Thursday, December 08, 2011

Here Is A Good Exposition Of How PHRs Can Be Made Relevant. The PCEHR Misses Most Of What Is Needed.

This very useful review appeared a few days ago.

How Providers Can Make PHRs Relevant

Greg Freeman for HealthLeaders Media , November 30, 2011

This article appears in the November 2011 issue of HealthLeaders magazine.
Personal health records have been a forward-thinking idea for some time now, but the rewards and requirements of achieving meaningful use are putting more pressure on providers to adopt a system that allows easy access for the patient but a reliable conduit of information from the health provider. Of the many models available, how does a provider know which way to go?
The key may be creating a PHR that is actually used by the patient and provider, not just offering a system that sounds good on paper but might not be what either party wants. In the past, healthcare providers have found that some PHRs aren’t user-friendly for the patient; the data is often incomplete or inaccurate, and many doctors don’t trust the accuracy of records created and maintained by patients. The result is that the PHR isn’t utilized to any significant extent.
One of the first decisions when considering a PHR is whether to have it tethered to the electronic medical record so that data can be linked automatically, or to have the PHR be a standalone system in which information must be entered. The tethered (or shared) option is winning favor among many providers, says G. Daniel Martich, MD, FACP, chief medical information officer and vice president for physician services at the University of Pittsburgh Medical Center. UPMC uses a PHR system called HealthTrak, a Web-based portal that allows patients at its 20 hospitals and 400 outpatient sites to feed data into the electronic record. More than 70,000 patients currently use the system.
UPMC explored both options originally, developing its tethered HealthTrak system but also partnering with Google and its untethered PHR called Google Health. Even before the recent demise of Google Health, UPMC was seeing better results with the tethered option, which saw higher participation and more positive feedback.
“Our research shows that patients like having a direct connection to their physician. A shared connection is what consumers really want,” Martich says. “They want to communicate directly with them, get their lab results in a timely fashion, and see their appointments. They like seeing what their doctor sees.”
UPMC’s HealthTrak system was developed in-house six years ago through a grant from the Department of Defense, because the health system treats many military patients. UPMC uses Epic’s EMR system, and the UPMC HealthTrak PHR was built on the framework of Epic’s MyChart PHR. When Epic developed its MyChart patient portal, the health system linked its PHR to MyChart and the EMR. The PHR allows patients to see their lab results, vital signs, appointments, and most other data in real time, as soon as it is available to the physician, with the exception of MRI, CT, and radiology results. In addition, patients can correspond directly with the doctor, who is expected to reply within one business day.
Another question involves who is going to pay for this access. There are fee-based models for PHRs, in which the patient pays for the right to access the system, but Martich says UPMC patients were not interested in paying—even though they are enthusiastic about the PHR when it is free to them. UPMC does charge $40 for e-visits, in which an established patient with a new condition fills out an online form for 21 possible diagnoses and submits it to the physician for evaluation.
Epic charges UPMC for each patient using the PHR linked to its EMR, but the health system does not pass that expense on to the user. The charge is approximately $2 per year per patient, Martich says. 
Once your PHR is in place, how do you engage both patients and physicians in using it? More than 1,100 physicians at UPMC use the Epic EMR, and they are encouraged to have their patients sign up for the PHR. The health system fosters participation by both patients and physicians by holding tutorials during staff meetings and having contests with a prize—such as a catered lunch for the staff—for the physician office that signs up the most participants.
The corporate communications department also helps market to patients by providing leaflets and screen savers for computers in the exam rooms that encourage patients to ask their doctors about HealthTrak. Sign-ups average about 700 per week, up from 500 last year, Martich says.
Patients with the most diagnoses—the sickest—are the most likely to use a PHR, says Holly Miller, MD, MBA, FHIMSS, chief medical officer with MedAllies, a company in Fishkill, NY, that provides PHR and other technical support for healthcare providers. She also is on the board of directors of HIMSS and is former CMIO for Cleveland-based University Hospitals and Health Systems.
Lots more here:
The point that struck me as most interesting was that there was useful evidence suggesting that the use of a ‘tethered’ approach was more popular than a standalone solution when offered head to head.
I believe this is because this approach provides better access to an individual’s key clinician and allows much better interaction between provider and consumer.
It is also interesting that consumers even seem to be prepared to pay a small amount to have access to a tethered PHR.
As I have said before the PCEHR needs a basic re-design to deliver this functionality and it needs to happen soon - before more waste on an essentially in-appropriate system.
It seems odd NEHTA and DoHA are unable to consider new evidence when it becomes available.
Who was the famous economist who said “I am prepared to change my mind when the facts change - what do you do?”.
David.

2 comments:

EA said...

The newly-reconstituted Government Digital Service (UK) is reputedly committed to open-source solutions and outputs.
In Oz, we continue to swoon at the feet of GE and Microsoft for eHealth.
One of these approaches has little smiley faces around it, the other is bound to end in bitter tears.
Once, we were self-congratulatory about our status as Clever Country. If any field demands input from the smartest minds, this morass of eHealth does.
Smart people, by nature, come up with new ideas that threaten management. Where's the culture of encouragement & support for innovations at DoHA?
If there is to be a ministerial re-shuffle, who should get onto Health?

EA said...

Just found http://www.theage.com.au/it-pro/government-it/government-ignores-own-it-rules-20111208-1okrb.html and some of the comments are valuable.
Trevor