Literature Review and Environmental Scan: Evaluation of Personal Health Records Pilots for Fee-for-Service Medicare Enrollees. Use Cases Related to PHRs


The American Health Information Community (AHIC) develops use cases to provide context for standards harmonization and inform policy discussions that advance health information technology activities.[238] The 2008 use cases under development include remote monitoring, patient-provider secure messaging, personalized healthcare, consultations and transfers of care, public healthcare reporting, and immunizations and response management. AHIC has released three new detailed use cases on patient-provider secure messaging, remote monitoring and personalized healthcare in March 2008. The use cases are described in this section because of their relevance to PHRs.

Patient-Provider Secure Messaging

AHIC released a detailed use case on patient-provider secure messaging, which explores the ability of patients to communicate with their health care clinicians from a remote location using technology.[239] AHIC defines patient-provider secure messaging as ‘both secure messaging sent from patients to providers as well as secure messages sent from providers to patients.’[240] In the detailed use case, AHIC also notes that patient caregivers or patient advocates may be included in these communications. Secure messaging tools are built around a PHR, EHR, patient portal, or other types of communication tools.[241] Information is exchanged live and transactions include messages with structured content, unstructured content, or a mixed format. Additional materials can be attached to communications. Secure messaging is not intended for use during emergency situations.

The detailed use case focuses on the processes for both patient-initiated communication from the patient and clinician perspectives, and for clinician-initiated communication from the clinician and patient perspectives. While presenting each of these processes in detail is outside the scope of this section, we provide a brief overview of the processes for patient-initiated communication from the patient’s perspective in order to highlight where the PHR fits into the process.

Patient-initiated communication from the patient’s perspective includes the following processes: (1) the patient is authorized and authenticated to participate in secure messaging with his/her clinician; (2) the patient receives a user identification code and password to establish his/her identity; (3) the patient may need to be trained to use the secure messaging tool; (4) the patient can compose a message and send it to a clinician (read receipt features and other capabilities are available); (5) once the clinician responds, the patient is notified that they have a secure message waiting to be read; (6) the patient logs in to read the secure message; and (7) the patient reads the secure message and may update his/her PHR to reflect the information.[242]

Remote Monitoring

The remote monitoring detailed use case focuses on the communication of ambulatory remote monitoring information (e.g., physiologic measurements, diagnostic measurements, medication tracking device information, and activities of daily living measurements) to the PHR or EHR.[243] Measurements collected by the remote monitoring devices are transmitted to the PHR so that patients and/or caregivers can access the data. The information may also be sent to clinicians to help them to better manage or treat the patient’s condition. In order to ensure that the data can be transmitted to a PHR or EHR, the remote monitoring information must be available in an interoperable manner.[244]

The detailed use case presents the processes communication of remote monitoring information to the EHR or PHR from three different perspectives: the clinician’s perspective, care coordinator’s[6] perspective, and patient’s perspective. Essentially, there are five main processes: (1) the patient or caregiver sets up the device; (2) the patient records measurements using the remote monitoring device, which communicates the data to the EHR, PHR, or other device at specific times; (3) the care coordinator reviews the measurement information via a portal provided by the device manufacturer or other third party; (4) the care coordinator will work with the patient or caregiver to check the information communicated and potentially acquire additional information; and (5) if necessary, the clinician will review the measurement information through the EHR, determine if a change in the patient’s treatment is necessary, and then transmit the needed change to the care coordinator and the patient’s PHR. Remote monitoring is an important component of care management for the aging population and people with chronic conditions.

Personalized Healthcare

AHIC defines personalized healthcare as the ‘processes by which health care providers can customize treatment and management plans for patients based on their unique genetic makeup.’[245] AHIC’s detailed use case on personalized healthcare focuses on the processes underlying the exchange of family history information and genetic and genomic testing information between patients and clinicians, and how this information is available in an EHR or PHR.[246] The detailed use case explores: (1) the clinical assessment from the clinician and consumer perspectives, and (2) genetic testing, reporting, and clinical management from the clinician and consumer perspectives. In terms of the clinical assessment piece, the use case describes that a consumer can share his/her medical history with a clinician by entering their personal health information into a PHR and then making that information available to the clinician. In terms of the genetic testing, reporting and clinical management component, the use case describes that consumers would receive and incorporate genetic/genomic testing information into their PHR. If the information is interoperable, then consumers can send the data to their clinician. Consumers may also wish to assign a proxy or caregiver access to the information within their PHR. [247]

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