JAMIA: PHRs need standards

Personal health records (PHRs) can empower patients, but there are substantial design and implementation issues that must be approached carefully, according to an article published online in the Journal of the American Medical Informatics Association.

Nhan V. Do, MD, from the clinical informatics department at Walter Reed Army Medical Center in Washington D.C., and colleagues sought to design, build, implement and evaluate a PHR that leverages Microsoft's HealthVault and Google Health infrastructure and is tethered to the Military Health System.

A pilot project was conducted in 2008 and 2009 at Madigan Army Medical Center in Tacoma, Wash., where a PHR was built on a platform that incorporated CCD and CCR standards-based data exchange models to map Department of Defense-sourced health data, via a secure Veterans Administration data broker, to Microsoft HealthVault or Google Health based on user preference.

Of the 250 beneficiary users in the study, approximately 73 percent were under the age of 65, and 38 percent were female. Microsoft HealthVault was the PHR of choice for 169 users (close to 68 percent), and 81 (roughly 32 percent) selected Google Health as their PHR. Sample evaluation of users revealed that 100 percent (n=60) were satisfied with convenience of record access and 91.7 percent (n=55) were satisfied with overall functionality of the PHR.

“Key lessons learned related to data-transfer decisions, purposeful delays in reporting sensitive information, understanding and mapping PHR use and clinical workflow and decisions on information patients may choose to share with their provider,” Nhan and colleagues wrote.

Adopting standards into PHR design can enhance the national goal of portability and interoperability, the authors concluded.

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