Title: Personal Health Records: Its Time
1Personal Health Records Its TimeBut what
should it be?Who should it be for really?
- Marc Pierson, MD
- Whatcom County, WA
- PeaceHealth
2Who is We?Where is Home?
3Boundary of a System
- The boundary of the system to be described may
be drawn around a single company, or around an
industry, or as in Japan in 1950, the whole
country. The bigger be the coverage, the bigger
be the possible benefits, but the more difficult
to manage. - Deming, The New Economics, p. 55
- Some things can be easily managed at a large
scale while others cannot. Look for those that
can and should scale to the community level. - Me
4The Big Idea
- Communities and states support interoperable,
standards based PHR for all citizensdesigned by
patients (citizens) and controlled by patients - THEN AND ONLY THEN let market respond by creating
plug-ins that add value for anyone and everyone
5A Shift in FocusTwo Focuses Will be Better than
One
- EMRs focus on the physician or hospital
enterprise - Personal health records can focus on the
individual and their network of supporters. - PHRs can be a quick path to very useful health
information integration focused on the patient. - PHRs can support the patients side of the
partnership for their health.
6A Patient Health Record, of a particular kind
- Shared Care Plan ( http//www.sharedcareplan.org
) - Supported by RWJF, Whatcom County patients and
providers, including PeaceHealth. Software
available for other communities for free - Patient designed for self management and
communication - Invite providers, family, friends
- Includes
- Patient preferences, goals, plans, actions
- Medications (linking to EMRs supported by AHRQ)
- Diagnoses
- Linked to Healthwise
- Medical history (in Oct., 04)
- Advanced directives
- Future--Test results images
- We are committed to standards for
interoperability - Continuity of Care Record as future standard?
- 800 users in Whatcom
7PURPOSE 1995 until today
- EVERYONE has the
- INFORMATION they need
- WHEN and
- WHERE they need it.
- PATIENTS are at the center.
8A Shift in PerspectiveToward the Patients real
Home 1995 to today
9A Shift in PerspectiveToward the Patients real
Home 1995 to today
10A Shift in PerspectiveToward the Patients Real
Home
- They want us to be a part of their world.
- Are we inadvertently trying to keep them as a
part of our world? - E.g., Medical Home, Compliance, Good Patient
/ Bad patient
11Debilitating Assumptions
- Chronic care is like acute care
- Old people are incompetent
- Doctors and hospitals are the center of health
caring - People cannot get access to the web
- Everyone needs to work on line and work from a
computer - Business medical records must be adopted before
personal health records/support systems - Everyone must adopt PHRs before they are useful
- Its OK for every business to provide a
different PHR
12IOM
- Not an indictment of physicians, nurses, or,
indeed any of the people who give or lead care. - futile to seek the improvement by further
burdening an overstressed health care workforce
or by exhorting committed professionals to try
harder. - A redesigned health care system can offer the
health care workforce what it wantsa better
opportunity to provide high-quality care.
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14Robert Wood Johnson FoundationTransform
American Health Care
- Give me a break!
- or
- Take it seriously?
15P2 Participating Orgs
- Family Care Network
- Sea Mar Community Health Clinics
- North Cascade Cardiology
- St. Joseph Center for Senior Health
- St. Joseph Hospital
- Group Health Cooperative
- Community Health Plan of Washington
- AND LOTS OF PATIENTS
16In Whatcom County, WA we invited patents to
redesign the system to support those with chronic
conditions. They created the Shared Care Plan,
a personal health communication tool.
17We offered them our business records.They had a
choice and the politely declined.Then they
created a personal health record
18For Four YearsWhatcom County, WA patients with
diabetes and/or congestive heart failuredesigned
and use their own Shared Care Plan, a personal
health record.
19PATIENTS EXPERIENCE
http//www.wwpp.org/media/fla/whatcomProf/whatcomP
rof.html
20Rebecca Brysons Conditions and Virtual Care Team
Pursuing Perfection in Whatcom CountyApril 2003
21Rebeccas Communication Burden
Pursuing Perfection in Whatcom CountyApril 2003
22Rebeccas Communication Burden
Shared Care Plan
Pursuing Perfection in Whatcom CountyApril 2003
23Information for a Care System
Patient centeredness -Personal preferences
-Personal goals -Next steps to those goals
-Care team members including fm fr -Patient
possession of accurate medication list -Useful
measures for patient-centered approach Patient
activation Health status -Depression
-Physical functioning -Health related
QOL Virtual team functioning
development Quality of care transitions Lab
values Demographics Diagnoses Medications Images
Transcriptions, orders, coding, billing, etc
PHR (Shared Care Plan) for Virtual Care Teams
Old Business EMRs
HInet (WAN)
24Involving Patients in the Process
25Patient Action Advisory Committee
26Patient Designed Features
- Control of access
- Audit trail
- Advanced directives
- Printing for refrigerator, purse and glove
compartment - Printing for wallet
- Connection to EMR medications for
reconciliation - AHRQ single accurate medication list
27Any Solution Should Accommodate these Facts
- Americans get their care from multiple
organizations - Our payers change frequently
- We dont all have payers
- We need to be active in our own health no matter
who delivers our care or who pays for it. - It is a matter of global competitiveness and for
a matter of national security in the broadest
sense - Any successful solution must also provide some
value to physicians and purchasers
28Integrating Community (families and their
supporters) with Professional Health Care
- Meaningful
- Interesting
- Hopeful
- (papoose or partners)
- Stimulates accountability and competence in the
community - Patient Activation (PAM)
- Tools for cooperation with patients
- E.g. Medication reconciliation
- Necessary
- Look at the demographics of population and
healthcare workers
29How to Make this Valuable for Physicians
- Medication reconciliation
- The only possible accurate medication list
- Office clip board function
- Like airlinesdo it at home before coming to
office - Emergency Medical System support
30How to Make it Valuable for Purchasers
- Activated patients do better
- Fewer visits to ER and Hospital
- Hopefully earlier thought about end of life
choices will result in lower costs
31Whos First
- People with chronic and complex conditions
- Their social support network
- Influences these people as well
32Who Might be Second and Third
- Children (grandchildren)
- Finally healthy adults
33Approaches for Widespread Adoption
- EMS support and use
- Physician workflow integration
- Integration with community-wide e-prescribing
- Clip board function integrated with the PHR
- EMR interoperability through secure web services
- Hospitals support
- Payers collaborate on the same PHR
- Capable of proprietary plug-ins
34You Have to Know What Is Most Important
- Its not us geeks and our toys
- Its BEHAVIOR CHANGE
- Its not so much about data or databases or even
electronics - Its about missing conversations that result in
behavior change - Its about Patient Activation
- Which results in better health outcome and lower
costs
35So What?
- Dont mess PHRs up so that they dont lead to
behavior change - Computer interface design with and for the actual
patient and family usersnot by or for doctors,
administrators, researchers, etc. - Ideally it is not an extension of a business
medical record reaching out for patients. - It is actually theirs, reaching out to us and to
everyone they want to be helping them. - Do provide paper artifacts that lead to
conversations which lead to changed behavior
36Lets Give Them a Chance
- With the devastating knowledge from the McGlynn
reports. - Lets empower patients and their social networks
in order to get this nation above 55 reliability
in health care - Lets let them help us make it safer
- Lets let them help us with the very difficult
job of delivering health care - Lets invite them in as full partners
- It is virtually free
37 Missing Conversations
- The focus shifts
- from EMR
- (organization specific business medical records)
- to include PHR
- (patient health records)
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46Screen Shots
47Screen ShotsAudit Trail
48Screen ShotsAudit Trail
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50Activated PatientsBetter for Everyone
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61PHR
- Will become much more than a record or document
- Home support platform
- Communication and messaging platform
- Base for home monitoring devises
- Workflow and decision support features build in
and under control of users.
62My Recommended Links
- http//www.wwpp.org/media/fla/whatcomProf/whatcomP
rof.html - http//www.wwpp.org/media/fla/BonnieWWPP2/TestVid.
html - https//www.peacehealth.org/apps/Forms/Default.asp
?FormID1191 - http//www.wwpp.org/users/0000002/
- www.sharedcareplan.org
- www.wwpp.org
- www.connectingforhealth.org/resources/wg_eis_final
_report_0704.pdf