Advantages of Personal Health Records

Tech Talk

Advantages of personal health records

By Tracy P. George, DNP, APRN-BC, CNE, and Deborah L. Hopla, DNP, APRN-BC

A personal health record (PHR) is an electronic ble than written documents.4 Tethered PHRs are application developed and maintained by patients linked to the HCP’s EHR and are useful within the to maintain and manage their health information in same healthcare system.8 However, many health- a private, secure, and confidential environment.1 care institutions have incompatible EHRs that Independent PHRs aren’t associated with the don’t interface with each other or with all tethered electronic health record (EHR).2 Independent PHRs PHRs.9 Tethered PHRs have many popular features Acan be printed, downloaded, or accessed via a tab- for patients, including the ability to send secure let or smartphone for improved accessibility.3 In messages to providers, make appointments, and contrast, tethered PHRs, also known as patient por- view lab results.5,10 tals, are connected to patients’ EHRs, which are Among a survey of 688 veterans, 72% felt that usually associated with a healthcare institution or access to personal records through tethered PHRs insurance company.4 was useful.11 Patients are able to input or upload PHRs are becoming more important in health- personal health data such as vaccinations received care today due to a stronger emphasis on patient at other sites, blood glucose results, daily weights, engagement, which can result in improved disease BP readings, monthly menstrual histories, and management and peak flow measure- patient outcomes.5 In ments into tethered addition, PHRs provide Independent PHRs can be PHRs. HCPs can review up-to-date information this information at the printed, downloaded, or on patients’ health con- next visit, which allows ditions including aller- accessed via a tablet or HCPs to make needed gies and surgeries.1 smartphone for improved medication changes.12 Many patients are accessibility. The use of tethered unaware of PHRs, and PHRs can result in adoption in the United patient empowerment, States remains low, although a survey conducted which may in turn improve patient outcomes.8,11 by the Markle Foundation found that PHR adoption Although independent PHRs don’t link to EHRs, increased from 3% to 10% from 2008 to 2010.2,6 some patients may have access to them through The Health Information Technology for Economic their insurance company or employer.2,8 In addi- and Clinical Health Act,enacted in 2009, created tion, many free or low-cost independent PHRs are financial incentives for healthcare providers (HCPs) available online or through a downloadable app. and hospitals to increase the use of EHRs for One example of a free PHR that patients can cre- Medicare and Medicaid patients, which should ate online is Microsoft HealthVault.2 Patients may raise the usage of PHRs in the near future. By print their PHR data or use a smartphone or tablet actively encouraging patients to use PHRs, 25.6% of app to access their health record.3 Patients create patients in a study involving eight primary care set- a profile for emergencies that’s available through tings utilized PHRs.7 an app or a printable wallet card. In addition, Even though some patients maintain written patients can choose to share emergency profiles health records, these often aren’t easily accessible with others, or have their profiles accessed by a during emergency situations. PHRs are more porta- responder, via an access code, on the emergency

10 l Nursing2015CriticalCare l Volume 10, Number 6 www.nursingcriticalcare.com

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. wallet card.3 Patients who create independent Literacy contributes to PHR utilization PHRs may decide to share their information with Patients who don’t speak English tend to adopt HCPs, family members, or friends.13 The data in PHRs less often than those who speak English.18 In the PHR can be exported and saved onto a porta- addition, Black and Hispanic patients utilize PHRs ble device or to a smartphone app, which allows less than other groups.7 Patients with limited HCPs access to the PHR.12,14 In addition, patients English proficiency or low health literacy skills may can input or upload their PHR into the Microsoft have difficulty understanding the questions or HealthVault.3 The Microsoft HealthVault also instructions on PHRs, so nurses may need to assist links to a healthcare organization’s EHR if this fea- them in completing a PHR.2 Some EHRs offer ture has been enabled, which promotes patient patient portals in Spanish in order to meet the engagement and accuracy of information.3 In the needs of a diverse patient population.12 It’s also future, it’s expected that independent PHRs will important for nurses and office staff to educate all link to more EHRs, thus creating healthcare hubs patients on the benefits of PHRs and provide assis- that lead to improved patient safety and out- tance to patients, if needed, to improve the adop- comes.15 tion of PHRs.12

Mobile devices close the digital divide Privacy issues Some low-income patients don’t have Internet Some patients are reluctant to adopt PHRs due to access at home.12 However, in 2015, approximate- concerns about the security of their health infor- ly 64% of Americans owned smartphones, which mation.2 In a 2012 study, 82 urban youth ages 14 allows them online resources even without a to 24 expressed concerns about privacy and con- home computer.16 Many PHRs permit patients to fidentiality in electronic communication with download free apps for their smartphones so they providers.17 A year later, breaches in EHR rose can easily input information.13 Most PHRs also to 8.7%, but this wasn’t considered statistically have links to reliable patient education materials significant.12 However, there are current policies for patients to learn more about their health and procedures in place by the federal govern- disorders.13 ment to address the privacy and security of It’s important for patients of all ages to create EHRs. PHRs that are available through HCPs and PHRs, making updated information on immuniza- insurance companies are protected by the Health tions, family histories, and health conditions acces- Insurance Portability and Accountability Act of sible to HCPs. Many young adults have access to 1996 (HIPAA).2 Although other PHRs aren’t cov- and frequently use technology.17 However, famil- ered by HIPAA, they’re required to provide iarity with electronics doesn’t necessarily lead to an patients with the PHR Model Privacy Notice, increased use of PHRs. In one study of eight prima- which discusses the privacy and security policies ry care sites, only 20.7% of patients under age 35 of the PHR they’re using.19 created PHRs, which was the lowest percentage of PHRs are useful in many healthcare settings. any age group.7 Young adults may not realize the Mrs. M, an unresponsive patient requiring importance of maintaining a current up-to-date mechanical ventilatory support, was transferred PHR. Educating younger adults on the importance from the ED to the ICU. Her emergency informa- of having a comprehensive health history, includ- tion was available on her smartphone and was ing medications and allergies, could increase the accessible to the healthcare team. Mrs. M’s PHR number of PHR users. In contrast, in the same contained information about her last visit to the study one-third of patients ages 60 to 69 were ED. The information from her PHR allowed the enrolled in a PHR, which was the highest percent- medical staff to view her past health history age among all the age groups.7 In addition, patients including her surgeries, medications, and most with chronic health problems, such as diabetes, important, Mrs. M’s allergies. The ICU staff was have more medical office visits and a greater need able to determine that Mrs. M’s HCPs included to self-manage health issues. They’re more likely to a primary care physician, cardiologist, and pulmo- use PHRs.7 nologist. Before Mrs. M’s family arrived, the www.nursingcriticalcare.com November l Nursing2015CriticalCare l 11

hospitalist and ICU nurses were able to institute 2. Koeniger-Donohue R, Agarwal NK, Hawkins JW, Stowell S. Role of nurse practitioners in encouraging use of personal health appropriate lifesaving measures tailored to her records. Nurse Pract. 2014;39(7):1-8. specific health care needs. 3. Microsoft HealthVault. Microsoft Heal. www.HealthVault.com. It’s important for all nurses to be aware of PHRs. 4. Are there different types of personal health records (PHRs)? FAQs. HealthIT.gov. 2013. www.healthit.gov/providers-profession- Whether a patient is being treated for an acute als/faqs/are-there-different-types-personal-health-records-phrs. ischemic stroke, myocardial infarction, or multiple 5. Wagner PJ, Dias J, Howard S, et al. Personal health records and trauma, a PHR provides important information for hypertension control: a randomized trial. J Am Med Inform Assoc. the staff caring for a patient. 2012;19(4):626-634. 6. Markle. PHR adoption on the rise. 2011. www.markle.org/ Unfortunately, nurses may not be aware that publications/1440-phr-adoption-rise. patients have PHRs. In the future, it will be help- 7. Krist AH, Woolf SH, Bello GA, et al. Engaging primary care ful if nurses ask about PHRs when patients arrive patients to use a patient-centered personal health record. Ann Fam Med. 2014;12(5):418-426. at any healthcare facility. The PHR assists with 8. Bates DW, Wells S. Personal health records and health care utili- patient safety by providing needed medical infor- zation. JAMA. 2012;308(19):2034-2036. mation in a timely manner to nurses and other 9. Studeny J, Coustasse A. Personal health records: is rapid adop- ❖ tion hindering interoperability? Perspect Health Inf Manag. 2014; HCPs. 11:1e. 10. Nazi KM. The personal health record paradox: health care REFERENCES professionals’ perspectives and the information ecology of personal health record systems in organizational and clinical settings. J Med 1. What is a personal health record? FAQs. HealthIT.gov. 2013. Internet Res. 2013;15(4):e70. www.healthit.gov/providers-professionals/faqs/what-personal-health- record. 11. Nazi KM, Hogan TP, McInnes DK, Woods SS, Graham G. Evaluating patient access to Electronic Health Records: results from a survey of veterans. Med Care. 2013;51(3 suppl 1): S52-S56. 12. Meeting the needs of a diverse patient population through patient portals. HealthIT.gov. 2013. www.healthit.gov/providers- professionals/meeting-needs-diverse-patient-population-through- patient-portals. 13. Kharrazi H, Chisholm R, Vannasdale D, Thompson B. Mobile personal health records: an evaluation of features and functionality. Int J Med Inform. 2012;81(9):579-593. 14. HealthVault Help. https://account.healthvault.com/help/en-GB/ default.htm. 15. Increase Patient Participation in Care with Health IT. HealthIT. gov. 2013. www.healthit.gov/providers-professionals/patient- participation. 16. Pew Research Center. A portrait of smartphone ownership. www.pewinternet.org/2015/04/01/chapter-one-a-portrait-of- smartphone-ownership/. 17. Lindstrom Johnson S, Tandon SD, Trent M, Jones V, Cheng TL. Use of technology with health care providers: perspectives from urban youth. J Pediatr. 2012;160(6):997-1002. 18. Kannry J, Beuria P, Wang E, Nissim J. Personal health records: meaningful use, but for whom? Mt Sinai J Med. 2012;79(5): 593-602. 19. Personal Health Records (PHR) Roundtable Policy Researchers & Implementers HealthIT.gov. www.healthit.gov/policy-researchers- implementers/advancing-privacy-and-security-health-information- exchange.

Tracy P. George is an instructor of nursing, and Deborah L. Hopla is an assis- tant professor of nursing and coordinator of the MSN/FNP Track. Both work at the Francis Marion University Department of Nursing in Florence, S.C.

The authors have disclosed that they have no financial relationships related to this article.

DOI-10.1097/01.CCN.0000472852.70431.1b

12 l Nursing2015CriticalCare l Volume 10, Number 6 www.nursingcriticalcare.com