Personal Health Record Handbook Designed To Energize Providers

To light a fire under clinicians, a new guide from the Agency for Healthcare Research and Quality extols the virtues of interactive PHRs and outlines steps for successful implementation.
Is A Personal Health Record In Your Future?
Is A Personal Health Record In Your Future?
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In a move that prepares primary care practices for a future in which the use of interactive personal health records (IPHRs) will be the norm rather than the exception, the Agency for Healthcare Research and Quality (AHRQ) recently released a guide that offers tips on implementing the technology. IPHRs will be a critical tool for clinicians to monitor patients' vital signs and prevent the onset of illness or a worsening of an individuals' medical condition, said the agency.

"An Interactive Preventive Care Record: A Handbook for Using Patient-Centered Personal Health Records to Promote Prevention" offers practical steps to guide healthcare professionals as they evaluate, deploy, and maintain an IPHR, which the document describes as a "highly advanced, patient-centered, evidence-based, patient portal focused on prevention."

The handbook is based on the lessons learned from implementing an IPHR at 14 different physician practices that use electronic health records (EHRs) from three different vendors.

Outlining the benefits of an IPHR, the handbook noted that the technology can collect information from patients and clinical data from existing electronic records. Not only can the technology translate clinical data into lay language, it can provide patients with relevant, customized clinical recommendations based on evidence-based guidelines.

Furthermore, the IPHR generates actionable information by providing tailored educational material, decision aides, risk calculators, motivational messages and reminders.

[ For another point of view on PHRs, see Why Personal Health Records Have Flopped. ]

During a one-year period, the 14 practices signed up 25,210 patients to create IPHR accounts, representing up to 25% of the patients seen by these practices. Patients found that by using the technology, significant improvements in their medical status occurred, including:

-- Nearly twice as many patients were up-to-date on all recommended preventive services after using an IPHR.

-- Colon cancer screening increased from 53% to 72%.

-- Cervical cancer screening increased from 80% to 91%.

-- Tetanus vaccination increased from 58% to 71%.

-- Pneumococcal vaccination went from 48% to 62%.

Similar increases were not seen for non-IPHR users. Still, to get these results requires organizational leaders to see an IPHR as a top priority. Practices must install the technology to reflect an individual practice's needs and culture. The project also requires a team effort; all staff members must be trained on an IPHR.

Nancy Fabozzi, principal analyst covering Healthcare at Frost & Sullivan, said the document can help keep clinicians focused on the core mission of improving patient engagement.

"Such a guide can--and should--serve to anchor team efforts around patient engagement initiatives. Having a dedicated staff member, most likely a nurse or physician assistant, in the role of educator and advocate can go a long way to instill long-lasting behavioral change," Fabozzi told InformationWeek Healthcare.

The handbook offers tips on data transmission between an EHR and an IPHR, and provides recommendations that include:

-- Have the EHR write a prevention summary document and send it to the IPHR. Many EHRs can generate standardized, patient-level summaries that can be electronically exchanged. Summary documents such as the Continuity of Care Record (CCR) and Continuity of Care Document (CCD) are examples of standardized patient health summaries. Providers also can configure an IPHR to trigger the transfer of an EHR's CCR or CCD to obtain a patient's clinical data.

-- Have the IPHR request data from the EHR using a built-in query program. This transfer mechanism is a program embedded within an EHR that other systems can trigger to perform a predefined action.

-- Build a parallel copy of the EHR data that an IPHR can use directly. Through this method, a practice could create a separate data warehouse containing all the data an IPHR might need. The IT team can configure the IPHR to access the warehouse for a patient's clinical data.

-- Directly access data within the EHR database. Practices can set up the IPHR to directly access data within an EHR using an open database connection (ODBC).

The handbook also says an IPHR can send information to an EHR as discrete data elements using HL7, which is a standard used for exchanging data between medical applications, or by generating a single summary document and sending it electronically to the EHR. Additionally, an IPHR can send a fax summary document to the EHR.

To encourage patient engagement, the guide asserts that a practice has to urge patients to create their own IPHR and to use the technology, but warns that the task requires a team effort.

"In general, all of a practice's staff needs to be involved in the process of getting patients signed up to use an IPHR. Workflows that rely solely on clinicians to get patients to use an IPHR will not likely succeed. Likewise, without clinician support and reinforcement, practice staff cannot get patients to use an IPHR," the guide states.

In this InformationWeek Healthcare virtual event, EHRs: Beyond The Basics, experts will discuss how to improve electronic health record systems. It happens July 31.