EHM-520_WEEK (8)منيف.pdf

EHM-520: ELECTRONIC HEALTH RECORDS WEEK 8 Prof. Bakheet Aldosari Presented by Dr. Muneef AlMokhlef 9/29/2022 1 Today Session # WEEK 8 Topic Reading Personal Health Records MARGRET’S CH 18 Due in Class 2 Learning Objectives • • • • • • • • • Recognize variation in PHR definitions, inc...

EHM-520: ELECTRONIC HEALTH RECORDS WEEK 8 Prof. Bakheet Aldosari Presented by Dr. Muneef AlMokhlef 9/29/2022 1 Today Session # WEEK 8 Topic Reading Personal Health Records MARGRET’S CH 18 Due in Class 2 Learning Objectives • • • • • • • • • Recognize variation in PHR definitions, including those from AHIMA, Connecting for Health, AHIMA, CMS, and California HealthCare Foundation. Identify PHR attributes, especially as described by NCVHS, HL7, and AHIMA Describe functionality for a PHR, especially as described by HL7 and CCHIT Describe the use of the ASTM CCR and its format companion from HL7 for supporting the PHR Define “consumer empowerment” and how PHRs aid in providing a natural extension of that to healthcare Describe initiatives supporting PHR adoption by the federal government, health plans, employers, and vendors Discuss the current status of PHR utilization, recognizing the disconnect between interest and actual utilization Identify various challenges offered by or perceived to exist in PHRs, and offer strategies for overcoming those challenges Assist patients in selecting and utilizing PHRs safely and effectively PHR Definition – No Standard • AHIMA defines the PHR as “an electronic, universally available, lifelong resource of health information needed by individuals to make health decisions. Individuals own and manage the information in the PHR, which comes from healthcare providers and the individual. The PHR is maintained in a secure and private environment, with the individual determining rights of access. The PHR is separate from and does not replace the legal record of any provider” (AHIMA 2005) • Connecting for Health (2006) observes that “PHRs encompass a wide variety of applications that enable people to collect, view, manage, or share copies of their health information or transactions electronically” National Alliance for Health Information Technology (NAHIT) defines PHR as “An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources while being managed, shared, and controlled by the individual” • PHR Definition – No Standard • CMS defines “a PHR [as] a confidential and easy-touse tool for managing information about your health. It is usually an electronic file or record of your health information and recent services…You control how the information is used and who can access it. They are usually used on the Internet so you can look up your information wherever you are” • California HealthCare Foundation, in issuing “Personal Health Records: Employers Proceed with Caution,” notes: “A PHR can exist in many different forms, both electronic and paper. It can be as simple as a form created by an individual to record important medical information or as complex as a Web-based system accessed and populated by patients, healthcare providers, insurers, pharmacies, employers, and companies providing health-related content PHR Attributes – No Standard • The National Committee on Vital and Health Statistics (NCVHS 2006) notes that “PHRs are broadly considered as a means by which an individual’s personal health information can be collected, stored, and used for diverse health management purposes. There is no uniform definition, and the concept continues to evolve. NCVHS concluded that “it is not possible, or even desirable, to attempt a unitary definition at this time” • Health Level Seven (HL7) notes that its PHR-System Functional Model does not attempt to define the PHR, but rather identifies the features and functions in a system necessary to create and manage an effective PHR. HL7 also makes a clear distinction between a PHR and a PHR system, where PHR is the underlying record that the software functionality of a PHR system maintains PHR Dimensions and Attributes From Connecting for Health: • Sponsor • Integration – Tethered – Standalon e • Platform • Data source • Business model From AHIMA: • • • • • • Ownership of PHR by individual or designee Functions include supporting individual health education and decision making, selected retrieval by providers, and others Format may be paper, electronic (personally held or Web-based), or hybrid; appropriate content is recommended to include all medical and clinical information from all providers, personal identification, genetic information, and more Privacy, access, and control are strictly controlled by the individual Maintenance and security provide for an audit trail and recommended backup and regular refreshment Interoperability helps achieve easy, accurate, and consistent exchange with others (as authorized by individual) HL7 PHR System Functional Model Continuity of Care Record (CCR) • ASTM International E31 Committee on Health Informatics, the Massachusetts Medical Society, American Academy of Family Physicians, and HIMSS recognized the need to organize and make transportable a set of basic information about a patient’s healthcare that can be provided to referring physicians • The CCR is a specification of content for an organized, transportable set of basic patient information consisting of most relevant and timely facts about a patient’s condition, especially for use in referrals and transfers of patients across the continuum of care. – – – – It is not an EHR It does not provide interactive clinical decision support It is not universally accessible It does not have a universal patient identifier or record locator service • Content specification has been widely used as recommended content for a PHR CCR + CDA = CCD • HL7’s Clinical Document Architecture is a Web Services Architecture (WSA) to support the exchange of documents (See Chapter 14) • ASTM and HL7 have harmonized these content and message standards to become the Continuity of Care Document standard Consumer Empowerment • Investment of power and authority in those who purchase goods and services • Healthcare consumerism is a natural outgrowth Federal Government Initiatives • Consumers deserve to know the quality and cost of their healthcare. Healthcare transparency provides consumers with the information necessary, and the incentive, to choose health care providers based on value. • Providing reliable cost and quality information empowers consumer choice. Consumer choice creates incentives at all levels, and motivates the entire system to provide better care for less money. Federal Government Sponsored PHRs • Blue Button – Portal for Medicare benefits and services, as well as information about acquiring a PHR (including reference to myPHR.com) • MyHealtheVet – Veterans Health Affairs portal for benefits and services, including Personal Health Journal, prescription refill requests; in the future will be able to view portions of their medical records Health Plan Initiatives • Pioneers – BlueCross BlueShield – Aetna • Payers are supplying providers and consumers with: – – – – Patient data to populate a PHR (and EHR) Clinical analysis tools Best practice and best process protocols Reimbursement for e-visits Employer Initiatives • “Fed up with rising health care costs, Intel, Wal-Mart, and others think giving employees digital records will help” Sound bite upon announcing Dossia PHR project • The goal of employer-sponsored PHR is to let employees compare costs, availability of services, and to some extent performance across care providers, putting more power into their hands (and reduce costs for employer) Vendor Initiatives • Many vendors – Internet, software, paper-based, wearable engraved or electronic – Product for purchase or free • Unregulated, except – Health Breach Notification requires vendors to report breaches to Federal Trade Commission • Watchdog groups have helped assure solid practices • Some vendors are getting out of the PHR business (e.g., GoogleHealth) Health Record Banking • Distinguished from healthcare banks that enable consumers to administer health savings accounts and other health reimbursement • Health record banks emulate commercial banking: – An organization would serve as a trusted custodian of up-todate copies of any electronic healthcare information selected by the consumer for inclusion in his or her account – Access to the information would be controlled by the consumer, who would make the information available to healthcare providers and others as necessary • Health record banks draw upon the concept of personal health records • The Health Record Banking Alliance at www.healthbanking.org identifies interest by several states in using this model for HIE Current Status of PHR Utilization • CHCF 2010: Use low • But interest strong Other Insights • Knowing more about their health care enables consumers to ask their doctors questions they would not otherwise have asked • Two-thirds of population remain concerned about privacy and security; skeptical about inappropriate use of health information • The most common model is one tethered to a provider • The number of persons with paper-based PHRs is much larger than those with e-PHRs PHR Policies and Practices • Concern: Accuracy and fraudulent use – Solution: source all content • Concern: Reimbursement for review – Solution: Use as a means of data entry to EHR • Concern: Liability for not reviewing content – Solution: Encourage patients to use PHR as a personal reference • Concern: Health literacy – Solution: Educate patients/hyperlink to appropriate Web sites • Concern: Sharing information – Solution: HIE participant agreements • Concern: Security – Solution: Address in practice “Deeper” Challenges of Sharing: • “Sensitive” diagnoses • Entire medication list • Lab results (especially when) • All clinical notes • Authentication • Minors’ access • Responses may vary among settings, depending on comfort level of providers • Some responses depend on state law • In general, trend is to share whenever feasible Patients and PHRs • PHRs are meant for patients! Even though they may need help in making wise choices Conclusion • Where EHRs are tools for clinical transformation, • PHRs are tools for consumer empowerment • Health 2.0 is a new concept wherein all constituents focus on healthcare value (outcomes/price) and use competition at the medical condition level over the full cycle of care as the catalyst for improving the safety, efficiency, and quality of healthcare (Shreeve 2007) For Next Session # WEEK 9 Topic Reading Health Information Exchange MARGRET’S CH 19 Due in Class 24 9/29/2022 25