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Improving Patient Care with Personal Health Records
by Dee McGonigle, Ph.D., R.N., F.A.A.N.; Kathleen Hunter, Ph.D., R.N.-B.C.; Toni Hebda, Ph.D., R.N., M.S.I.S. Minority Nurse Writer
Every time an individual sees a doctor or visits a hospital, clinic, or health care facility, a record of their health information is kept. From allergies and vaccinations to past consultations and procedures, information is recorded to help nurses and other health care professionals treat their patients quickly, safely, and effectively. All of the information related to an individual's health is compiled into what we call a health record.
With so much health data tracked over such a long period of time, individuals end up accumulating several different health records, especially as they enter adulthood. Family practitioner, cardiologist, allergist, surgeon, chiropractor—the list of health care providers one sees throughout his or her life can be extensive. In fact, the various elements of an individual's health record are likely scattered across those providers—possibly residing in numerous cities— and are kept in various combinations of paper and electronic record-keeping formats.
Ultimately, this leads to a disconnected record of an individual's health.
What is a personal health record (PHR)?
According to the American Health Information Management Association website, a PHR, as defined in 2004, is a lifelong resource of health information needed by individuals to make health decisions. Individuals own and manage the information in the PHR, maintaining and updating it in a secure and private environment and determining rights of access.
In short, PHRs allow individuals—not health care providers—to record, access, and share personal health information when they want, where they want, and with whom they want. Even though a PHR can be electronic, it is important to remember that PHRs are not the same as electronic health records (EHRs). An EHR is a collection of health information that has been collected—and is managed—by individuals' various health care providers. In today's health care system, one patient might have several EHRs under the control of numerous organizations.
In contrast, a PHR is compiled and maintained only by the individual and serves as a comprehensive record of one's health history. With some software, an individual can authorize a health care provider to add data to a PHR.
The content found in a PHR depends on the type of care a patient has received. Documents commonly included in PHRs range from identification sheets and medications to X-ray reports and hospital summaries. Each one of these documents is a unique component of an individual's PHR with his or her own health history.
What kinds of PHRs are available?
PHRs can be as simple as a handwritten card in your wallet, a portable thumb drive in your pocket or purse, a typed document, or information located on the Internet. They can be kept in print- or electronic-based formats. The major differences between the two are the convenience with which they can be updated and maintained, as well as their accessibility.
Make the Web Work for You For more helpful information on PHRs, visit the following websites:
Paper PHRs can provide a good overview of one's health history. The downsides, however, are the effort needed to keep the forms up-to-date and the limited accessibility of the information. For example, a print version of a PHR will not be available in an emergency unless the patient is carrying it at the time.
Some individuals install a PHR program onto their personal computer so that they are able to upload all of their health information and easily update or print forms when necessary. However, similar to the paper-based format, the main disadvantage of keeping electronic PHRs on a personal computer is the lack of access, though it is not difficult keep them updated.
In our rapidly evolving health care system, in which nurse informaticists are utilizing innovative technology every day, some individuals choose to manage their electronic PHRs on the Internet. The obvious advantage of this format is its immediate, one-click accessibility in emergency and non-emergency situations. However, Internet-based PHRs have had a low adoption rate. Because practitioners themselves may not fully understand the way PHRs work and the risks and benefits, they do not necessarily encourage patients to use these applications.
Individuals have many choices when selecting a PHR provider or sponsor, as they are usually called. Primary care providers, employers, and health insurers may offer PHR options as well as independent entities, who may sell software applications or online services for a monthly or annual fee. Individuals should understand the advantages and disadvantages of each type of PHR sponsor by asking questions relating to PHR comprehensiveness, ownership rights, accessibility, security, portability, and cost.
How do PHRs improve patient care?
Since an individual's PHR has the capacity to serve as a complete and comprehensive health history, not an amalgamation of disjointed health records, each health care professional is able to apply a more holistic view—and thus more insight—into their patient's unique health story simply by reviewing the patient's PHR.
This allows health care professionals to deliver safer, more effective care as a result. The accessibility of health information in a PHR also improves treatment for conditions or emergencies that occur away from an individual's primary care provider.
In addition to political discussions and actions around health care reform, a central factor stimulating the use of PHRs is the individuals' increased desire to engage more actively with their personal health and collaborate more directly with their health care providers—with more control and more informed decision making—whether that be while discussing treatment options, negotiating costs, or prioritizing preventive actions.
Another underlining idea behind the PHR is that the more informed an individual is regarding his or her health—with all of its strengths and weaknesses—the likelier individuals are to become more involved participants and more interested in managing their own health care.
How can nurses increase the use of PHRs?
Nurses are in a prime position to influence the use of PHRs among patients, friends, and family. We provide a large portion of direct patient care. Nurses are the ones who listen regularly to the terms that patients use when asking questions or digesting data; they can be instrumental in deciding what type of health information is necessary for patients to include.
To those interested in PHRs, nurses should stress the importance of having a consistent, accessible record of one's health in one location that can be updated by one's self. This accessibility of health information can be essential during times of emergency or while planning health-related purchases such as buying insurance.