A Field Guide to Online Personal Health Records

January 2011 Table of Contents

Tethered PHRs ...... 1

Portal PHRs...... 2

Open Platform PHRs...... 2

All or Nothing?...... 3

Recommendations & Next Steps...... 4

Other PHRs...... 4

About the Author...... 5 A Field Guide to Online Personal Health Records Health Personal Online Guide to A Field

www.aspenadvisors.net i portal, andopenplatform PHRs. are basedonpatient data fed from healthcare provider systems have stratified into three distinct flavors: tethered, It was interesting to discover how thePHRmarket has evolved over thepast 10 years. What I found was that PHRsthat (one inpatient, two ambulatory) into onelongitudinalpatient record. and providers by usingaPHRasanaggregation tool for integration of patient data fromtheir three core EMR systems by offering patients electronic access totheirhealth information. Butthe organization also saw value forboth patients state” ofPHRs.Theorganization was considering aPHRprimarily to meet theproposed Stage 2MeaningfulUsecriteria I recently was asked by alarge integrated delivery system client intheMidwest to lookinto thecurrent “state ofthe to me. health problems (withafocus toward treatment tracking kids),sothesubject forremains nearanddear “frequent flier” the privilege ofworking withaprominent pediatric to develop acustomized PHRfor theirpatients with chronic Leading thediscussionare issuesofprivacy, patient ownership ofdata, accuracy, and availability ofdata. In2001,Ihad personal healthrecords, orPHRs,have beenasubjectofmuchinterest anddebate inthehealthcare community. Since thelate 1990swhenDrKoop.com first encouraged us to putourmedical healthhistories online, web-based comprehensive with tools for physician The PHRisusuallyjust onecomponent ofamore Patient Onlineare read-only “windows” into the EMR. vendor. For example, EpicMyChartandGE health record isto useatool provided by your EMR The fastest route to providing apatient-facing personal Tethered PHRs • • Provide patients withan • Provide accessto patient- Provide patients withan specific education resources. discharge uponrequest. and procedures at timeof discharge instructions electronic copy oftheir methods. using secure electronic procedures) uponrequest discharge summary, medication list, , lab results, problem lists, information (including electronic copy ofhealth ST 2011 AG Three Types of PHRsFed byP E 1 Te thered • • • • Document family patient preferences Provide accessto patient- Provide accessfor allpatients to Nondiscrimination Actof2008. theGeneticGINA, Information history, incompliance with treatment options). media, healthcare proxies, preferred(e.g. communication languages.primary specific educational resources in . PHR populated inreal timewith aent Dataf ST Po 2013 AG rt E 2 al MyChart, includingtheiPhone application. two ofseveral organizations that have rolled outEpic’s Health andScienceUniversity and DeanClinicare just implemented atethered For PHR. example, Oregon and payment. Anumberofmajorhealthsystems have communication, physician andbillinquiry scheduling, ro m Healthca Pla Open o rm re Prov • • Utilize electronic reporting Provide patients withaccess still under review). on experience ofcare (details to self-management tools. ider Syst www.aspenadvisors.net ST 2015 AG ems E 3

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A Field Guide to Online Personal Health Records System inKansas Cityhasimplemented RelayHealth’s your physicians aswell. For example, Saint Luke’s Health is agreat way to go notonlyfor your patients but for data from affiliated physicians, aportal PHRsolution on multipleEMRsandalso wish to integrate ambulatory geographically diverse system withmultiplehospitals connectivity suite for HIN/HIEenablement. If you are a purchase inaddition to the rest of your physician As such,theportal PHRtends to beaproduct you can be“turned” to beprovider facing aswell. a PHRrelated to medical information importanddisplay enabling data aggregators. Thecore technology behind Some ofthesenameswillbemore familiar asHIE Millennium EMRplatform. Connect (HIE)platform, rather thandirectly tied totheir PHR alsofitsinthis category, beingbasedontheirCerner (now MedFusion),MedSeek,andRelayHealth. ’s request functionality. Examples includeMedemiHealth incorporating physician communication andschedule of amore comprehensive “patient portal” product, partner facilities). ThePHRitselfisoffered aspart as well asentry from multipleEMR systems (including but are capable ofsupportingself-entered information be branded to your facility andare fed by your systems Portal PHRsare products from third partiesthat can Portal PHRs of PHRs. For that, you need to look to the next two flavorssolution. your facility andnotbemarketed asacomplete PHR as aconvenience for patients to accesstheirdata from record. Inthat, thetethered PHRneedsto beseenmore PHR, there isnoway for thepatient to addit to their encounter didn’thappeninthefacility withthetethered patient isallowed to enter ormaintain themselves. Ifthe Also, most tethered PHRslimittheamount ofdata the will leadto alessthanoptimal patient experience. will likely have multiple tethered PHRsasa result, which multiple ancillary, ambulatory, andinpatient EMRs, you are tied to asingleproduct. If your organization has vendor, butthey have someinherent limitations. They configure andare well supported by your core EMR for many healthcare organizations. They are easy to In general, tethered PHRsare anexcellent option your EMRvendor. personal healthrecord isto useatool provided by The fastest route to providing apatient-facing connectivity solution. (NoMoreClipboard.com) for theirPHRandphysician the recent assessment for selected aportal PHR for HIEconnectivity as well. Theclient I was performing Meaningful Usecriteria andcould provide aframework would helpyour organization deliver onStage 2 That said,aportal PHRisstill awiseinvestment and course, your competitor isparticipating inaHIN). would notshow upinthepatient’s PHR(unless,of health record. AnEDvisitto acompetitor’s hospital may notbe seen asatrulycross provider “personal” limited to viewing data from your facilities, andthis Be aware that aswithatethered PHR,patients are out direct supportfor theopenplatform PHR. A numberofmajorhealth systems have rolled health record, thesetools lead theway. as well. Interms ofthepromise of a truly“personal” They can even importdata from competitors’ networks networked glucometers andhomehealthmonitors. from major retail networks anddirect interfaces from maintain. There are tools to importpharmacydata and therecords are thenthepatients’ to keep and does notown thisrecord. You feed patients’ records, The fundamental difference isthat your health system and healthnetworks. importing data directly from pharmacies,labproviders, can addtheirown data to aswell as“hooks” for offer atrueprovider-neutral PHRplatform that patients HealthandMicrosoft HealthVault. These tools In 2008,two majorplayers entered thePHRmarket: Open Platform PHRs for theproject. PHR aswell althoughPHRwasn’t driver theirprimary “Carelink”) for provider connectivity and rolled outthe portal product (internally branded at Saint Luke’s as well. your patients butfor your physicians as solution isagreat way togo notonlyfor from affiliated PHR physicians, aportal and alsowishtointegrate ambulatory data with multiple onmultiple EMRs If you are ageographically diverse system www.aspenadvisors.net 2

A Field Guide to Online Personal Health Records record solution. view for HIEenabling.Thisisatrue personal health data cannot beeasilyrepurposed into aprovider-facing However, sincethisPHRisentirely patient-owned, this functionality. Mayo. Mayo isonlyproviding awindow into Microsoft’s The securityandaccessiscontrolled by Microsoft, not by Health Manager account withoutbeingaMayo patient. on top oftheHealthVault platform. One can create a example, theMayo ClinicHealthManager tool isbuilt custom data elements andhealthmaintenance tools. For a branded “entry into thePHRaswell point” asadding of anopenplatform PHR,offering yourhealth system that provide acustomizable shellthat lays across thetop To preserve brand identity, there are multiple products daily use. the tool, there isstronger incentive for maintenance and longitudinal healthhistory across healthsystems isin Use criteria. Andbecause more ofthepatient’s system, andyou are compliant withStage 2Meaningful present your organization asa forward-thinking health First, simplyby supportinganopenplatform PHR, you solution help? retain themas afuture customer, how doesthisopen of aPHRisto provide value to thepatient that willhelp So where doesthehealthsystem fitinto this?Ifthe goal your supportteam create theaccount. simply handthepatient anID card at discharge andhave to. Whereas inaportal ortethered solution, you can Microsoft andcreate anaccount that you can thenlink this data, theonusisonpatient to go to Googleor A majorchallenge isthat because you donothost orown health andlifestyle portal. in Marlton, New Jersey, asapartofitsVirtuaWoman recently rolled outby Virtua,amulti-hospital system HealthVault, andanew PHRbasedonHealthVault was Clinic partnered with Microsoft to populate data into a tethered PHRfor TheMayo theirEpicClinical EMR. export to GoogleHealthwhilecontinuing to provide The Cleveland Clinicisanearlysupporter ofdata Meaningful Usecriteria. health system, andyouarecompliant withStage 2 present yourorganization asa forward-thinking Simply by supportinganopenplatform PHR,you 1. general caveats: Your PHRstrategy must take into consideration several enough to have established them. you alsosupportopen platform export for thosesavvy PHR may be your preferred offering to patients, while your HIEenabledportal Likewise, PHR. your tethered PHRs, soyou can supportboththeopenplatform and support importandexport withtheopenplatform flavors ofsolutions.Anumberportal PHR vendors may besome blendofthethree aforementioned In theend,ultimate solution for your organization All orNothing? 2. 3.

segregated andidentified. pursue, that theusereditable areas are clearly data was sourced. Besure that inany solution you import have non-editable indicators ofwhere the To ameliorate this,most PHRsthat allow data for may have beenaltered to suitanulterior motive. a great fear oftrusting a“medical record” that is thehypochondriac’s best friend”, andthere is I’ve heard from several physicians that “Google previous encounters, treatments, ordiagnoses. entered data, especiallydocumentation ofany to beskeptical aboutthe validity ofpatient- and retention, be aware that providers continue their records isakey to themtaking ownership While givingpatients theability to customize Providers are skeptical ofpatient-entered data. Many PHRsare alsobeingpitched to adult from that record to helpfilloutschool forms. creating PHRs for theirbabiesandusingprintouts literate patient populations. especially amongyounger, more technically However, thisusercommunity isgrowing, foreseeable timeframe. not anticipating HealthVault tobe profitable in any through theirBingtools inHealthVault), they were user volumes (leadingto lower search traffic Microsoft recently announcedthat due to low use ofportal PHRsat amuchlower rate. And Studies by Forrester Group andTheAdvisory put basis (thoughinitialsignup rates were higher). discharge) was lessthan10percent onanongoing PHR (for whichevery patient was given alogin at worked withindicated that use oftheirtethered PHRs isvery low. Onehealthcare system Irecently Also beaware that right now, useradoption of www.aspenadvisors.net Many parents are 3

A Field Guide to Online Personal Health Records 2. 1. your organization: evaluating theright typeofpersonal health record for Here are somepragmatic next steps you can take when creating “custom entry points” enter themarket. may change intheyears to come asmore tools for organization’s PHRoffering around thisplatform. This or HealthVault, butyou may notwant to buildyour be well served by supporting export to GoogleHealth may take some time to mature. At this stage, you will to beanimportant component moving forward, butit Clearly, Ibelieve that theopenplatform PHRis going strategy. you intend to roll itoutasacomponent ofalarger HIE solution may beright for you, and even more so, if EMR systems across your organization, theportal PHR tethered PHRisaneasy choice.Ifyou maintain multiple If you are afacility predominantly withasingleEMR,the own health. patients take ownership oftheir own records and their record isarecognized right, andthesetools can help for patient health.Having access to one’s own medical Despite thechallenges, aPHRholdsgreat potential Recommendations &Next Steps

• a PHR: Define thevision for andobjectives tobeachieved by • Learn more aboutPHRs: review labresults intheirPHR. of thosewhosignedupactuallyusedthesystem to reporting a35percent signup rate, andalmost half of tethered PHRsisalsoontherise,withonesite likely continue throughout theirlives. Further, use system and,unfortunately, theirhealthissueswill complex conditions can bedifficultinapaper-based to bestrong adopters ofPHRssincetracking oftheir patients with complex chronic health issues continue that got meengaged withPHRsinthefirst place, during acrisis.Andcoming backto thepopulation their parents’ healthinformation easily accessible children caring for elderlyparents asaway ofhaving

Meaningful Usecan besupported by atethered make thecase to your organization for PHRs. testimonials andindustry resources to help you http://myphr.com. At thissite, there are patient web resource onpersonal healthrecords at Association (AHIMA) maintains an excellent The American HealthInformation Management 4. 3.

• Assess your own PHRoptions: • Decide ifyou willsupportopenplatform PHRs: • • • 1. types ofPHRsto beaware of: provider-centric PHRs.There are two other This articleis concerned withthree flavors of Other PHRs healthcare providers. but neitherisdirectly fed by ormaintained by Both PHRshave direct benefit to consumers, 2.

functionality? What doyou needto doto leapfrog their What are your local competitors doing? include PHRfunctionality? connectivity portal toolsets that might already Are you currently usingHIEorphysician vendor offer a tethered PHR? For singleEMRorganizations, does your EMR and marketed? PHR bepresented to YOUR patient population additional benefits ofaportal oropenplatform their openplatform partnerships. How willthe Mayo Clinicbothgot considerable publicityfor product offering. TheCleveland Clinicandthe as avalue-add to alarger women’s health Woman PHRmentioned above was rolled out organization AND your patients. TheVirtua should bejustified byincreased benefit to your Going to aportal and/or openplatform PHR services andincreaseservices patient satisfaction. ■ and HealthVault isagreat way to expand your offering an export to supportGoogleHealth Even ifyou have aportal ortethered solution, strategy aloneeven inamulti-EMRsetting. tools aswell. PHRs usuallyincludehealthmanagement by way ofyour submitted claims.These providers, itshows you your healthhistory The Claims-Fed PHR self-maintained. web-based solutions, butthey are entirely model. Thesecan bedesktop applications or providers. ThisistheoldDrKoop.com record withnodata feeds from healthcare fully patient maintained personal health The Self-Maintained Record –Thisisa www.aspenadvisors.net – offered by insurance 4

A Field Guide to Online Personal Health Records Mr. B-Reay holdsaBA inMusicCompositionfrom Macalester College, MN. implementation projects. at HealthiaConsulting(nowIngenix) where he managed a myriad ofsuccessful clinical and revenue cycle on businessintelligence governance. Priorto joiningIngenix, Mr. B-Reay was anindependent consultant Before joiningAspenAdvisors, Mr. B-Reay served asVicePresident at Ingenix Consultingwhere he focused Principal, AspenAdvisors Jim B-Reay About theAuthor • • • • • • • • •

HealthVault isaRegistered Trademark ofMicrosoftCorporation. Google HealthisaRegistered Trademark ofGoogle,Inc. Cerner ConnectandMillenniumareRegistered Trademarks ofCernerCorporation. RelayHealth isaRegistered Trademark ofMcKesson Technologies, Inc. MedSeek isaRegistered Trademark ofMedSeek,Inc. iHealth isaRegistered Trademark ofMedem,Inc. Centricity isaRegistered Trademark ofGeneralElectricCompany. MyChart isaRegistered Trademark ofEpic Systems, Inc. DrKoop.com isaRegistered Trademark ofVitacost Holdings,Inc. Contact Us:412-370-4900 or that eachpast andcurrent client is100%referenceable. Healthcare Informatics. Ourhallmarks are andsatisfied top qualityservice clients; we’re proud 2006, thefirmhasgrown significantly by year over year and wasnameda2010“Upand Comer” Every client isimportant to us,andevery project iscritical to our reputation. Established in political realities, andtheimportance of projects that are executed successfully –the first time. understand thecomplexities ofhealthcare operational processes, the vendorlandscape, the investments. Ourexperienced team ishighlyskilledinallaspectsofhealthcare technology. We We work withhealthcare organizations to optimize the valueoftheir information technology rising stars whoare united by acommitment to excellence andongoing dedication to healthcare. Aspen Advisors isaprofessional firmwitharichmixof services respected industry veterans and About Aspen Advisors strategic information to supportmanagement decision-making. creating innovative solutions to convert transaction-basedclinical andfinancial data into has alsoassisted healthcare clients inreaping thebenefits from operational systems by sponsors. Withabackground inapplication designanddata warehousing, Mr. B-Reay a diverse project team, orfacilitating decisionsamongagroup of executive andclinical enable Mr. B-Reay to demonstrate equalcomfort assessingtechnical details, managing healthcare operations, breadth of technical experience, and strong interpersonal skills manager andadvisorto healthcare andITexecutives. Hisdeepunderstanding of Jim Balabuszko-Reay hasover 18years ofexperience asanaccomplished program [email protected] www.aspenadvisors.net 5

A Field Guide to Online Personal Health Records