Personal Health Records
It wasn’t long ago that a person’s personal health record was a box kept at home, overflowing with immunization records, lab results and past prescriptions, and there was a similar file at all the various doctors and clinics you visited. Nowadays, many of those records—along with doctors’ notes—are being offered online, with hospitals and companies making an effort to increase patient access to health information.
Online personal health records (PHRs) lower barriers between patients, their medical information and their doctors, says Dr. Matt Handley, a primary care doctor and director for quality at Group Health Cooperative, a local pioneer in PHRs that has had online records since 2003. Handley describes two types of PHR: In one model, patients integrate their information into a system (this is the most common form of PHR keeping in the United States); in the other, doctors allow patients to view the electronic health record that the care team uses.
HealthVault, a Web-based Microsoft system that stores medical records and other data online, is an example of the patient-driven model. Patients can fill out a basic profile, as well as integrate HealthVault into their exercise regimen or illness management. Many labs, clinics and pharmacies can access HealthVault and send patient information directly to patient profiles; it also connects with a growing list of health and fitness apps. Patients can add in information from all of the various doctors they visit and can control who—doctors, family members, caregivers—has access to which files and whether they can modify them. They can also create an emergency profile, which contains key information that can be printed out or accessed online. People can create health files for others as well, such as an elderly relative or a child.
“In an emergency situation, having up-to-date medication and allergy lists can easily save your life,” says Melissa O’Neill, director of business development for HealthVault. “For anybody trying to keep a chronic condition like diabetes or blood pressure under control—or even just keep motivated to lose a few pounds—being able to see trends and share status with caregivers can make a huge difference.”
Group Health uses the second type of PHR system, by which doctors enter information into Group Health’s shared online medical records, available through My Group Health, which also enables patients to send a message to their doctor, access lab results and other medical records, and order prescriptions. Patients can also give permission to release that information to caretakers and family members. According to Handley, about 75 percent of Group Health patients actively use this system. Other local clinics have followed suit: The Polyclinic recently went to an online record system, as has Virginia Mason, Swedish and Franciscan Health System.
Other health organizations are trying variations on the concept. In 2010, two doctors at Boston’s Beth Israel Deaconess Medical Center, with nine other doctors across the country, launched the OpenNotes initiative, a unique study looking at the impact of allowing patients access to doctor’s office notes as part of their medical records. Harborview Medical Center was one of three medical institutions nationwide that participated, with Group Health’s James D. Ralston, M.D., M.P.H., as one of the study’s coauthors. According to the organization, doctors’ notes “are the thread that tie together many pieces of information in the medical record,” but often go unseen by patients. At the end of the study, patients reported feeling more in control of and better able to understand their care, and a few medical centers nationwide have signed on. Harborview, which is currently rolling out changes in its electronic medical records access, is in the process of getting OpenNotes set up for its adult medicine and ophthalmology clinics; the notes would be accessible via Harborview’s sytem.
“Our patients want OpenNotes, and it will help them to become involved and educated partners in their medical care,” says study coauthor Joann G. Elmore, M.D., M.P.H., and professor at the University of Washington School of Medicine and Harborview Medical Center. She adds, “I can provide better care to my patients when they are actively engaged and knowledgeable about their health.”
Legislation is moving toward putting more patient information online. The Health Information Technology for Economic and Clinical Health (HITECH) Act (part of the 2009 American Recovery and Reinvestment Act) promotes the use of accessible electronic medical records, modernizing technology in clinics across the country, O’Neill says. “Part of these improvements include the tools and systems that can connect to personal systems like HealthVault, making it easier for people to gather and share up-to-date records.”
PHRs will be essential as clinics try to bring patients more choices—and peace of mind. As Handley puts it, “Information is therapy.” +