Health Advantage for Patients Who Use EMR

Electronic reminders can help heart patients stay healthy and on their medications even though they are no longer being closely monitored, new research shows. The study is among the first in the U.S. to show that electronically maintained health records can improve outcomes among heart patients and possibly even lower health care costs.

Researchers followed 421 patients with coronary artery disease enrolled in the Kaiser Permanente Colorado managed care health plan. Medical records for the patients, including physician visits and laboratory and pharmacy data, were kept electronically. The patients were participants in an intensive pilot intervention program designed to keep them on cholesterol-lowering and blood-pressure-lowering drugs with the goal of reducing their risk for future heart attacks and strokes.

The program -- which linked patients to teams of cardiologists, pharmacists, nurses, and primary care doctors through electronic health records and direct counseling -- resulted in high rates of patient drug compliance and attainment of goals for blood pressure and cholesterol levels. After participation in this intensive program, half of the patients were moved to a program where they were followed only by their primary care doctor and received far less costly electronically generated reminders of needed lab tests. These electronic prompts proved to be just as effective as the intervention program for keeping cholesterol and blood pressure at goal levels. Using technology and integrated systems already in place, we can help keep patients healthy for longer and deliver continuity of care in a cost-efficient manner.

Wireless home health said to grow nearly 15-fold by 2013

The market for home-based wireless healthcare products and services isn't just going to grow; it's going to explode over the next four years. Parks Associates, a Dallas-based research company, forecasts U.S. sales of wireless home-health technology to soar to $4.4 billion in 2013 from just $304 million this year, in part due to the federal stimulus money for health IT. Parks estimates the market to grow by 96 percent next year, 126 percent when the stimulus takes effect in 2011, and by 95 percent in 2012, before cooling to a 68 percent growth rate in 2013. Device and service connectivity is the model for future home health care applications, and mobile networks will link a growing number of monitoring products to health care providers," says a study.

EMR vs EHR vs PHR vs LHR

Electronic Medical Record (EMR) encompasses the medical history – tests, diagnoses, treatments and other elements – of a single patient specific to a particular facility. The record is owned by the provider. EMRs may be used to achieve a more efficient exchange of information within the facility and to guide clinical decision-making. Likewise, an EMR system describes the local provider’s computerized environment that makes these records possible.

Electronic Health Record (EHR) ideally includes a patient’s complete medical history, spanning multiple providers and geographies. A comprehensive EHR requires compilation of data from various EMRs. In the case of personal health records (PHR) such as those provided by Microsoft HealthVault® or MyHealthRecord®, and Google Health®, the patient owns the record, but most EHRs are owned by a facility, insurance company or insurance consortium. The EHR is the type of record proposed to reside on a shared National Health Information Network.

Legal Health Record (LHR) is similar to an EMR in that it comprises a patient’s information from a single care provider, but carries with it a more binding and unalterable structure. According to the American Health Information Management Association (AHIMA), the LHR serves as the hospital’s permanent business record and would be released upon request if the appropriate patient consent was on file.

HL7 finalizing PHR standards

Health data standards group Health Level Seven (HL7) has begun accepting votes on whether or not to approve its Personal Health Record Functional Model (PHR-S), an interesting development given that health plans, employers and providers still don't seem to have agreed upon what content a PHR should actually contain. Both members and non-members of HL7 can vote on the standards, though non-members must pay an administrative fee to participate. If approved, the HL7 standards will become a draft standard, and will be refined for two years until they comply with ANSI requirements.

HL7's standards define what functions a PHR and security features are common in existing PHR platforms, and offers ideas on how to share between PHRs or from PHR to EMRs. PHR-S may be the first industry standard defining core functions for PHRs, according to the group's statement.

Health IT is now a consumer buzzword

The pre-HIMSS show excitement has started building. I think this should be one of the most vibrant--and overwhelming--shows in the history of HIMSS itself. Why? Well, in part, it's because this has to be one of the first times in any of our professional lives when health IT went from the concern of group practice administrators and hospital leaders a topic that seems to interest everyone but my grandma. On the other hand, I'm not sure I like where this is going. Let me explain...

One of the most obvious indicators that health IT has gone public that there are bills and proposals directly affecting the industry mounting up daily. These days e-prescribing, PHRs, EMRs and health information exchanges are on the lips of elected officials who could barely use their own Blackberry otherwise. While President Bush has encouraged much of this, if the Democrats seize the White House, I don't think that's going to change. Health IT has moved from esoteric to a matter of mainstream discussion, and that's that.

This is something of a problem. After all, while legislators may be well-intentioned, they're usually not subject-matter experts, so they may not have a realistic picture of what problems you face. Besides, while they have to win some ill-defined popularity contest--if EMR is the flavor of the week in the mainstream press, well, then, everyone should have one--you just want to make sure your organization keeps delivering good care. We're talking a slight conflict of interests here.

I don't know about you, but when I'm at HIMSS, I'm usually more interested in talking with vendors who are solving non-trendy problems in a sensible way than listening to rah-rah new stuff. That's particularly true now that consumer interest has seeped into the industry and begun influencing how products are developed, sold and presented to you.

But hey, I don't want to be too cynical. Maybe there's some things that are both praised by the vox populi and worthy of being implemented. All I know is, when I'm at HIMSS, I'm planning to keep my trendiness quotient to a minimum

What's a PHR?

One view comes from America's Health Insurance Plans: "The industry model personal health record (PHR) is a private, secure web-based tool maintained by an insurer that contains claims and administrative information." Makes sense if you're a health plan, definitely.

Or what about AHIMA's take: "A PHR is an electronic, universally available, lifelong resource of health information maintained and owned by the individual." Should calm the nerves of the privacy advocates, no?

The HIMSS definition takes us in a slightly different direction: "To enable the goals of reducing medical errors, improving quality of care, and improving the validity of information available to care providers, Personal Health Records (PHRs) function to consolidate an individual's medical information in one place." This one doesn't dwell on a patient's rights so much as the comprehensiveness of the data, which is of course a wrinkle worth considering.

Yes, I think it's pretty clear what the intent of various employer- and healthplan-driven PHRs is (cheaper, better care), but that's not enough. You can know that you want to ride from Phoenix to Denver without knowing what parts are needed to build a car.

I'm taking up this issue again, in part, because that the indefatigable folks at HL7 are voting on a functional PHR model over the next few weeks. While I'm delighted to see some consensus building on key PHR functions (such as wellness reminders or prompts to look at lab results), that still begs the question of what the ultimate goal of a PHR is. Quick: tell me in one sentence what your PHR effort is trying to accomplish. Not so easy, is it?

When it comes to PHR content, some key unanswered questions include:

* What is the core clinical data set a PHR must contain to deserve the name? Patient medical history, drug allergies, care plans, genetic data, what?
* Does the name "personal health record" imply that it's largely or entirely maintained by consumers, or are consumers merely its custodians?
* What's the benefit of maintaining a PHR? (No, I don't agree that the answer to this is obvious.)
* What is the minimum amount of data a PHR must contain to be useful?

Yes, I realize that health plans, employers, software vendors, standards groups and even consumers will have to do a lot more talking before they arrive at a shared conclusion on these issues--and that technology never moves ahead without some fuzzy logic in between--but in my view things are still too fuzzy. As I see it, it's critical to get bit more clarity on core issues like, say, whether a PHR should be populated by claims data, consumer self-reporting, EMR data or a mix before more dollars are spent. In the mean time, let's not put the cart before the horse, shall we?

HIMSS08: Google unveils details of PHR

So, the Google boys have marched into town with their own PHR, which they demonstrated last week for a marveling crowd at HIMSS08. At a modest booth on a side alley at the exhibition, Google was premiering a simple PHR interface consisting of only few text links, including a link to a feature allowing users to search for doctors, and another accessing Google Scholar to search for medical information. The PHR's key function was a link to a utility allowing users to import records from varied provider systems, then store the records online. Of course, Google CEO Eric Schmidt has been making the rounds assuring privacy advocates that the search giant won't share these records without the patient's consent, but as I understand it, since Google's not a provider they're not required to meet HIPAA standards unless they feel like it. How long that will last, particularly if competitors like Microsoft and Revolution Health begin to loosen their standards?

As we've previously noted, the records will be accessible through the same name/password combination consumers use to access other Google features, such as Calendar and Gmail. OK, readers, I'm sure you know far more than me on this front, but isn't that a fairly weak security method to store extremely private information? When I asked one of the young Google-ites manning the booth this question, he brushed it away. I don't know about you, but that didn't impress me much.