Early experiences with personal health records

Learning points from paper

Paper discusses three case studies of US hospitals that provide PHRs to their patients:

• MyChart at Palo Alto Medical Foundation, a community-based multi-specialty group practice.
• PatientSite at Beth Israel Deaconess Medical Center, a university hospital. Clinical messaging is the most popular feature (20 per month per 100 patients), followed by prescription renewals (4 per month per 100 patients), followed by appointment making (2 per month per 100 patients).Indivo_at_Children’s_Hospital_Boston
• Indivo at Children’s Hospital Boston, a children's hospital.

Challenges 1997-2007

1. Should the entire problem list be shared?
2. Should the entire medical list and allergy list be shared?
3. Should all laboratory and diagnostic test results be shared with the patient?
4. Should clinical notes be shared with the patient?
5. How should patients be authenticated to access the PHR?
6. Should minors be able to have their own private PHR and should patients be able to share access to their PHR via proxies?
7. Should the PHR include secure clinician / patient messaging?

Challenges 2008 and beyond

1. PAMF and BIDMC are institution-based and patients will want a single PHR that works with all their sites of care
2. PAMF and BIDMC do not currently support electronic data input from outside institutions
3. Patients may want to integrate knowledge sources on the Internet with their PHRs
4. Patients with specific diseases may want to connect to communities of others with similar diagnoses
5. Patients may wish to participate in clinical trials, post market pharmaceutical vigilance, or public health surveillance via their PHRs
   

Critique of paper

Perspective is biased towards the historical closed source, patient portal approach of PAMF and BIDMC. But the authors are grappling with the issues.

Other comments

Excellent paper, well worth reading.

Citation and Abstract

1: J Am Med Inform Assoc. 2008 Jan-Feb;15(1):1-7. Epub 2007 Oct 18.

Early experiences with personal health records.

Halamka JD, Mandl KD, Tang PC.

Beth Israel Deaconess Medical Center, Boston, MA, USA.
jhalamka@caregroup.harvard.edu

Over the past year, several payers, employers, and commercial vendors have announced personal health record projects. Few of these are widely deployed and few are fully integrated into ambulatory or hospital-based electronic record systems. The earliest adopters of personal health records have many lessons learned that can inform these new initiatives. We present three case studies--MyChart at Palo Alto Medical Foundation, PatientSite at Beth Israel Deaconess Medical Center, and Indivo at Children's Hospital Boston. We describe our implementation challenges from 1999 to 2007 and postulate the evolving challenges we will face over the next five years.

PMCID: PMC2274878
PMID: 17947615 [PubMed - indexed for MEDLINE]

Related Links

Virtual consolidation of Boston's Beth Israel and New England Deaconess Hospitals via the World Wide Web. [Proc AMIA Annu Fall Symp. 1997] PMID:9357646

Patient record access--the time has come. [Stud Health Technol Inform. 2006] PMID:17095813

Implementing security in computer based patient records clinical experiences. [Medinfo. 1995] PMID:8591292

The Royal Hobart Hospital digital medical records success story. [HIM J. 2008] PMID:18245865

Electronic patient records and the impact of the Internet. [Int J Med Inform. 2000] PMID:11154957