On Friday last week, Chilmark Research participated in the session, “PHRs and EHRs, Should They Be Linked?” as part of the Health IT Stimulus Summit that was put on by Health Data Management. With meaningful use criteria that was approved on July 16th clearly stating that providers are to provide a PHR to their customers by 2013, we thought this question to be nonsensical. Of course PHRs and EHRs are to be linked, how else might a provider offer a PHR to their customers? By the way, our counterpart on the panel, Steven Fox of BCBS-MA stated a resounding yes to this question at the beginning of his talk.
So rather than dwell on the question, our approach was to raise a number of questions that providers will need to grapple with as they prepare to provide a PHR. These questions, listed below, are the types of questions we have unearthed in our research on the PHR market and of course talking to a numerous providers who have already gone down this path.
What to consider:
1) What information from the EHR will you present within the PHR? Will you offer a complete view of the record, or just med lists, allergies, immunizations and demographic data? Will you provide problem lists, procedures? Will you provide lab reports? If yes to labs, will it be all lab reports or some subset? For example, Group Health provides their customers with full access to all lab reports whereas UPMC looked at all the labs and decided that about 200 were appropriate for populating a PHR. Children’s Hospital in Boston on the other-hand is populating the PHR with only labs from ambulatory practices. After visit summaries (AVS) are also an important consideration to include within the PHR. Group Health has found that providing AVSs has been absolutely transformative to their operations.
Deciding what personal health information (PHI) you provide to your customer within the PHR may be one of the most significant hurdles to overcome and needs careful consideration. Our advice to providers is to form a small committee of both doctors, nurses and customers to assess what is indeed the most important PHI to share.
2) When you provide the customer a PHR populated with PHI, how will you insure that the information is provided in context? This is especially critical for lab reports, procedures and maybe even problem lists. Lab data is probably the most critical issue here wherein results can often be quite confusing for the average consumer to understand within the context of their own health. It would be fool-hardy to provide just lab data. Imagine the number of phone calls coming into the front office from your customers asking what the values represent! There are numerous solutions in the market today that can automatically provide this information and your PHR and/or EHR vendor will be able to assist you with this effort. By the way, time and again, providers have found that sharing lab data within the PHR is one of the top attributes of a PHR that consumers appreciated most.
3) When will PHI populate a PHR? Again, this is probably most important for lab data. Some institutions today provide the lab data simultaneously to both the physician and consumer. Others provide the data first to the physician and after a pre-defined lag time, they populate the PHR. There is no clear cut answer here, it really depends on the culture of your operations and we have seen both approaches be successful.
4) To what extent will you allow the consumer to add information to a PHR? Will you only provide a portal and not allow the consumer to add any information? Or might you allow them to enter very basic information such as health plan policy number and the typical information one would fill-out on the clipboard? Maybe you might extend this and allow them to contribute more in-depth information regarding family health history. Further yet, you might allow a customer to annotate the record, for example pointing out a mistake in the record or mild adverse reaction to a new medication.
Our position on this is that to truly support care coordination, the customer/patient must be encouraged to play an active role and all of the above activities should not only be allowed, but strongly encouraged.
5) To what extent will you facilitate transactional processes through the PHR? Increasingly, consumers are conducting business over the Web, from online banking, to booking flights with e-tickets to making hotel reservations in far flung places and even reservations at local restaurants without ever touching the phone. Successful provider-based PHR roll-outs that see large customer satisfaction enable the consumer to schedule appointments, request prescription refills and even provide for limited e-consultations, via email, directly with their care team. This capability is not solely dependent on the EHR, but will need to be tied into the Practice Management (PM) system as well.
Our opinion is unequivocal: It is time for the healthcare sector to join the 21st century and enable these capabilities immediately and guess what, it will actually save you money with reduced demand on front office resources.
6) Lastly, how freely available will you allow the data within the PHR to flow, i.e., how “portable” will it be? What we mean here is will you allow the consumer to export the PHI from their PHR account which you are sponsoring to another PHR or Personal Health Platform (PHP) that is under the full control of the customer? This is another tough issue that many providers struggle with and frankly, most are quite nervous to relinquish control for fear that the consumer may go to another provider. This can be especially true in highly competitive markets.
Frankly, HIPAA law stipulates that providers must turn PHI over to the consumer for a reasonable fee. But what is a reasonable fee when the data is digital and does not require a staff person to run off photocopies of the record?
We have been stressing to providers that if they truly wish to have a customer for life, you treat them with respect and you trust them to do the right thing. By putting trust in your customer, they will put trust in you. It is about time that providers (and payers for that matter as well) relinquish PHI to the rightful owner, the person who paid for it, the consumer. There really is no justification to hold on to it in the hopes that this will bind the customer to you. More likely than not, it will alienate them. And as for the fee, forget it, digital data should be allowed to flow freely (securely of course) and you should not assess any fees if the consumer invokes the export of their data.
That is our advice and we welcome the input of others who frequent this site to offer their own suggestions and comments, especially those from providers who have already traveled, or are traveling down this path. Based on the questions we received following our talk, many a provider is struggling to understand what the PHR requirement means to them. As the CIO of UPMC stated to us the day prior to our session: “Among all the requirements in the meaningful use matrix, the PHR requirement may prove most challenging.”
Recently, we have argued that it is time to ditch the PHR acronym in favor of the broader, more comprehensive term PHP, personal health platform. Yet for this post we purposely used PHR for it is in the vernacular of common speech for all things HIT and of course is the term actually used in the meaningful use matrix.
PHR vendor NoMoreClipboard recently authored a post that attempts to put to rest many of the myths surrounding PHRs and their use in a medical practice. They make some good arguments that PHRs may actually save a physician time if used appropriately with attention paid to workflow.