Evaluation of the Personal Health Record Pilot for Medicare Fee-For Service Enrollees from South Carolina. PHR Utility.

08/01/2009

Overall Utility for Patients.  Providers agreed that patients benefit from maintaining their own health records, and that being in charge of their own PHR could help facilitate their care.  Additionally, providers noted that patients who are on vacation and need quick access to records could benefit from having a PHR. Some participants indicated that the patients who currently maintain paper records and are significantly invested in their own health and care are the same patients who would use a PHR.  A couple providers agreed that roughly 20 percent of their patients would be able to use a PHR, as they anticipated disability would inhibit the rest of their patients from being able to use a PHR. They also agreed that of those patients who would be able to use a PHR, only 5 percent or less would actually use the PHR.  Overall, providers agreed that patients could find PHRs helpful, but the patients who need them the most may also be the least likely to adopt.

Overall Utility for Providers.  While PHRs could be valuable for patients, providers noted that PHRs could not take the place of EMRs in a provider’s office.  While not a substitute, providers suggested a practice without EMRs could still benefit from having access to patient PHRs.  One provider indicated that the PHRs would be more helpful to providers in an Emergency Room particularly when dealing with patients who are not able to provide a medical history, for example, if they were unconscious or were suffering from dementia.

Control and Access to PHR.  While providers articulated numerous situations in which PHRs could help them or their patients facilitate better care, providers also identified key criteria which would be necessary for PHRs to be useful for them.  Firstly, providers suggested PHRs must be owned and controlled chiefly by patients for them to be effective.  Providers indicated they do not have the time nor do they receive any compensation for using PHRs. While PHRs could be useful for public health purposes, for example, to data mine for health trends or disease occurrences, the group generally agreed that consumers’ personal health information should not be controlled by or available to the government without consent. 

PHR Content.  Although previous research suggests providers would prefer not to include content from EMRs such as clinical information or provider notes[34],[35], several providers in this group suggested they already share data directly from the EMR with patients.  One provider indicated that he regularly shares EMR information with patients to facilitate their care, and this information would be useful to include in the PHR as it could facilitate their care in other settings.  Another participant added that there were circumstances when sensitive information was not included in the medical record.  A few providers agreed they would be willing to share the EMR data with patients if it were useful, but the best strategy would be to allow patients the flexibility to decide what they want included in the PHR.

Reimbursement.  Consistent with findings from previous research on provider perceptions of PHRs, providers reported that reimbursement will affect their decision to use PHRs.  PHRs might require additional time and effort, and many providers expressed feeling overextended already.  Participants indicated that less than 2% of medical school graduates choose to enter primary care today because they believe reimbursement is not adequate.  In general, providers agreed that they already perform a number of tasks that they are not compensated for and would, therefore, be reluctant to use a PHR.

Data Accuracy and Relevancy of a Claims-Based PHR.  Many providers indicated that claims data can be inaccurate or incomplete. For example, when patients obtain covered prescriptions from pharmacies like Wal-Mart or fill other medications from their own out-of-pocket or health savings accounts. Thus, providers discussed the issue that claims information only provides one view into the patient’s health care records, and, is likely incomplete, making it less useful for providers.  One provider noted reviewing patients’ reports from the insurance companies before patients come in for visits to assist in providing care, filtering the data that is irrelevant and understanding its limitations.  Overall, providers believe that the PHR should provide an accurate picture of the patient’s health through accurate and comprehensive data, and that claims information alone does not achieve this goal.

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