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PHRs, What Are They Good For?

by John Moore | August 18, 2009

ahrqTitle of this post is the title of a session I’ll be moderating at the upcoming AHRQ conference to be held in Bethesda, MD from Sept 13-16.  If you’ve been thinking of attending this free conference (its put on by the feds) you’ll have to register soon for as of yesterday the event was almost sold-out.

Having been to this conference twice, the event is primarily structured to serve as a forum for AHRQ grant sponsored researchers.  Researchers present findings, AHRQ presents future funding priorities, initiatives, and even basic guidelines to successful writing successful grant proposals.  While much of what I have heard has been, how shall I say it diplomatically – “academic” every now and then one does get some valuable insight on some aspect of the effectiveness of HIT adoption.

In a departure from the typical format, AHRQ will have the track, PHRs, What are They Good for?, with participants on the panel not AHRQ grant recipients, but people knowledgeable in the subject matter and include:

James Hereford, Group Health Cooperative
Kim D. Slocum, KDS Consulting, LLC
Ted Eytan, The Permanente Federation, LLC

Now my task for this session is to first provide some introductory comments and give a “market status update” for the audience.  That’s the easy part.  The tougher task is keeping the audience awake and engaged as this session is n that deadly time spot, right after lunch on Monday.  Now there is only one way I know of to keep an audience from sleeping after lunch and that is to have an active, lively discussion among the panelists, insure they deliver some thought provoking messages and get the audience involved.

Now a request to you, particularly those who have clear quantifiable evidence of “what PHRs are good for”.

I need your feedback on what you have seen or experienced in the deployment and use of PHRs, whether it is sponsored within the context of an employer wellness program, a payer’s efforts to get members more proactively involved in managing their health and the health of loved ones, or within the clinical setting, what have you seen, what is working, what is not.

To get you thinking, following are a series of questions that I have asked Ted Eytan, who works for Kaiser-Permanente who have one of the best PHR programs today.

What is the breakdown of populations/demographics that actually use the KP PHR? Is it just the worried well, or Mothers?  Are their any conclusions that can be drawn?

To what extent due specific sub-groups use, or not use the PHR, e.g. are there any racial or socio/economic disparities?  What is KP doing today to minimize disparities and insure broader participation?

What about Chronic Disease grps?  Has KP found that patients with certain chronic diseases lend themselves to greater PHR use? If yes, what are they?

Reflect on the role of the physician in encouraging adoption and use of a PHR?  Does consumer use require a a lot of guidance and encouragement?  What tricks has KP learned along the way to encourage broader adoption and use?

How has KP embedded the use of PHRs into physician workflow and driven adoption and use by the physician (that is assuming that KP allows the patient to add comments/notes to their PHR)?

The transition from acute to outpatient care is fraught with challenges and data drops.  How has KP used the PHR to minimize such? And on a related note, how does the KP PHR accept clinical data from systems outside of the KP network (not sure it even does that today)?

Hopefully, Ted will be able to get some answers to these questions as one may be able to infer from the answers the answer to the over-riding question: PHRs, what are they good for?

In addition to commenting on your own experiences regarding the value proposition for PHRs, if you have any specific questions to contribute, would love to hear them.  Sure, I have a list as long as my arm, but that doesn’t mean there may be something I totally missed, so please have at it.

Looking forward to your input.

5 responses to “PHRs, What Are They Good For?”

  1. […] Article John Moore, Chilmark Research, 18 August 2009 SHARETHIS.addEntry({ title: "PHRs, What Are They Good For?", url: "http://articles.icmcc.org/2009/08/18/phrs-what-are-they-good-for/" }); […]

  2. John,

    This is a terrific post and one that I have a lot of interest in and excitement about. I have many thoughts on this topic as I have been consulting in the area now for some time (with HealthString here in Chicago who you posted about earlier this year) and working on a research project with HealthString and a physician in the area who is heading up a RHIO/HIE here in Northern IL where we have created an electronic data exchange between the physician’s EHR and the patient’s PHR utilizing the CCR standard and also using PDF-Healthcare best practice to transport the CCR to the patient and allow them to view and store via PDF although we are also extracting discreet data to the PHR to pre-populate certain fields for the patients. Although PHRs are valuable, I feel that Personal Health Systems or Applications really step it up a notch and take it from just a ‘record’ to more of an interactive tool and support system for patient’s health.

    – Corporate side- PHRs that include both Health Risk Assessment (HRA) and nurse coaching are very powerful to educate and motivate employees to learn about their health. My involvement with a PHR and wellness program to a very large manufacturing company based here in Chicago was most interesting and took me by surprise. I didn’t realize that there are still so many consumers out there who don’t have computers or don’t know how to use computers. Many also do not know a think about their health, disease risk factors, and have not been to see their physician in 10+ years! Through the PHR, HRA, and nurse coach roll-out, we were able to teach members not only how to use the PHR and take their HRA, but also how to use a mouse/computer and just the basics of health…. What is blood pressure, why is high cholesterol bad, how can you check to see if you’re diabetic or prevent diabetes. Employees who would have otherwise kept going about their lives, never motivated to learn about their health, make an appointment at the doctor (and many did!), get a screening for the basics (but critical) metrics… BP, Cholesterol, glucose…. decided to finally do it. It was with a lot of effort and determination on the part of the nurse coaches and others who made the phone calls, went to the manufacturing plants, showed compassion and understanding to the employees, showed they cared…. This is what pushed many over the ‘I don’t want to learn about my health and I can’t use a computer” threshold and go them a little excited about taking control of their health. I could go on and on here but it was very exciting and I know will make a big impact on the health of thousands of employees who are now engaged and on the road to learning and leveraging technology to get or stay healthy.

    – Provider Side- there are so many benefits here as well. With our data exchange project, we are hoping to motivate those who would otherwise forego using a PHR because it’s too complex and too much work to input all of their personal health info…. e.g. those with chronic disease, on multiple meds, lots of conditions. If we can send a ‘snap shot’ of their visit from the physician’s EHR to the PHR, have the patient review and validate the information, import the ‘cumbersome to enter’ and complex data to the PHR and be able to store the entire file (including images, hospital d/c info, etc…) and, with the help of a nurse coach to teach and guide them, they are more open to trying it and eventually enjoy using it. There has to be value to the patients with health education and behavior change tools and ways to improve communication with their physicians. Ultimately we would like to see the patient sending data back to their physicians or sending to other care providers who are on their care team and helping to improve care coordination with their primary care provider (with the patient at the center and empowered) The process is all very complex and there are still many legal concerns to factor in but we need to begin somewhere. I also see substantial value in the health coaches leveraging the data for risk and disease ID and prevention and have also written on this topic with examples of how this might work. With data from the EHR, self-entered data and talking to the patient, the nurse or health coach is able to identify potential health issues that they can then alert the care providers to observe or test further and, I believe, can assist with disease prevention or helping to keep major and costly complications at bay.

    These are a few examples of what PHRs are good. Moreover, including a health/nurse coach, a little motivation and education to get them started, and a way for them to gather and share information outside of the PHR will be key for the patient to realize the most value and continue to use and leverage the PHR to stay healthy. Some patients and consumers just need a little nudge to get them over their fears of both health and technology but it is possible!

  3. Ted Eytan says:

    Thanks, John, for the cross posting and the comments. I’ve put out a draft abstract of my portion of the discussion here:

    http://www.tedeytan.com/2009/08/19/3353/comment-page-1#comment-5139

    More comments are of course welcome as we get closer to September 14!

  4. […] » PHRs, What Are They Good For? « Chilmark Research […]

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