Literature Review and Environmental Scan: Evaluation of Personal Health Records Pilots for Fee-for-Service Medicare Enrollees. Chapter 4. PHR Definitions, Attributes and Models


There is a high level of interest in PHRs among both health IT experts and the stakeholders who stand to benefit from their implementation (e.g., consumers, providers, employers, payers, and vendors). New approaches to engaging consumers to become active participants in their own healthcare have influenced the health care industry’s interest in PHRs. For example, the concepts of “consumer-directed care” and “consumer-facing technologies,” have gained popular attention in recent years. Both emphasize empowering consumers to assess their own health care needs, and to make informed choices about what services would best meet those needs.[30]

By offering tools that facilitate information-seeking and record-keeping, PHR applications are able to help consumers take a more proactive role in their healthcare. Due to the efforts of PHR sponsors, vendors, and government and private funders, considerable progress has been made over the past decade in developing valuable PHRs. Yet much work remains to be done to ensure that PHRs are appropriate for and accessible to a wide range of potential users, including elderly and disabled populations and those who lack health and computer literacy skills.

Despite the groundswell of interest in PHRs, general consensus has not yet been reached on how they should be structured, what functions they should deliver, or how they can be of greatest use. No commonly accepted definition of what constitutes a PHR has been developed to date, although the Office of the National Coordinator for Health Information Technology (ONC) is currently developing a standardized definition funded by the National Association for Health Information Technology (NAHIT). This chapter explores the landscape of current knowledge about PHRs, including how they are being defined, what attributes they typically have, and what components (e.g., screen configurations, data elements, and features or functions) are currently being offered. Examples of key PHR models and initiatives are provided.

As noted by Patricia Flatley Brennan, RN, PhD, FAAN (consultant to ASPE for this evaluation) this review takes an approach to PHRs that is largely health care provider-focused. Many PHR case studies offered in this document are described in terms of who ‘owns’ or provides the PHR, and emphasize the PHR as a connection to clinical care providers or claims data services. Brennan has commented that this emphasis is understandable, because health care providers generate data, and the PHR abstracts some subset of that data. While provider-focused PHRs may be typical of those available at the time of this review (Spring 2008), future developments in the field may yield a broader suite of personal health information management tools.

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