PHR popularity increasing, but deployment best practices still unknown
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In the U.S., new Meaningful Use requirements that providers electronically send patients their health information are driving increased utilization rates, according to Seuli Bose Brill, MD, an assistant professor of internal medicine at the Ohio State University (OSU) Health System in Columbus. While there has been some negative feedback regarding those specific requirements, Bose Brill believes PHRs will allow her to provide more individualized care and increased access to care.
She relayed the story of a patient with depression who, during an especially acute moment of suffering, was unable to leave his home to see her. Bose Brill asked him to send her a message through a PHR tethered to the OSU Health System’s EMR. The patient agreed to the request. “It gave me peace of mind to know that I could send him home safely,” said Bose Brill.
OSU Health System policy states that individual providers must make PHRs available to their patients, but doesn’t dictate how much each individual provider should promote the health management tool. Bose Brill examined usage rates and determined that patients with older primary care physicians were less likely to have activated their PHR. In other words, there was a negative correlation between activation and increased physician age.
Bose Brill’s findings seems to indicate that, as has been the case with other health IT tools, PHR adoption rates could follow a hockey stick-shaped curve. Many PHR development projects and efforts to encourage PHR use are still in their infancy.
“There’s currently a need to put patients at the center of healthcare,” said Liliana Laranjo Silva of the Portuguese National School of Public Health in Lisbon, Portugal. “They should be able to control their PHRs and share it with whomever they want.”
She is currently developing a PHR specifically for Portuguese-speaking diabetics to help them manage their health. Approximately 5,000 use the tool in its current form, as an online patient portal. Silva and her colleagues plan to transform the portal into a PHR tethered to multiple EHR systems by 2013 and the next phase of their project will investigate its impact on health outcomes and literacy.
As research on outcomes becomes available, it will hopefully guide PHR implementation through several unclear areas. The Canadian province of Alberta has EHRs for all of its approximately 3.75 million residents and is nearing the second phase of a PHR implementation that will eventually extend to all of them, according to Mike Sharun, managing director for EMC Canada.
However, there are still many unanswered questions: How should clinical information be presented to patients? Should patients receive laboratory results as soon as their clinicians do? For now, the “key to what we’re doing is listening,” Sharun said. “What Albertans want is something that comes up a lot.”