PHR portal could improve chronic disease management

November 03, 2010 | Molly Merrill, Associate Editor

BROOKLYN, NY – Although the Internet age has improved American lives in many areas, researchers writing in the International Journal of Medical Engineering and Informatics say healthcare still lags behind. Use of a personal health record portal offers potential to gain ground – particularly in chronic disease management.

Researchers Chif Umejei and Daniel Wiafe of the Department of Medical Informatics State University of New York, Brooklyn, say that self-management of chronic disease, such as diabetes, high blood pressure, cancer and COPD (chronic obstructive pulmonary disease) can improve patient health and reduce hospital visits. Disease management itself can be significantly improved by using current technological advancements such as the Internet and digitized personal health records, they say.

They point out that although PHRs have been used to store patient clinical history, coupling their use to disease management could make capable patients more active participants in their healthcare.

Currently, a PHR will contain the following information about a patient, which is usually accessible to healthcare workers and may also be available to caregivers and the patient themselves.

Identification sheet - registration form with contact and insurance details
Problem list - the patient's significant illnesses and operations
Medication record - medicines prescribed and medication allergies
History and physical - major illnesses and surgery, significant family history, health habits, and current medications; physician's findings on examination
Progress notes - notes made by the healthcare workers on observations and treatment plans
Consultation - healthcare worker opinions about health conditions
Physician's orders - directions to other healthcare workers regarding medication, tests, diet, and treatment

Other entries might include X-ray and imaging reports, laboratory results, immunization records, consent forms and details of hospital visits.

For patients with a chronic disease, there is a need for continued patient education as well as ongoing documentation of symptoms, medication and side effects, the above summary of PHR opens up many possibilities for two-conversation between patient and healthcare workersm, say researchers.

"With computer technology there is the opportunity to provide dynamic data communication and real-time patient education specifically at the point of care," the research team writes, noting that its survey of healthcare workers and patients suggests that demand for a PHR portal-type system would be high, yet no current implementations fulfill the various demands.

A healthcare portal that utilizes PHRs would improve the dialogue between patient and healthcare worker and so could improve patient health overall, the team concludes. Such an application "provides an opportunity to facilitate communications as well as make the consumer an active part in the management of their care."

Reader Comments (1)Login to Post a Comment

ccabales says: PHR portals: reducing redundancy, leveraging existing data

November 29, 2010 | 9:13PM GMT

There are several considerations to be addressed with regards to how best leverage PHR data against other data that already exists. There needs to be clarification about what data would need to be entered by the patient, vs. what can be accessed or leveraged either from existing claims data (ex. pharmacy or medical claims), as well as inpatient/outpatient records.

For example: A patient might indicate being prescribed a recommended medication for diabetes management (ex. an ACE inhibitor), might use a stand-alone or provider sponsored PHR tool to either enter the drug name & does manually, or use a drop down menu to select the drug. However the critical input will be with regards to this patient's compliance with the prescribed medication regimen: did the patient use the medication as prescribed? This would ideally require an interface with either pharmacy data from the dispensing pharmacy or from a prescription benefit management company if available.

There also needs to be an accepted assumption that the data culled in & of itself cannot be the sole determinant of compliance or success. Systems will need to accommodate variations on standard treatment plans to account for individualized care as prescribed by care providers, without bogging down the providers with excessive calls, faxes, letters for clarification.

PHRs, if not well integrated with other existing & standardized sources of health care information, run the risk of creating redundancies, possible errors in patient care. A patient may already have a version of related data sets through an employer sponsored health plan, prescription benefit management plan, or disease management program, yet not be aware of it. If that patient creates their own PHR via a public tool (ex. Google Health), but does not keep it current, the data from that source will not be as current as the data in the possible data sets noted above. This puts continuity & safety of care at risk.

In order for PHR solutions to meet the expectations to "improve chronic disease management" there will need to be requirements for a) defining the source & content of a PHR, b) assuring interoperability between various possible source systems, c) clincial oversight of the variations in individual care.