PHRs and HIEs

Mary Stevens, editor, CMIO

As health information exchanges (HIEs) tap data from more sources, personal health records (PHRs) present both compelling potential and a raft of challenges. HIE access to and use of PHR data was a topic of interest at recent a Beacon Community panel discussion, and PHRs could be vehicles for patient accountability in future care delivery models. But we’re not there yet for a variety of reasons.

Security of patient data represents one sticking point: The Office of the Inspector General’s report earlier this month cited CMS’ lax enforcement of HIPAA's security rule. ONC efforts to secure patients' individually identifiable health information at the policy level also need work, a second OIG report found.

The ONC and other agencies continue to hammer out some of the key issues of trustworthy exchange, including digital certification of HIE users, Health IT Standards Committee Chair John Halamka, MD, stated earlier this month.

However, the question of who owns the data continues to be a challenge, said Brian Yeaman, MD, CMIO at Norman Regional Health System, during at a recent Webinar on Oklahoma’s HIE efforts. (Normal Regional was featured in "Five HIEs to Watch" in the February issue of CMIO.)

HIE stakeholders in Oklahoma, like those in other states, are looking at PHRs with an eye to the future. “It’s significant that we get that information from the patient ... as we move forward, we’re going to be accountable for the compliance of the patient. We’re going to need [PHRs] to bring this information to us in a timely fashion, for monitoring and decision support,” Yeaman said.

The healthcare reform law and meaningful use program haven’t addressed proper implementation, funding or ownership of PHRs, he said. As a result, “every health system and clinic is launching their own PHR, yet there’s no aggregator there to bring that information together to help make it meaningful.”

Patient accountability—their “compliance” with recommendations for care—also is missing, he said, but will be necessary for accurately assessing clinicians in pay-for-performance environments. “We’ve got to have a way to capture that information back into our systems and ultimately, our reports,” he said. Embedding educational resources and health-risk appraisal tools in the PHR could help, but only if patients use them consistently. “Accountability has to come at some point and time,” he said.

The HIE ultimately will be the enabler, collecting information from PHRs and other sources and moving data across the care environment, Yeaman said.

The vision is compelling, but a lot of work remains to be done. What role should PHR data play in your organization’s HIE? Let me know at mstevens@trimedmedia.com

Mary Stevens,
Editor, CMIO