Consumer Use of Computerized Applications to Address Health and Health Care Needs. Use a personal health record or multi-function portal

03/01/2009

In addition to facilitating electronic communication between patients and their physicians and office staff, provider portals can be associated with an electronic health record (EHR), allowing patients to view part or all of their medical charts. A particularly popular component of many of these portals is that they often allow individuals to see the results of lab and other diagnostic tests and view lists of their medications, immunizations, and allergies.[60]

These portals may also be a source of health information for patients, as some providers purchase subscriptions to health information databases and allow their patients to search for information in those databases. This health information can be integrated into other portions of the portal. In a pilot test conducted at one provider organization, one-half of individuals followed hyperlinks from the lab results page to the information section. Some portals include decision aids to assist patients in selecting appropriate treatment options, and the ability to deliver reminders about screenings and check-ups.[61]

Another approach to monitoring one’s health data is the personal health record (PHR). Currently, despite growing interest in the concept, there is no consensus definition of a PHR.[62] One working group described the ideal PHR as “an internet-based set of tools that allows people to access and coordinate their lifelong health information and make appropriate parts of it available to those who need it.”[63]PHRs are often distinguished from EHRs by the fact that patients control the information in a PHR. Rather than solely containing information entered by providers, PHRs often allow patients to add information about such topics as symptoms, over-the-counter medication, and diet or exercise regimens, as well as information produced from personal monitoring devices.[64]

Comprehensive PHRs could offer a variety of benefits to patients.[65] Web-based PHRs are portable, allowing patients to take their health histories with them on vacation or through an interstate move. They also can help ensure more accurate and complete records are kept, which in turn could improve the quality of care if it gives providers more information in making diagnoses and helps them avoid potential adverse drug interactions. (One publicly available PHR—Google Health—includes a feature that checks for potential interactions between the medications, allergies, and conditions that an individual has entered into his health profile.) PHRs, if shared with providers, have been touted as a means of making care more efficient for both doctors and patients (and potentially lowering costs) by reducing the likelihood of repeated recording of medical histories and duplicative tests or diagnostic procedures. In light of these potential benefits, the Bush administration and the Institute of Medicine advocate a comprehensive PHR for the majority of Americans that would allow them to gather data from all of their providers and to input additional personal information.

PHRs can be constructed in several ways: they can be built around a patient’s EHR from a particular provider; they can be formed by the patient independent of a provider using an online or other type of software application; or they can be coordinated by insurers and populated with insurance claims.[66] According to several experts, PHRs may be more attractive to consumers if there is a mechanism to allow individuals to avoid entering in their medical data themselves because that task is accomplished by another entity—a provider, insurer, or a web-services provider that acts as an “infomediary” and collects data from other sources.

For patients looking to establish a PHR on their own, a variety of websites are available. Although there was a series of unsuccessful attempts by commercial vendors to establish PHRs in the early years of the decade,[67] in more recent years they have become more prevalent.[68] The American Health Information Management Association provides links to about 90 PHR applications on its website.[69] The recent launches of PHR-related sites from Google and Microsoft may have a large impact on PHR use in this country, but it is too early to appreciate how they will change the landscape.

Microsoft HealthVault, which began in September of 2007, is not itself a PHR, but a platform through which individuals can access PHRs and other applications from a wide number of partner organizations. Microsoft helps coordinate these different services. For example, users can plug glucometers and other monitoring devices into their computers, download the results, and integrate them with the rest of their health data.

Launched in May 2008, Google Health is a PHR that also serves to aggregate data from multiple sources. The company has partnered with hospitals, labs, and pharmacies so that individuals who receive care from those partners can grant permission for their data to be exported and incorporated into their Google Health profile. Google Health account members can also grant permission to other third-party partners to offer tailored services for a fee, such as sending a member research related to the conditions in her profile.  

WebMD also offers a PHR. As one company representative remarked, many people are aware of the WebMD brand and will therefore visit the site when seeking health information. Once they arrive, they are exposed to the PHR, provider search, and other functions.

In addition to these PHRs that are initiated by individuals using public websites, several large private employers have sought to allow their employees to view their health records. One large initiative is Dossia—created by Wal-Mart, Intel, Pitney-Bowes, Applied Materials, and BP America—which provides patients access to their electronic medical records.[70] Although Dossia is a patient data system rather than a PHR, other employers, like Dell, provide PHRs for their employees. Employer-sponsored access to PHRs is not yet universal among big firms, but Helen Darling, president of the National Business Group on Health, predicts it will be: "It is very safe to say that every large employer in the United States will either enable through a health plan or portal or help make available through some vendor personal health records and benefits."[71]

By one estimate, 70 million individuals can access a PHR through their health plan.[72] The Centers for Medicare and Medicaid Services (CMS) are also exploring the role of PHRs for Medicare beneficiaries in Medicare Advantage plans, and among a small subset of fee-for-service beneficiaries.

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