accurate? Are the medications accurate? What about the laboratory and diagnostic results? Are they entered correctly? Abundant but poor-quality data defeats the purpose of the PHR.
- Security and privacy of data – Most PHRs are web-based or mobile applications that were developed for commercial distribution and use. Unlike EHRs and EMRs with more robust security features since they are usually linked to bigger institutions, PHRs are, as mentioned, often web- or mobile-based. Data contained in a mobile app, for example, may only stored in the mobile device. If there is an option to store it elsewhere, it usually in a cloud-based storage (which is often another application not primarily intended to store medical data). Or the data could be exported as a PDF or Excel or Comma Separated Values file, and then sent to an intended user (ex. physician) via email. The transfer is usually not encrypted and therefore vulnerable to breach or exposure.
What, then, are the criteria for a good personal health record system or application? Kim and Johnson (2002), in their paper Personal Health Records: Evaluation of Function and Utility, reviewed and evaluated several web-based PHRs that were available the time based on several criteria. Under function, they evaluated the website application in terms of access, medical conditions, medications, laboratory test, diagnostic tests, and immunization. As for utility, they assessed whether the application could incorporate data to manage conditions at a basic and more comprehensive level of representation. The overall conclusion of the study was that the PHRs available then had limited functionality and therefore had limited ability to serve as adequate representations of medical information for use in clinical practice.
Basing on Kim and Johnson’s paper, the identified barriers to adoption and on my personal experience as well, I developed a scoring system for the evaluation of PHRs. This, in a way, also helps answer the driving question for this week “What features are considered critical or most useful by users of Personal Health Records?”
Each criterion is will be scored from 1 to 5, with 1 being the lowest and 5 the highest. The rating per category will be averaged at the end, and the overall score will serve as basis if the app will be recommended or not. PHRs that scored 5/5 will be highly recommended, 3-⅘ as recommended, and 1-⅖ as not recommended.
To explain further the scoring system I created, I signed up for personal health record. I was not able to find a PHR that was made or based in the Philippines. I settled for the top hit in Google, which is the application My Medical.
See slide presentation below for my review of the application.
- Personal Health Records: Definitions, Benefits and Strategies for Overcoming Barriers to Adoption by Tang, et. al (2006)
- Personal Health Records: Evaluation of Functionality and Utility by Kim and Johnson (2002)
- How Patients Can Improve The Accuracy of their Medical Records
- Definition of PHR from HealthIT.gov