Sunday, June 19, 2011

The PCEHR and The PHR - Are They Going To Be Useful And Used By Clinicians? Seems Not Without Changes!

The following interesting reports appeared a few days ago.

Personal Health Records: Docs Have 3 Big Doubts

Data management, changes to the patient relationship, and practice management issues are key barriers to implementation, doctors say in study.

By Neil Versel, InformationWeek

June 13, 2011

URL: http://www.informationweek.com/news/healthcare/EMR/230600009

Primary care physicians like the idea that personal health records will make healthcare data more portable and open up communications channels with patients, but they still have plenty of questions about data security, workloads, and how PHRs might change their relationships with patients, a new study says.

According to the study, an online exclusive for the journal Canadian Family Physician, family physicians are interested in the general concept of PHRs, but the technology needs to be integrated with electronic health records, easy to use, and add value to family practice before doctors will consider bringing PHRs into their practices.

Physicians generally believe that PHR adoption is "inevitable," and helpful to getting patients more engaged in their own care, researchers at the University of Western Ontario in London, Ontario, reported. "However, participants consistently raised concerns about data management, changes to the patient-physician relationship, and practice management issues. These concerns were the three key barriers to the implementation and adoption of PHRs," they wrote.

While previous research has focused on consumer attitudes toward PHRs, this study looked at family physicians. The researchers studied 10 family physicians in southwest Ontario in 2009, half of whom occasionally worked in emergency departments or walk-in urgent care clinics, and thus saw patients they weren't familiar with. Six of the physicians were EHR users.

Data management issues raised included security, stewardship, and completeness of records. "If [patients] are entering information, it may not be accurate for what's going on ... it may be their interpretation of the layman's description that is given to them," one physician said, according to the study.

Integration of a PHR into an EHR might alter the physician-patient relationship, the researchers wrote, by removing the information filtering that the doctor provides. "With full and independent access to the EHR, patients would not have the medical information transmitted to them by their physicians. In the absence of this traditional framing of medical information, patients might experience unnecessary anxiety as they attempt to interpret the complex medical information stored in their charts," the study said.

This issue of creating unnecessary anxiety is particularly worrisome in the context of mental health, according to the researchers.

More at the URL in the article.

Coverage also appeared here:

PHR-EHR integrations present challenges for physicians

June 16, 2011 — 10:43am ET | By Janice Simmons

Personal health records (PHRs) can be beneficial in improving interactions with patients, according to interviews with 10 family physicians conducted by researchers at the University of Western Ontario.

However, implementation and adoption of PHRs still present many challenges--such as integration with electronic health record (EHR) technology, burdens on cost and/or time, and perceived added-value to the practice of medicine--that need to be addressed before those physicians make PHRs a part of their practices, say the researchers in a recent online study published in Canadian Family Physician.

In particular, the physicians questioned whether the integration of a PHR with an EHR could alter the patient-physician relationship. If patients have "full and independent access" to EHRs, then patients then would not have the medical information transmitted to them by their physicians, the researchers said.

In the absence of this traditional framing of medical information, patients could experience "unnecessary anxiety" as they attempt to interpret the complex medical information stored in their charts, the researchers added.

More (with links) here:

http://www.fierceemr.com/story/phr-ehr-integrations-present-challenges-physicians/2011-06-16

Here is the abstract to the article:

Family physicians’ perspectives on personal health records -Qualitative study

Gary L. Yau

Andrew S. Williams

Judith Belle Brown, PhD

Abstract

Objective To explore FPs’ perspectives on the value of personal health records (PHRs) in primary care and the implementation and adoption of PHRs in Canada.

Design A qualitative design using semistructured interviews.

Setting Southwestern Ontario.

Participants Ten FPs.

Methods The 10 FPs participated in semistructured interviews, which were audiotaped and transcribed verbatim. An iterative approach using immersion and crystallization was employed for analysis.

Main findings Participants were generally positive about PHRs, and were attracted to their portability and potential to engage patients in health care. Their concerns focused on 3 main themes: data management, practice management, and the patient-physician relationship. Subthemes included security, privacy, reliability of data, workload, remuneration, physician obligations, patient misinterpretation of medical information, and electronic communication displacing face-to-face visits. Participants identified 3 key facilitators for adoption of PHR systems: integration with existing electronic health record systems, ease of use without being a burden on either time or money, and offering a demonstrated added value to family practice.

Conclusion This study replicates previously published literature about FP concerns and opinions, and it further identifies remuneration as a potential barrier in Canadian fee-for-service payment models. Participants identified 3 key facilitators, which were suggested for implementation and adoption of PHRs, providing a basis for future research and development of these systems for use in Canadian family practice.

A personal health record (PHR) is an Internet-based tool that allows the user to input information about his or her lifelong medical history. Personal health records are maintained by users, and they have control over who can access their records.1 Specific tools available through PHRs can include functions to input daily measurements (eg, blood pressure, body weight, blood glucose), access provider-endorsed websites, or communicate directly with health care providers by electronic means.2 Another possibility within the scope of PHR technology is integration with provider-maintained electronic health records (EHRs), allowing patients access to their full medical records.3

Considering the potential market for PHR technologies, it is not surprising that multinational companies are already testing their versions of PHRs at large health centres, such as the Cleveland Clinic,4 which uses Google’s Google Health, and Beth Israel Deaconess Medical Center,5 which uses Microsoft’s HealthVault. In Canada, Sunnybrook Health Sciences Centre in Toronto, Ont, currently offers PHRs to its patients,6 and the Canadian Medical Association has commissioned mydoctor.ca, a free PHR, to encourage use by Canadian physicians.

Most studies examining the issues with implementation of PHRs into practice have been based in the United States. This is in large part owing to the Markle Foundation,1,7 which conducted an important survey targeted at US physicians and citizens. Responses to this survey have formed the basis for the formal definition and preferred attributes of PHRs. All the major prototypes have been developed by US companies and trialed in US institutions. With the recent push by the US government to implement EHRs across the country within a decade,8 the increasing accessibility of PHR platforms, and the willingness expressed by patients to use them,7 PHRs are a highly relevant and timely topic of discussion.

Kaelber et al9 developed a research agenda for PHRs based on a review of all existing PHR-specific literature. One of the 4 main directions for further research was evaluating the adoption of PHRs and the attitudes of health care providers and patients toward PHRs. Previous studies have documented patients’ perspectives on PHRs7,10; however, Kaelber and colleagues state there is a paucity of data on provider attitudes to technology. An understanding of this view can lead to information that will help alleviate barriers to adopting PHRs.

The purpose of this study was to explore FPs’ ideas about and views on the implementation and adoption of PHRs.

The full article is available free here:

http://www.cfp.ca/content/57/5/e178.full

What is really important here are the following (from the Abstract):

Barriers to use are:

“Their concerns focused on 3 main themes: data management, practice management, and the patient-physician relationship. Subthemes included security, privacy, reliability of data, workload, remuneration, physician obligations, patient misinterpretation of medical information, and electronic communication displacing face-to-face visits.”

Things that will be needed to achieve adoption:

Participants identified 3 key facilitators for adoption of PHR systems: integration with existing electronic health record systems, ease of use without being a burden on either time or money, and offering a demonstrated added value to family practice.”

Not to harp, but these two paragraphs nail it in my view. And the PCEHR as we are currently seeing it presented fails on pretty much all these counts.

I hope NEHTA / DoHA read and take careful note of what it found here. As the recent survey showed (see here):

http://aushealthit.blogspot.com/2011/06/aushealthit-poll-number-74-results-13.html

You go ahead with implementation without clinical support and you are dead in the water. And despite some headlines to the contrary Australian docs are rather similar to the Canadians in terms of their concerns!

David.

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