Efforts are now under way by leading health plans and employers to aggregate patient information into personal health records
(PHRs). This aggregation of data into a patient-centered and patient-controlled record can empower healthcare consumers and
enhance care optimization among physicians, other caregivers and patients.
PHRs can help enable the consumer-driven health movement, and support President Bush's federal priority to provide Americans
with electronic health records by 2014. They are a centerpiece for public and private sector initiatives for healthcare IT
connectivity to improve care, reduce medical errors and lower costs. PHRs also offer an opportunity to customize individual
information.
Today, PHRs are offered by health plans, employers and independent vendors. Several are pre-populated with medical claims
data so that each time a patient visits a doctor, fills a prescription or gets a lab test, this information is added to the
PHR. The result is an evolving, comprehensive picture of the patient's health. In addition, some PHRs encourage users to enter
personal health information not available from claims, such as height and weight, smoking status, allergies, over-the-counter
medications, and herbal supplements. Patients may be able to enter information directly into the PHR or through an integrated
health risk assessment.
Links to educational resources may be provided so that the patient can access general information about a range of health
issues. Additionally, patients may be able share portions of their PHR with their physicians or print out sections to bring
with them to appointments. Most PHRs are effectively static data repositories. An analytical, dynamic PHR takes this data
rich environment to the next level by actively driving patient activity, access and interaction between physician and patient.
PHR technology exists today that provides real-time clinical analysis and two-way, interactive data exchange. An analytical,
interactive PHR can help improve healthcare quality and lower costs through the communication of individualized, timely information
to patients and their physicians.
Dynamic PHRs integrate in real-time with clinical decision support technologies designed to aggregate data to compare with
thousands of medical rules that represent incontrovertible standards of care. This allows for discrepancies to be highlighted
between the care that a patient is actually receiving as reflected in their claims history, and the care that they should
be receiving as reflected in the evidence-based literature.
As new data is received, either from claims or from the patient, it is added to existing patient data and analyzed for targeted
and actionable opportunities to improve care. When an issue is identified, the user receives an alert in the PHR, which they
are directed to through email notification. In addition, the issue is communicated to the treating physician. By sending clinical
alerts to both the patient and the physician, both parties are provided with the information they need to make informed decisions
and to collaborate intelligently and productively.
For example, if a patient uses his or her PHR and enters that he or she is taking acetaminophen, the system can immediately
tell the patient that the over-the-counter drug, in the context of an abnormal liver function test, is not recommended. Other
examples of alerts include potential misdiagnoses, potential adverse drug interactions, absence of therapeutically beneficial
drugs, missing lab tests and reminders for preventive exams.
By leveraging clinical intelligence and data analytics, the latest generation of PHRs can serve as a true foundation for consumer-directed
healthcare and help achieve the goals of improved care, lowered costs and empowered consumers.
Lonny Reisman, MD, is a cardiologist and founder/CEO of ActiveHealth Management, a clinically-based, technology-driven health
management services company serving health plans and employer groups.
