oa Utility of a comprehensive Personal Health Record (PHR) strategy

A fundamental component of improving health care quality is to include the patient as a participant in achieving their health goals and making decisions about their care. While many may see clinical information systems as a way to improve communication and track health information for clinicians, the role played by personal health records (PHRs) should not be overlooked in developing a modernized Integrated Health Management system. This presentation will outline the positives and negatives of sharing clinical data between providers and their patients, outline a few PHR functionalities that can support care coordination and health outcomes, and describe the components of a national strategy to support the development of PHRs. A PHR, also referred to as a patient portal, is a system that allows an individual to keep track of their health information. While access to information is important for patients, doctors may feel uncomfortable with the idea of sharing information with their patients in this manner. Alternatively, patients may worry about sharing information they would like to keep private. These concerns can often be controlled with the right policies to prevent unexpected use and sharing of the information such as: * providing data segmentation functionalities that allow patients to share only selected data with certain providers, * sharing items such as medications and test results, but not sharing other information that providers might like to keep private such as "notes". Many PHRs draw information out of an existing clinical information system maintained by the physician. If a patient sees providers over multiple systems, the information can still be difficult to track. The most effective PHR allows data from any system to be included. To increase usefulness, a PHR may also store information that the patient adds themselves and provide tools such as medication reminders. Ideally, if a patient is seeing different doctors, those doctors will have information from everyone on the care team, but this does not always happen. If the patient has access to the information, they can share it with a range of providers- improving care coordination at the point of care, where it matters most. A PHR can be useful to all members of a population, and should be considered when planning a clinical information system implementation strategy. However, because different hospitals may provide different systems, it is helpful to have a government-wide strategy. For example, in the United States the government has developed a lightweight standard technical infrastructure based on secure messaging which is being used to populate PHRs. The government also supports development of governance to outline standard policies that ensure all stakeholders can trust the information in the system. A strategy to coordinate the use of PHRs is envisioned to have potential in a number of areas, from improvements in individual health to leveraging these systems to improve research on quality and health behaviors.