A video presented by Dr. David Lansky and John D. Halamka provide us a very good overview about the Personal Health record in USA. It starts with model in page 4, which helps to illustrate who can access to the personal health record. From the presentation, we can see it was strongly support by the President of USA and it will be committed in 10 years (2004-2014). It also tell us all the major parties involve in the processof defining rules and policies, build tools and applications to create and maintain the personal health record and the issues that we are going to face in the year ahead in implementing systems and using PHR in our daily lives.
There are so many PHR services are provided today. They are appointment scheduling and reminders, drug refills, drug interaction checking … All the services are provided by using web-base applications and tools developed by different vendors or companies in healthcare industry.They are some portal as Epic systems (www.epicsystems.com) or Medem (www.medem.com ) allow us to create our personal health record online or Capmed (allow you to download you personal Health record to your PDA….).Some web site from Life Ledger(www.thelifeledger.com) or PeoplelikeMe allows user to share data or information between groups have common interests about cancer, fitness and diet.
Some surveys are conducted and gives us some top priority about the keeping electronic healthcare record private and confident. 91% of people conducting the survey worried about “unauthorized access” to their personal health record. 81% of people want to be able to review who has had access to their personal health information. 68% of people do not want their employee access to their PHR. However, we can see a lot of support and interested in using information technology to create access to their PHR in order to check for medical record (69%). 68% of interviewee wants to check and fill their prescription and 58% want to get their test result over the Internet. In addition, based on the survey the group will be likely used PHR are baby boomer and chronic ill. Before the ideas of allowing the patient creating their own personal health record, health information about any patient was exchange between doctors, health care provider, pharmacy, lab test facilities except patients. Now with the applications and tools develop by vendors, users can create /access their personal health record using laptop, mobile phone, and PDA and the elements of their record can be text, numeric, or documents. Based on the presentation, we can divide the stakeholders into three groups : Consumer, Global Internet Brands and Health Care Institutions.
According to the Dr. Lansky, some key factors were identified for PHR successful as following:
a)Able to define a Consumer Access Service that is trusted by consumer and other participants on the network
b)Able to determine minimum necessary privacy and security policies and practices
All of the key factors generate some big questions:
a)Will the Consumer Access Services succeed and create a trustworthy environment?
b)What kind of business model will emerge?
Cuong Nguyen on Saturday, 22 March 2008, 02:19 Pacific Daylight Time # |
Personal Health Services using Personal Health record will help to improve the quality of the HealthCare systems and the relationship between the patient and doctor make them work as a team. For examples, the doctor can prescribe the prescription allowing the patient using the new drug. The patient will enter the side effect causing by new drug and refill using a web-based application. It helps to save a lot of time for phone calls and trips to go to the doctor’s office. By collecting data from patients from the different web sites, doctors and patient can help the pharmaceutical company develop a new drug and medical researcher and doctors come up with better treatment for disease like cancer, or heart disease. With the growing and expanding of blog and social-interactive networking tools, we can see the more and more people like to access their personal health record as they do with checking balance of their banking account. However, according to Dr. Lansky presentation we still have to face with issues related to protect confidential data of patient from unauthorized users and what kind of data we should allow user see and when they should see it( one week , two week after doctor find out they get cancer) and how we present the data(results) patients.
Other issues will be related to standardization of systems, tools, and architecture of healthcare systems that are used for creating and accessing PHR. What kind of standards should we choose and follow and how to come up with the guideline for develop application and tools? Those questions need to be resolved and answered to speed up the process of design and implement PHR systems and tools.
Cuong Nguyen on Saturday, 22 March 2008, 22:59 Pacific Daylight Time # |
Having watched the video, ‘PHR an Overview’, I find the notion of PHR innovative and beneficial to consumers and all involved entities in the health information system (eHealth): health providers, physicians, laboratories, pharmacies, health insurers, and other providers. I learned a lot from David Lansky’s presentation on the functional and architectural issues of PHR as a central repository: the complexity of network topology, the scattered information among several providers, the need for information sharing, the challenges presented by the need for interaction among several parties, and the control of the information. The main difference between PHR and EHR systems is that the consumer controls the information in the PHR, while it is the healthcare provider who controls EHR. PHR has become a hot topic in the health information field and its architecture has gradually developed from simple to rich, complex, and dynamic. PHR includes important information about my life time medical records such as personal medical facts, doctor visits, allergies, medications, etc that are stored in a central warehouse which I can delegate and/or share with others, as I see fit. I also learned about the leading PHR applications and their models such as Epic, Medem, CapMed, SophiosGarden, and many others.
In the context of challenges, there are three areas or parties that need to interact to implement a PHR: the 21st century consumer, the global internet brands such as Google Health and HealthVault from Microsoft, and the healthcare institutions. The challenges and barriers presented by the need for interaction among these parties will not preclude the efforts to step up the pace towards the implementation of PHR. The efforts toward implementation are represented by the emergence of numerous PHR applications, the willingness of people for this transformation to happen, and research continuity. Nonetheless, although PHR enables people to electronically access their health information wherever they are and at anytime, the issue of defining PHR remains unresolved as mentioned by Lansky.
John Halamka discussed the control and sharing of patient PHR. PHR has made it possible for the involved parties, consumers, hospitals, clinics, payers, laboratories, and pharmacies, to share health information in three ways: provider2provider, provider2patient, and provider2other users. Due to PHR’s complicated architecture as it involves non-organized entities, not well-structured networks, technology, and people’s private live, I absolutely agree with Halamka about the need for healthcare information standards to facilitate the transmission of demographics, medications, allergies, and personal records preferences. The notion of utilizing the Continuity of Care Document (CCD) and Clinical Document Architecture (ACD) is appealing as it’s design is simple and includes educational documents, so the patient can understand the information and make informed decisions about his/her healthcare.
The possibility of communicating the local copy of PHR with other applications run on the consumer’s desktop is an important advantage. For example, this will enable the consumer to run chart diagnosis software to develop a chart for his BP or cholesterol records. The importance of such a feature is clearly implied in Microsoft‘s announcement that they are developing the BeWell plug-in product to enable users to install and communicate with a central repository. Standardizing the access to PHR through web browsers is also critical to save and protect consumer privacy, so browsers do not cash information locally. This will help bridge the so-called digital divide as the consumer does not need to have his own computer or even to subscribe to the internet because user can securely access his/her PHR from any public computer (e.g. libraries, educational centers, etc). PHR has a promising future, but data security and privacy and control issues are the real challenges in implementing a PHR system. In the light of this, I wonder whether there will be an authority that is responsible for organizing and managing the whole process to control data ownership and ensure privacy and confidentiality. In other words, why it is necessary to trust and believe Google’s promises of not sharing or releasing data to a third party, not practicing data mining, and not selling data. Who will guarantee these promises are kept, and what if Google is bought by another company!
Mohamed on Tuesday, 25 March 2008, 20:50 Pacific Daylight Time # |
After watching the video by Dr. David Lansky and John D. Halamka on Personal Health Records, I find it interesting that not that long ago, simply being able to type 50wpm was a skill to brag about on your resume.We were using typewriters and only a few us out there were using computers.The daily use of the computer after the wide spread use of the Internet has turned the average Joe in to a fast typer and using the computer has become second nature to most people.This familiarity most people have today with computers makes NOW the best time to take advantage of eHealth and PHRs. This was not as possible before the widespread use of the Internet: not because we did not have the means, but society did not have the computer skills to navigate such a system on their own from home. When consumers of different ages were asked about their preference for PHR media, about 40% of those who were 65+ responded by saying they preferred a paper based PHR.“As of 3/07, (only) 29% of seniors reported regular use of the Internet. (65% of people age 50-64).”About 10% wanted a Web site PHR, another 10% wanted a portable device PHR, and 8% wanted a PC hard drive PHR.After viewing these numbers, I can see how crucial it would be to find a way to deliver a PHR for consumers of every level of computer literacy.I also found it important to note that only 4% of the users of Patient Site were over 70. The concerns for patients with poor computer skills is also noted in the article Patient Education And Recovery Learning System (PEARLS) Pathway: A Tool to Drive Patient Centered Evidence-based Practice.When they tested the WebTV educational tools in hospitals for patients to watch while recovering they noted the difficulty patients who are older and not as computer literate face with such emerging educational tools.Since our health becomes more compromised as we get older and the elderly do not favor using computers, I find this as a challenge for the success of computer based PHRs.
Aisha on Tuesday, 25 March 2008, 22:40 Pacific Daylight Time # |
This webinar presentation of personal health records covers several aspects of PHR's and EHR's. There are various topics in which this webex documents and walks the user through this digital landscape. The two speakers here are David Lansky (formerly of the Markle Foudation) and John Halamka (CIO Harvard Medical and Beth Israel). David opens up with a introductory discussion of what exactly is a PHR and talks of the 'different flavors' that organizations and corporations are providing. John Halamka goes further into details including both health aspects (safety of patients) along with some of the more pertinent technical challenges facing PHRs (security). based on these two gentlemen's presentations, Personal Health Records assist both patients and doctors (as well as even helping some streamline operations for insurance companies) as they form a central repository for control and management purposes. Through many PHRs, a patient has the ability to refill drug prescriptions, setup Dr. appointments, and even communication with doctors. Personal Health Records also assist in the formatin of new groundbreaking health based technologies. For example with Microsoft Health Vault a patient has the ability to track aspects of their health and have it immediately recorded into their PHR (for example a daily blood pressure count). The speakers in this web broadcast seem very optimistic about the ability for PHRs to allow for patent information dissemination and data flow. However, they also seem a bit apprehensive as there are many obstacles which need to be tended to in the very near future.
My take on this webinar shares a bit of excitement, mixed with technological interest topped with a hint of skepticism. Although I am not a member of the Kay Center, nor focusing a dissertation on PHRs, I think this subject is very interesting and there are promising technologies which should be expected. There seems to be no doubt PHRs are becoming a tangible artifact that practitioners will have to learn to deal with one way or the other. The notion of useful patient information on- demand and readily available far out weighs any lobby which may form against it. However, this industry seems to move slow. Very slow. Especially when dealing with something that is not tangible or analog based. Also, a lack of conformity lends its hand to longer latency of a standardized PHRs and EHRs.
Chris Liapis on Monday, 31 March 2008, 09:46 Pacific Daylight Time # |
In general, the presentation provides a good overview of PHR with updated information. After watching this web conference, I realized how rich and complex the PHR is. It is a hot topic and major concern of different parties: consumers, healthcare providers, researchers, health insurance companies, employers and IT corporations. I expected to find a standard definition for PHR but I learned that there is no specific definition for PHR up to date. This is due to the availability of different PHRs in terms of the technical aspect and use. Once there is a trustworthy, valuable, safe, and sustainable PHR, which will be commonly accepted and widely used by consumers, then PHR can have clear and accurate definition.
Although the U.S. government is very concerned about PHR, implementation and adoption of PHR might take longer than planned due to many barriers mainly related to privacy and security issues. It seems that the benefits of PHR for the consumers are evolving and cannot be counted for the time being. It is a field of innovation and creativity. The benefits, however, touch the convenience of the consumer, education, knowledge, health quality and economy. Different preferences of people for PHR add complexity to the issue. These variety of tastes are affected by some factors like education, literacy, medical condition and culture.
It is interesting to know that the major incentive for people to use PHR is to check for mistakes in their records. I believe that the rank of the incentives will change as people become aware of the potential advantages of the PHR.
The demonstration of by John Halamka of his own PHR has given me an idea about how a PHR looks like. I wonder if making the privacy of sensitive information, like HIV test result, optional would help to enhance the privacy since I belief that those with negative HIV for example do not mind to make the test result accessible by others who are needed to share the PHR.
It is good to know that using PHRs did not increase the communication overload between patients and their doctors as patients are exposed to bad news where they become worry. This is a good news for the doctors.
The experience of PatientSite system shared by Halamka shows that the PHR has a promising future.
Fahad Alhelal on Monday, 31 March 2008, 17:22 Pacific Daylight Time # |
Personal Health Record got a great attention lately. PHR became rich, dynamic topic that keeps many parties’ minds busy thinking of where this new approach may take us as providers, patients, health researchers and any party may be involved in this new technological trend. After watching the Video for Dr David Lanasky and Dr John Halamka I got the basic review for PHRs system which was clear enough and very interesting to me. From the presentation I can say that the idea behind the PHR is very ideal to any person especially we all as patients need to have this accessibility to our health information and having our own control on it.Presenting the Google new health platform was a new info to me which raised a question up to my mind. To what extent Google will take us in the future?Just a question!!! Both Dr Lanasky and Dr Halamka gave a basic understanding for the topic and its basic idea and the benefits for PHRs parties. Dr Lanasky talked about different products for some companies which are functioning as PHR systems. Moreover, the main concerns around PHR systems. After watching this video I started to think of some points which are valid in our world and may also act as main obstacles to developing and employing PHR. From my understanding to the topic, PHR won’t have this ability to serve the benefits as it is designed for without being interoperable with EHR system while US has already problem with its fragmented health delivery system. The issue that indicates to me that in order to have beneficiary PHR, we need to look first how to get unified EHR system, and this to obtain the benefits from both EHR and PHR as well. Another challenge also I thought about is how to handle such vast amount of data which may be very costly process.
Dr Halamka also talked about three challenges, one of them is (Global internet brands and others), this part made me think of some global challenges that may go beyond our control, such as the legislations in every country and how to meet such issue, also the development level for every country that is not necessary to be similar for US.
According to the presentation also, 91% of Patients concern about the security, privacy, and getting secure access to their health information, and I thought of the fact that there isn’t anything secured over the internet, is there? For instance, our bank accounts. It is still not 100% secure logging into our accounts because there might be people like hackers could know what we are doing and hack our accounts, and there are already many cases of bank fraud happened. However, despite of this fact, we are taking this risk because we need those web-based services. Talking about PHR system, I think we may not achieve the 100% security access because it is web-based application, beside the security perception varies from one person to another which makes achieving the security according to patients’ needs and perceptions more complicated. Therefore, I think we need to obtain the maximum level of security and privacy that meet the patients’ and providers’ expectations to get their trust and their contributions which I believe they are key success factors to PHR development.
Shaimaa Ewais on Monday, 31 March 2008, 21:09 Pacific Daylight Time # |
The teleconference reviewed was definitely a great introduction to the overall course. It provided high-level insight relative to the emergence of PHR technologies. Based on the session, it is evident that the healthcare domain is extremely complex in nature. This view becomes even further complicated when examining the various sources, seekers, and providers of information within the health industry. There are different stakeholders involved, and the patients are inter-mingled between various individuals and entities. From a value perspective, the retrieval and access from all of the relative data sources is vital to produce meaningful information and knowledge. The key ingredient to achieve this is ‘tight integration’ amongst all of the players and data/information sources.
What is nice to see is that different leaders and corporations have realized the value of HIT and have started different initiatives to move this forward. Accordingly several technological advancements have taken place, and the need for electronic personal health records has emerged. Currently, the different PHRs available for the patient consumers have different functionalities. These functionalities are being enhanced and add-ons keep coming up. As we progress, and develop tighter integration amongst the various players within the healthcare domain, we will start realizing further benefits and values of PHRs. From the consumers’ perspective, it seems that there is already a strong interest in using health information technology to participate in managing their personal health care. Their primary concerns however revolve around issues related to the privacy and security of their records. Accessibility, personalization, pre-populated data/information, and the convenience of self-service functions are also key elements that consumers would like their PHRs to accommodate for them. After all, it should all be about empowering the patient consumer, increasing their personal healthcare knowledge, and providing them with the right tools at the right time to manage their health status. This should ultimately lead to the optimization of the overall quality of their personal health.
Currently however, there are several problems, challenges and barriers that need to be resolved in order to increase both the adoption and success rates of PHR technologies. The main problems in my opinion are relative to the lack of integration, standards, and an effective sustainable business model/strategy. Another problem is that there are many different flavors of PHRs available in the market, each designed from a different perspective, and in some cases for different types of end-users, hence causing confusion for both the patients, and the healthcare providers / organizations. In line with this matter of different types of PHRs, I would personally love to see one unique entity, whether be it a new entity, or an existing one, to take the lead in establishing a national fund to aide in the design and development of one standard PHR solution (one size fits all), with the provision of allowing minor customizations to adhere to certain specifically unique cases the different healthcare organizations may have and need to accommodate for. Moreover, it would be great for this same national-level entity to develop and establish a knowledge repository for the storage, and reuse of PHR systems design knowledge, in addition to storing and maintaining a national database pertaining to the lessons learned from the cases already implemented. Why do we have to reinvent the wheel every single time we come to implement these forms of technologies?
What I felt was missing from the teleconference session was substantial information and discussions pertaining to the project management and implementation issues of PHR systems. My opinion is that these are also key issues that define the success or failure for the majority of these projects. All in all however, as mentioned previously, this was an excellent overview and introduction to theme of ‘consumer health informatics’.
Fadi Al-Buhairan on Monday, 31 March 2008, 22:54 Pacific Daylight Time # |
I found this to be very interesting to hear about the hot topic of Personal Health Records.Just within the last 3 to 4 years this idea has really starting to gain momentum and grow.The original idea behind PHR was to enable people to have access to their health information.Most people have their information housed in a wide variety of organizations (some medical, some social service).The intent is to have access whether it is for personal use or to share with other services and to exercise control over whether the patient wants to share with family or other care givers.This has been a challenge and is difficult for a patient to obtain their information especially in electronic form.
Ideally, the goal would be for all information to be electronically transferred to a central repository so that the patient can have access or allow someone who they think should be able to access in order to provide better service to them.It was amazing to hear that Bush announced that every American should have access to their PEHR record by 2014 and being half way towards this time frame, we are no where near that goal.This thought has really challenged the way the industry will go about implementing.The Department of Health and Human Health Services launched AHIC - Americas Health Information Community to try and find out how to stimulate this progress.Congress has given this topic a lot of attention and various ideas are under way.One congress man proposed incentives to doctors if doctors would insure that their patients had access to PHR’s.Another thought it might be a good idea to have federal employees have access to a PHR through their health insurance plan.Another made mention of the idea of creating health record banks.The Major National Health Insurance Plans the big private health insurance under AHIC (bluecross/blueshield) said they would have a standard for portability of PHR of information which cover about 100 million people.This is a great launch pad to get this process started.Corporations such as Microsoft and Google are announcing a platform to give access for general internet services to large employers such as IBM.By doing so, they will collect PHR data to aggregate information.
Services that PHR offer are provided in various forms. There is not one product that offers all of these services.Some of the services are as follows:Educating patients by helping them take care of themselves or family members through their home.Secure messaging to their doctor. Availability of certain transactions such as making appointments or setting up reminders. Refilling prescriptions. Reminders to stay on track with drugs or exercise programs.Allowing patients to keep track of their own information of interest such as monitoring pain levels or tracking side effects from medications or combination of drugs.Keeping track of long term health trends and checking for drug interactions that can be sent back directly to patient instead of having to go back to dr. or pharmacy.
It will be very exciting to see what the conference has to offer in terms of obtaining a better understanding of thes e services and the difficulties associated with the implementation process.
Rita Clemons on Friday, 04 April 2008, 17:33 Pacific Daylight Time # |
The video by Landskey and Halamka was an excellent overview of PHR and the intimate connection with the EHR/EMR.The potential and intentional scope of PHR’s in ultimately motivating an individual’s behavior toward a healthy lifestyle is far reaching – not only for the individual, but for multiple communities and large groups of people as well.The vision is that an individual would have access to their entire life’s medical history: records, status, encounters, growth, development, inoculations, medications taken, illness cycles, pubertal issues, hospitalizations, minor procedures, adult aging from young adult to senior.It could be possible for one to automatically gain information every time there was a doctor’s visit, pharmacological entry, hospital stay, imaging and lab test results, vaccinations, etc.This information could be linked to population statistics, symptoms and pathways for exacerbations, remissions and health, side effects of medications, information regarding allergic reactions’ signs, symptoms and treatment; interpretations of X-ray, CT, and other lab tests and results; coaching information for coping with medical conditions and much more.
The speakers spoke of the availability of various PHR’s including institutional and web based PHR’s like those offered through Google and Microsoft.They shared insight of how the major health stake holders can interrelate to provide a rich PHR environment that could offer benefits for all involved.Halamka described and shared his experiences and lab values with his own PHR to illustrate the benefits the PHR can offer a person.
The public health as a whole could benefit from population statistics developed from anonymous PHR information.The possibilities are endless in the utopian environment of exchanging, sharing and accessing medical data.Our president has committed our country to a goal for all health records to be electronic and exchangeable by 2014.
Policies and standards are currently developing for this fast paced entity.Privacy is tantamount to these standards.There are many barriers to achieving the ideal which include the individuals as patients, the physicians, the institutions, i.e. hospitals, pharmacies, labs, suppliers and equipment manufacturers, software developers, vendors, employers, insurance companies and the government.Individuals are especially sensitive where privacy and confidentiality are concerned.It also takes much time and would require ready access to an electronic device to implement. Physicians and institutions realize the disruption in work flow and the tremendous capital outlay that would be involved for their work places to convert to electronic records.Another barrier currently is that most EHRs are stand alone entities.A major boost to improve salience of the PHR would be for the development of software/IT solutions to integrate the stand alone software options currently available.A central bank or repository was also discussed.This would streamline access and portability of an individual’s medical records.
This video presented quite a vision for the future and was an excellent preparatory tool for the course in Boston.
This video cover the agendas to set to President’s 10-year commitment toward 2014 to get American Health Information Community – Consumer Empowerment “Breakthrough” . We are seeing the entire Healthcare industry behind this huge task.
• Provider organizations (e.g., VA, Kaiser Permanente)
This is really an exciting period in the healthcare industry. It is a whole revolution. They had cover Policy Framework for Consumer Access Service which is critical for developing the Networked personal Health Information. They had deliver PHR and some the expectation and feature we are expected to see. Using PatientSite, they had shown what PHR can actually deliver. Standardization of systems and architecture of healthcare systems seems to be a constant challenge. Practice and standards for other area like hospitals, pharmacies, labs, suppliers and equipment manufacturers, software developers, vendors, employers, insurance companies and the government are some of the area to set the standards in. This is seen as something everyone hopes to see in the near future.
Victor Neo on Saturday, 05 April 2008, 11:04 Pacific Daylight Time # |
The web conference presented by Dr. David Lansky and Dr. John Halamka provided an excellent overview of the many players in Health Information including supporters and barriers. Dr. Lansky focused on defining the PHR and the primary types available today while Dr. Halamka focused on discussing some of the challanges such as standards and privacy. While the defintions of what a PHR is and its exact functionality varied, most parties agreed that it aids the communication and data transfer process between the patient and the doctor.
This video really put into perscpetive the number of players involved, some of which include: insurance companies, health providers, software companies, and pharmacies. With the number of PHRs expanding in the market, one of the primary concerns addressed was the idea of standardization. Standardization includes the issues surrounding uniform data exchange (challanging because of the the various flavors of stand alone PHRs available and their unique functions).
Another significant barrier focused on here was the idea of security or privacy of the medical information. Surveys presented in the video highlighted the importance of security to patients. For this reason, it is an important consideration in the development of privacy standards. Interesting comments were made in regards to actual versus perceived privacy to end users as well as the need for consistent legislation to be developed in this area.
Overall, the most interesting portion of the video was the discussion of the potential benefits of the PHR. While several of the logistics including full implementation are not well defined at this time, the driving forces are already in place. The final goal being patients with full access to their medical history available in a standard format. Once this is in place, the further ambition of generating more accurate population based heatlh statistics becomes a realistic goal.
Jill on Thursday, 10 April 2008, 00:37 Pacific Daylight Time # |
The presentation "Personal Health Records: An Overview" is exactly what the title promises. David Markle and John Halamka clarify what Personal Health Records are (as well as what they are not) and the future impact they will have as consumers begin to take a more active role in their own health care.
Actors across the range of health care delivery are excited about the prospect of PHR usage. Employers such as IBM, PepsiCo and Wal-Mart are sponsoring PHR usage. Major health care providers like the VA, Kaiser and Partners have developed PHRs that are integrated with their internal Electronic Medical Records. Even global Internet companies like Microsoft and Google are bring Personal Health Records to market this year.
The key challenge for Personal Health Records appears to be adoption.
People are concerned about privacy. This concern is accentuated when the PHR is employer sponsored. Employees are concerned that their "private" health data may be accessed when the time for promotion or evaluation comes.
However, when the request to use a PHR comes from the patient's physician, there is a higher level of trust and interest. When the PHR is connected to the providers, people are much more likely to utilize the system. Lab results are a highly viewed resource by patients that elect to use a PHR. Physicians are excited at the prospect of patients taking a more active role in managing their health. Moreover, individuals with chronic conditions such as diabetes or high cholesterol tend be more cognizant of making "healthy" choices when they are frequently viewing their lab results online. Furthermore, patients will more readily identify errors in their medical record if they have transparent access to their data.
Doctors are concerned about being overwhelmed with E-mail inquiries from their patients. However, as Dr. Halamka noted, patients have lives too and the physicians do not get bogged down in a flood of E-mail correspondence.
In a nutshell, a successful PHR should be automatically populated with data from hospitals, clinics, payers, labs and pharmacies. It should be interoperable between disparate systems and it should empower patients to take a more active role in their health.
Gary Richmond on Thursday, 10 April 2008, 18:32 Pacific Daylight Time # |
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A video presented by Dr. David Lansky and John D. Halamka provide us a very good overview about the Personal Health record in USA. It starts with model in page 4, which helps to illustrate who can access to the personal health record. From the presentation, we can see it was strongly support by the President of USA and it will be committed in 10 years (2004-2014). It also tell us all the major parties involve in the process of defining rules and policies, build tools and applications to create and maintain the personal health record and the issues that we are going to face in the year ahead in implementing systems and using PHR in our daily lives.
There are so many PHR services are provided today. They are appointment scheduling and reminders, drug refills, drug interaction checking … All the services are provided by using web-base applications and tools developed by different vendors or companies in healthcare industry. They are some portal as Epic systems (www.epicsystems.com) or Medem (www.medem.com ) allow us to create our personal health record online or Capmed (allow you to download you personal Health record to your PDA….). Some web site from Life Ledger(www.thelifeledger.com) or PeoplelikeMe allows user to share data or information between groups have common interests about cancer, fitness and diet.
Some surveys are conducted and gives us some top priority about the keeping electronic healthcare record private and confident. 91% of people conducting the survey worried about “unauthorized access” to their personal health record. 81% of people want to be able to review who has had access to their personal health information. 68% of people do not want their employee access to their PHR. However, we can see a lot of support and interested in using information technology to create access to their PHR in order to check for medical record (69%). 68% of interviewee wants to check and fill their prescription and 58% want to get their test result over the Internet. In addition, based on the survey the group will be likely used PHR are baby boomer and chronic ill. Before the ideas of allowing the patient creating their own personal health record, health information about any patient was exchange between doctors, health care provider, pharmacy, lab test facilities except patients. Now with the applications and tools develop by vendors, users can create /access their personal health record using laptop, mobile phone, and PDA and the elements of their record can be text, numeric, or documents. Based on the presentation, we can divide the stakeholders into three groups : Consumer, Global Internet Brands and Health Care Institutions.According to the Dr. Lansky, some key factors were identified for PHR successful as following:
a) Able to define a Consumer Access Service that is trusted by consumer and other participants on the network
b) Able to determine minimum necessary privacy and security policies and practices
All of the key factors generate some big questions:
a) Will the Consumer Access Services succeed and create a trustworthy environment?
b) What kind of business model will emerge?
Personal Health Services using Personal Health record will help to improve the quality of the HealthCare systems and the relationship between the patient and doctor make them work as a team. For examples, the doctor can prescribe the prescription allowing the patient using the new drug. The patient will enter the side effect causing by new drug and refill using a web-based application. It helps to save a lot of time for phone calls and trips to go to the doctor’s office. By collecting data from patients from the different web sites, doctors and patient can help the pharmaceutical company develop a new drug and medical researcher and doctors come up with better treatment for disease like cancer, or heart disease. With the growing and expanding of blog and social-interactive networking tools, we can see the more and more people like to access their personal health record as they do with checking balance of their banking account. However, according to Dr. Lansky presentation we still have to face with issues related to protect confidential data of patient from unauthorized users and what kind of data we should allow user see and when they should see it( one week , two week after doctor find out they get cancer) and how we present the data(results) patients.
Other issues will be related to standardization of systems, tools, and architecture of healthcare systems that are used for creating and accessing PHR. What kind of standards should we choose and follow and how to come up with the guideline for develop application and tools? Those questions need to be resolved and answered to speed up the process of design and implement PHR systems and tools.
Having watched the video, ‘PHR an Overview’, I find the notion of PHR innovative and beneficial to consumers and all involved entities in the health information system (eHealth): health providers, physicians, laboratories, pharmacies, health insurers, and other providers. I learned a lot from David Lansky’s presentation on the functional and architectural issues of PHR as a central repository: the complexity of network topology, the scattered information among several providers, the need for information sharing, the challenges presented by the need for interaction among several parties, and the control of the information. The main difference between PHR and EHR systems is that the consumer controls the information in the PHR, while it is the healthcare provider who controls EHR. PHR has become a hot topic in the health information field and its architecture has gradually developed from simple to rich, complex, and dynamic. PHR includes important information about my life time medical records such as personal medical facts, doctor visits, allergies, medications, etc that are stored in a central warehouse which I can delegate and/or share with others, as I see fit. I also learned about the leading PHR applications and their models such as Epic, Medem, CapMed, SophiosGarden, and many others.
In the context of challenges, there are three areas or parties that need to interact to implement a PHR: the 21st century consumer, the global internet brands such as Google Health and HealthVault from Microsoft, and the healthcare institutions. The challenges and barriers presented by the need for interaction among these parties will not preclude the efforts to step up the pace towards the implementation of PHR. The efforts toward implementation are represented by the emergence of numerous PHR applications, the willingness of people for this transformation to happen, and research continuity. Nonetheless, although PHR enables people to electronically access their health information wherever they are and at anytime, the issue of defining PHR remains unresolved as mentioned by Lansky.
John Halamka discussed the control and sharing of patient PHR. PHR has made it possible for the involved parties, consumers, hospitals, clinics, payers, laboratories, and pharmacies, to share health information in three ways: provider2provider, provider2patient, and provider2other users. Due to PHR’s complicated architecture as it involves non-organized entities, not well-structured networks, technology, and people’s private live, I absolutely agree with Halamka about the need for healthcare information standards to facilitate the transmission of demographics, medications, allergies, and personal records preferences. The notion of utilizing the Continuity of Care Document (CCD) and Clinical Document Architecture (ACD) is appealing as it’s design is simple and includes educational documents, so the patient can understand the information and make informed decisions about his/her healthcare.
The possibility of communicating the local copy of PHR with other applications run on the consumer’s desktop is an important advantage. For example, this will enable the consumer to run chart diagnosis software to develop a chart for his BP or cholesterol records. The importance of such a feature is clearly implied in Microsoft‘s announcement that they are developing the BeWell plug-in product to enable users to install and communicate with a central repository. Standardizing the access to PHR through web browsers is also critical to save and protect consumer privacy, so browsers do not cash information locally. This will help bridge the so-called digital divide as the consumer does not need to have his own computer or even to subscribe to the internet because user can securely access his/her PHR from any public computer (e.g. libraries, educational centers, etc). PHR has a promising future, but data security and privacy and control issues are the real challenges in implementing a PHR system. In the light of this, I wonder whether there will be an authority that is responsible for organizing and managing the whole process to control data ownership and ensure privacy and confidentiality. In other words, why it is necessary to trust and believe Google’s promises of not sharing or releasing data to a third party, not practicing data mining, and not selling data. Who will guarantee these promises are kept, and what if Google is bought by another company!
After watching the video by Dr. David Lansky and John D. Halamka on Personal Health Records, I find it interesting that not that long ago, simply being able to type 50wpm was a skill to brag about on your resume. We were using typewriters and only a few us out there were using computers. The daily use of the computer after the wide spread use of the Internet has turned the average Joe in to a fast typer and using the computer has become second nature to most people. This familiarity most people have today with computers makes NOW the best time to take advantage of eHealth and PHRs. This was not as possible before the widespread use of the Internet: not because we did not have the means, but society did not have the computer skills to navigate such a system on their own from home. When consumers of different ages were asked about their preference for PHR media, about 40% of those who were 65+ responded by saying they preferred a paper based PHR. “As of 3/07, (only) 29% of seniors reported regular use of the Internet. (65% of people age 50-64).” About 10% wanted a Web site PHR, another 10% wanted a portable device PHR, and 8% wanted a PC hard drive PHR. After viewing these numbers, I can see how crucial it would be to find a way to deliver a PHR for consumers of every level of computer literacy. I also found it important to note that only 4% of the users of Patient Site were over 70. The concerns for patients with poor computer skills is also noted in the article Patient Education And Recovery Learning System (PEARLS) Pathway: A Tool to Drive Patient Centered Evidence-based Practice. When they tested the WebTV educational tools in hospitals for patients to watch while recovering they noted the difficulty patients who are older and not as computer literate face with such emerging educational tools. Since our health becomes more compromised as we get older and the elderly do not favor using computers, I find this as a challenge for the success of computer based PHRs.
This webinar presentation of personal health records covers several aspects of PHR's and EHR's. There are various topics in which this webex documents and walks the user through this digital landscape. The two speakers here are David Lansky (formerly of the Markle Foudation) and John Halamka (CIO Harvard Medical and Beth Israel). David opens up with a introductory discussion of what exactly is a PHR and talks of the 'different flavors' that organizations and corporations are providing. John Halamka goes further into details including both health aspects (safety of patients) along with some of the more pertinent technical challenges facing PHRs (security). based on these two gentlemen's presentations, Personal Health Records assist both patients and doctors (as well as even helping some streamline operations for insurance companies) as they form a central repository for control and management purposes. Through many PHRs, a patient has the ability to refill drug prescriptions, setup Dr. appointments, and even communication with doctors. Personal Health Records also assist in the formatin of new groundbreaking health based technologies. For example with Microsoft Health Vault a patient has the ability to track aspects of their health and have it immediately recorded into their PHR (for example a daily blood pressure count). The speakers in this web broadcast seem very optimistic about the ability for PHRs to allow for patent information dissemination and data flow. However, they also seem a bit apprehensive as there are many obstacles which need to be tended to in the very near future.
My take on this webinar shares a bit of excitement, mixed with technological interest topped with a hint of skepticism. Although I am not a member of the Kay Center, nor focusing a dissertation on PHRs, I think this subject is very interesting and there are promising technologies which should be expected. There seems to be no doubt PHRs are becoming a tangible artifact that practitioners will have to learn to deal with one way or the other. The notion of useful patient information on- demand and readily available far out weighs any lobby which may form against it. However, this industry seems to move slow. Very slow. Especially when dealing with something that is not tangible or analog based. Also, a lack of conformity lends its hand to longer latency of a standardized PHRs and EHRs.
In general, the presentation provides a good overview of PHR with updated information. After watching this web conference, I realized how rich and complex the PHR is. It is a hot topic and major concern of different parties: consumers, healthcare providers, researchers, health insurance companies, employers and IT corporations. I expected to find a standard definition for PHR but I learned that there is no specific definition for PHR up to date. This is due to the availability of different PHRs in terms of the technical aspect and use. Once there is a trustworthy, valuable, safe, and sustainable PHR, which will be commonly accepted and widely used by consumers, then PHR can have clear and accurate definition.
Although the U.S. government is very concerned about PHR, implementation and adoption of PHR might take longer than planned due to many barriers mainly related to privacy and security issues. It seems that the benefits of PHR for the consumers are evolving and cannot be counted for the time being. It is a field of innovation and creativity. The benefits, however, touch the convenience of the consumer, education, knowledge, health quality and economy. Different preferences of people for PHR add complexity to the issue. These variety of tastes are affected by some factors like education, literacy, medical condition and culture.
It is interesting to know that the major incentive for people to use PHR is to check for mistakes in their records. I believe that the rank of the incentives will change as people become aware of the potential advantages of the PHR.
The demonstration of by John Halamka of his own PHR has given me an idea about how a PHR looks like. I wonder if making the privacy of sensitive information, like HIV test result, optional would help to enhance the privacy since I belief that those with negative HIV for example do not mind to make the test result accessible by others who are needed to share the PHR.
It is good to know that using PHRs did not increase the communication overload between patients and their doctors as patients are exposed to bad news where they become worry. This is a good news for the doctors.
The experience of PatientSite system shared by Halamka shows that the PHR has a promising future.
Personal Health Record got a great attention lately. PHR became rich, dynamic topic that keeps many parties’ minds busy thinking of where this new approach may take us as providers, patients, health researchers and any party may be involved in this new technological trend. After watching the Video for Dr David Lanasky and Dr John Halamka I got the basic review for PHRs system which was clear enough and very interesting to me. From the presentation I can say that the idea behind the PHR is very ideal to any person especially we all as patients need to have this accessibility to our health information and having our own control on it. Presenting the Google new health platform was a new info to me which raised a question up to my mind. To what extent Google will take us in the future? Just a question!!! Both Dr Lanasky and Dr Halamka gave a basic understanding for the topic and its basic idea and the benefits for PHRs parties. Dr Lanasky talked about different products for some companies which are functioning as PHR systems. Moreover, the main concerns around PHR systems. After watching this video I started to think of some points which are valid in our world and may also act as main obstacles to developing and employing PHR. From my understanding to the topic, PHR won’t have this ability to serve the benefits as it is designed for without being interoperable with EHR system while US has already problem with its fragmented health delivery system. The issue that indicates to me that in order to have beneficiary PHR, we need to look first how to get unified EHR system, and this to obtain the benefits from both EHR and PHR as well. Another challenge also I thought about is how to handle such vast amount of data which may be very costly process.
Dr Halamka also talked about three challenges, one of them is (Global internet brands and others), this part made me think of some global challenges that may go beyond our control, such as the legislations in every country and how to meet such issue, also the development level for every country that is not necessary to be similar for US.
According to the presentation also, 91% of Patients concern about the security, privacy, and getting secure access to their health information, and I thought of the fact that there isn’t anything secured over the internet, is there? For instance, our bank accounts. It is still not 100% secure logging into our accounts because there might be people like hackers could know what we are doing and hack our accounts, and there are already many cases of bank fraud happened. However, despite of this fact, we are taking this risk because we need those web-based services. Talking about PHR system, I think we may not achieve the 100% security access because it is web-based application, beside the security perception varies from one person to another which makes achieving the security according to patients’ needs and perceptions more complicated. Therefore, I think we need to obtain the maximum level of security and privacy that meet the patients’ and providers’ expectations to get their trust and their contributions which I believe they are key success factors to PHR development.
The teleconference reviewed was definitely a great introduction to the overall course. It provided high-level insight relative to the emergence of PHR technologies. Based on the session, it is evident that the healthcare domain is extremely complex in nature. This view becomes even further complicated when examining the various sources, seekers, and providers of information within the health industry. There are different stakeholders involved, and the patients are inter-mingled between various individuals and entities. From a value perspective, the retrieval and access from all of the relative data sources is vital to produce meaningful information and knowledge. The key ingredient to achieve this is ‘tight integration’ amongst all of the players and data/information sources.
What is nice to see is that different leaders and corporations have realized the value of HIT and have started different initiatives to move this forward. Accordingly several technological advancements have taken place, and the need for electronic personal health records has emerged. Currently, the different PHRs available for the patient consumers have different functionalities. These functionalities are being enhanced and add-ons keep coming up. As we progress, and develop tighter integration amongst the various players within the healthcare domain, we will start realizing further benefits and values of PHRs. From the consumers’ perspective, it seems that there is already a strong interest in using health information technology to participate in managing their personal health care. Their primary concerns however revolve around issues related to the privacy and security of their records. Accessibility, personalization, pre-populated data/information, and the convenience of self-service functions are also key elements that consumers would like their PHRs to accommodate for them. After all, it should all be about empowering the patient consumer, increasing their personal healthcare knowledge, and providing them with the right tools at the right time to manage their health status. This should ultimately lead to the optimization of the overall quality of their personal health.
Currently however, there are several problems, challenges and barriers that need to be resolved in order to increase both the adoption and success rates of PHR technologies. The main problems in my opinion are relative to the lack of integration, standards, and an effective sustainable business model/strategy. Another problem is that there are many different flavors of PHRs available in the market, each designed from a different perspective, and in some cases for different types of end-users, hence causing confusion for both the patients, and the healthcare providers / organizations. In line with this matter of different types of PHRs, I would personally love to see one unique entity, whether be it a new entity, or an existing one, to take the lead in establishing a national fund to aide in the design and development of one standard PHR solution (one size fits all), with the provision of allowing minor customizations to adhere to certain specifically unique cases the different healthcare organizations may have and need to accommodate for. Moreover, it would be great for this same national-level entity to develop and establish a knowledge repository for the storage, and reuse of PHR systems design knowledge, in addition to storing and maintaining a national database pertaining to the lessons learned from the cases already implemented. Why do we have to reinvent the wheel every single time we come to implement these forms of technologies?
What I felt was missing from the teleconference session was substantial information and discussions pertaining to the project management and implementation issues of PHR systems. My opinion is that these are also key issues that define the success or failure for the majority of these projects. All in all however, as mentioned previously, this was an excellent overview and introduction to theme of ‘consumer health informatics’.
I found this to be very interesting to hear about the hot topic of Personal Health Records. Just within the last 3 to 4 years this idea has really starting to gain momentum and grow. The original idea behind PHR was to enable people to have access to their health information. Most people have their information housed in a wide variety of organizations (some medical, some social service). The intent is to have access whether it is for personal use or to share with other services and to exercise control over whether the patient wants to share with family or other care givers. This has been a challenge and is difficult for a patient to obtain their information especially in electronic form.
Ideally, the goal would be for all information to be electronically transferred to a central repository so that the patient can have access or allow someone who they think should be able to access in order to provide better service to them. It was amazing to hear that Bush announced that every American should have access to their PEHR record by 2014 and being half way towards this time frame, we are no where near that goal. This thought has really challenged the way the industry will go about implementing. The Department of Health and Human Health Services launched AHIC - Americas Health Information Community to try and find out how to stimulate this progress. Congress has given this topic a lot of attention and various ideas are under way. One congress man proposed incentives to doctors if doctors would insure that their patients had access to PHR’s. Another thought it might be a good idea to have federal employees have access to a PHR through their health insurance plan. Another made mention of the idea of creating health record banks. The Major National Health Insurance Plans the big private health insurance under AHIC (bluecross/blueshield) said they would have a standard for portability of PHR of information which cover about 100 million people. This is a great launch pad to get this process started. Corporations such as Microsoft and Google are announcing a platform to give access for general internet services to large employers such as IBM. By doing so, they will collect PHR data to aggregate information.
Services that PHR offer are provided in various forms. There is not one product that offers all of these services. Some of the services are as follows: Educating patients by helping them take care of themselves or family members through their home. Secure messaging to their doctor. Availability of certain transactions such as making appointments or setting up reminders. Refilling prescriptions. Reminders to stay on track with drugs or exercise programs. Allowing patients to keep track of their own information of interest such as monitoring pain levels or tracking side effects from medications or combination of drugs.Keeping track of long term health trends and checking for drug interactions that can be sent back directly to patient instead of having to go back to dr. or pharmacy.
It will be very exciting to see what the conference has to offer in terms of obtaining a better understanding of thes e services and the difficulties associated with the implementation process.
The video by Landskey and Halamka was an excellent overview of PHR and the intimate connection with the EHR/EMR. The potential and intentional scope of PHR’s in ultimately motivating an individual’s behavior toward a healthy lifestyle is far reaching – not only for the individual, but for multiple communities and large groups of people as well. The vision is that an individual would have access to their entire life’s medical history: records, status, encounters, growth, development, inoculations, medications taken, illness cycles, pubertal issues, hospitalizations, minor procedures, adult aging from young adult to senior. It could be possible for one to automatically gain information every time there was a doctor’s visit, pharmacological entry, hospital stay, imaging and lab test results, vaccinations, etc. This information could be linked to population statistics, symptoms and pathways for exacerbations, remissions and health, side effects of medications, information regarding allergic reactions’ signs, symptoms and treatment; interpretations of X-ray, CT, and other lab tests and results; coaching information for coping with medical conditions and much more.
The speakers spoke of the availability of various PHR’s including institutional and web based PHR’s like those offered through Google and Microsoft. They shared insight of how the major health stake holders can interrelate to provide a rich PHR environment that could offer benefits for all involved. Halamka described and shared his experiences and lab values with his own PHR to illustrate the benefits the PHR can offer a person.
The public health as a whole could benefit from population statistics developed from anonymous PHR information. The possibilities are endless in the utopian environment of exchanging, sharing and accessing medical data. Our president has committed our country to a goal for all health records to be electronic and exchangeable by 2014.
Policies and standards are currently developing for this fast paced entity. Privacy is tantamount to these standards. There are many barriers to achieving the ideal which include the individuals as patients, the physicians, the institutions, i.e. hospitals, pharmacies, labs, suppliers and equipment manufacturers, software developers, vendors, employers, insurance companies and the government. Individuals are especially sensitive where privacy and confidentiality are concerned. It also takes much time and would require ready access to an electronic device to implement. Physicians and institutions realize the disruption in work flow and the tremendous capital outlay that would be involved for their work places to convert to electronic records. Another barrier currently is that most EHRs are stand alone entities. A major boost to improve salience of the PHR would be for the development of software/IT solutions to integrate the stand alone software options currently available. A central bank or repository was also discussed. This would streamline access and portability of an individual’s medical records.
This video presented quite a vision for the future and was an excellent preparatory tool for the course in Boston.
This video cover the agendas to set to President’s 10-year commitment toward 2014 to get American Health Information Community – Consumer Empowerment “Breakthrough” . We are seeing the entire Healthcare industry behind this huge task.
Some members of the group are:
• “Retail” PHR providers (e.g., WebMD, Intuit, Medem)
• Consumer portals (e.g., Google, Yahoo)
• Data clearinghouses (e.g., SureScripts)
• Retail pharmacies (e.g., Walgreens, Wal-Mart)
• Health plans (e.g., AHIP, BCBS)
• Provider organizations (e.g., VA, Kaiser Permanente)
This is really an exciting period in the healthcare industry. It is a whole revolution. They had cover Policy Framework for Consumer Access Service which is critical for developing the Networked personal Health Information. They had deliver PHR and some the expectation and feature we are expected to see. Using PatientSite, they had shown what PHR can actually deliver. Standardization of systems and architecture of healthcare systems seems to be a constant challenge. Practice and standards for other area like hospitals, pharmacies, labs, suppliers and equipment manufacturers, software developers, vendors, employers, insurance companies and the government are some of the area to set the standards in. This is seen as something everyone hopes to see in the near future.
The web conference presented by Dr. David Lansky and Dr. John Halamka provided an excellent overview of the many players in Health Information including supporters and barriers. Dr. Lansky focused on defining the PHR and the primary types available today while Dr. Halamka focused on discussing some of the challanges such as standards and privacy. While the defintions of what a PHR is and its exact functionality varied, most parties agreed that it aids the communication and data transfer process between the patient and the doctor.
This video really put into perscpetive the number of players involved, some of which include: insurance companies, health providers, software companies, and pharmacies. With the number of PHRs expanding in the market, one of the primary concerns addressed was the idea of standardization. Standardization includes the issues surrounding uniform data exchange (challanging because of the the various flavors of stand alone PHRs available and their unique functions).
Another significant barrier focused on here was the idea of security or privacy of the medical information. Surveys presented in the video highlighted the importance of security to patients. For this reason, it is an important consideration in the development of privacy standards. Interesting comments were made in regards to actual versus perceived privacy to end users as well as the need for consistent legislation to be developed in this area.
Overall, the most interesting portion of the video was the discussion of the potential benefits of the PHR. While several of the logistics including full implementation are not well defined at this time, the driving forces are already in place. The final goal being patients with full access to their medical history available in a standard format. Once this is in place, the further ambition of generating more accurate population based heatlh statistics becomes a realistic goal.
Actors across the range of health care delivery are excited about the prospect of PHR usage. Employers such as IBM, PepsiCo and Wal-Mart are sponsoring PHR usage. Major health care providers like the VA, Kaiser and Partners have developed PHRs that are integrated with their internal Electronic Medical Records. Even global Internet companies like Microsoft and Google are bring Personal Health Records to market this year.
The key challenge for Personal Health Records appears to be adoption.
People are concerned about privacy. This concern is accentuated when the PHR is employer sponsored. Employees are concerned that their "private" health data may be accessed when the time for promotion or evaluation comes.
However, when the request to use a PHR comes from the patient's physician, there is a higher level of trust and interest. When the PHR is connected to the providers, people are much more likely to utilize the system. Lab results are a highly viewed resource by patients that elect to use a PHR. Physicians are excited at the prospect of patients taking a more active role in managing their health. Moreover, individuals with chronic conditions such as diabetes or high cholesterol tend be more cognizant of making "healthy" choices when they are frequently viewing their lab results online. Furthermore, patients will more readily identify errors in their medical record if they have transparent access to their data.
Doctors are concerned about being overwhelmed with E-mail inquiries from their patients. However, as Dr. Halamka noted, patients have lives too and the physicians do not get bogged down in a flood of E-mail correspondence.
In a nutshell, a successful PHR should be automatically populated with data from hospitals, clinics, payers, labs and pharmacies. It should be interoperable between disparate systems and it should empower patients to take a more active role in their health.