Data management, changes to the patient relationship, and practice management issues are key barriers to implementation, doctors say in study.
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Primary care physicians like the idea that personal health records will make healthcare data more portable and open up communications channels with patients, but they still have plenty of questions about data security, workloads, and how PHRs might change their relationships with patients, a new study says.
According to the study, an online exclusive for the journal Canadian Family Physician, family physicians are interested in the general concept of PHRs, but the technology needs to be integrated with electronic health records, easy to use, and add value to family practice before doctors will consider bringing PHRs into their practices.
Physicians generally believe that PHR adoption is "inevitable," and helpful to getting patients more engaged in their own care, researchers at the University of Western Ontario in London, Ontario, reported. "However, participants consistently raised concerns about data management, changes to the patient-physician relationship, and practice management issues. These concerns were the three key barriers to the implementation and adoption of PHRs," they wrote.
While previous research has focused on consumer attitudes toward PHRs, this study looked at family physicians. The researchers studied 10 family physicians in southwest Ontario in 2009, half of whom occasionally worked in emergency departments or walk-in urgent care clinics, and thus saw patients they weren't familiar with. Six of the physicians were EHR users.
Data management issues raised included security, stewardship, and completeness of records. "If [patients] are entering information, it may not be accurate for what's going on ... it may be their interpretation of the layman's description that is given to them," one physician said, according to the study.
Integration of a PHR into an EHR might alter the physician-patient relationship, the researchers wrote, by removing the information filtering that the doctor provides. "With full and independent access to the EHR, patients would not have the medical information transmitted to them by their physicians. In the absence of this traditional framing of medical information, patients might experience unnecessary anxiety as they attempt to interpret the complex medical information stored in their charts," the study said.
This issue of creating unnecessary anxiety is particularly worrisome in the context of mental health, according to the researchers.
The study does not address the fact that this may already be happening in some locales. In the U.S., providers attempting to earn Medicare and Medicaid bonus payments for "meaningful use" of EHRs must be able to give patients electronic summaries of their records upon request.
Physicians interviewed for the study did mostly agree that PHR usage would both necessitate and facilitate better communication with patients. "Providing [PHRs] opens another opportunity to communicate with people. I don't think you can ever communicate too much," one doctor is quoted as saying.
However, the survey participants were wary of PHRs shifting some in-person interaction to the Internet, via email or other form of electronic messaging. "We have to remember that the art of medicine is not in the technology, the art is in the face-to-face contact and the patient-centered care that we deliver to patients and that's what heals them, that therapeutic relationship that we have with our patients; it's not the technology," one physician said.
Canada's healthcare system may be government-funded, but, just like in the U.S., fee-for-service still predominates, and physicians expressed concern about whether there would be a business case for them to embrace PHRs. Physicians obviously would object if PHRs added to their workloads, but they also could find themselves losing money if the technology actually saved time by decreasing the frequency of patient visits.
"If you're in a capitation model, which is not fee-for-service, that is an incentive to keep your patients in good health and out of the clinic," according to one participant. "You don't need to see them to bill, to make money. So if you're providing good care and doing it more efficiently, and can do it more efficiently with a PHR, then that would be a positive thing."
One doctor expressed concern about PHRs offered by private companies with no direct interest in patient care by suggesting that the College of Physicians and Surgeons of Ontario, a provincial regulatory body, give physicians the right to refuse to share data with private PHR vendors. "So if patients start demanding that I
fill in [PHR information], that's when we need to have some strict measures from our College," this physician said.
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