When%20is%20the%20PHR%20the%20LHR%20?

1
When is the PHR the LHR ?

• Joan Beach
• CHW Privacy Official

The Privacy Symposium Sixteenth Annual National
HIPAA Summit August 20, 2008 Cambridge, MA
2
When is the PHR the LHR?

• The Personal Health Record
• What is a Personal Health Record (PHR)?
• A personal health record (PHR) is a confidential
  and easy-to-use tool for managing information
  about your health. A PHR is usually an electronic
  file or record of your health information and
  recent services, such as allergies, medications,
  personal medical facts, and doctor or hospital
  visits that can be stored in one place, and then
  shared with others, as you see fit. You control
  how the information in your Personal Health
  Record (PHR) is used and who can access it.¹
• Email messages

¹ Available at http//www.medicare.gov/PHR/Overvie
w.asp
3
When is the PHR the LHR?

• What Components are valid?
• Continuity of Care Record - CCR ¹
• Problems Encounters
• Family History Functional Status
• Social History Plan of Care
• Allergies/Alerts Payers
• Medications Medical Equipment
• Immunizations Advanced Directives
• Vital Signs Health care providers
• Results Non-professional caregivers
• Procedures

¹Developed by American Society for Testing and
Materials (ASTM)
4
When is the PHR the LHR?

• Standardized Format HL7 Reference Information
  Model (RIM)
• Continuity of Care Document (CCD)
• Similar to CCR with an additional Identifier
• Agreement reached to work with ASTM (XML) to
  combine CCR CCD
• Common Platform Components (CPC)¹
• Functional Requirements (Elements)
• Technical Requirements (Architectures)

¹Availabe at www.PojectHealthDesign.com
5
When is the PHR the LHR?

• User Community
• Consumers
• Increased Mobility
• Computer and Internet Acceptance
• Graying of America
• Insurance Companies
• Kaiser Permanente My Health Manager
• https//members.kaiserpermanente.org/kpweb/toc.do?
  thememyhealthmanager_members
• Aetna SmartSource (CareEngine)
• https//www.aetna.com/member/

6
When is the PHR the LHR?

• Vendors
• Google Health Sharing Information
• Google Health contains a directory of
  third-party websites that are capable of securely
  sending information to Google Health. These
  websites (which may include your medical
  provider) may give more information about certain
  conditions or extend the functionality of Google
  Health in other ways. By creating a link to these
  websites, you give them permission to send you
  information such as medical records, prescription
  histories, or test reports.
• You can approve access for some of these websites
  to view your health information. If a website
  accesses your health information and stores a
  copy of your information, that copy will be
  governed by that websites privacy policy. Others
  at that facility like an on-call doctor may
  be able to view your information. Google is not
  responsible for the content, performance, or
  privacy policies of third-party websites.

7
When is the PHR the LHR?

• Vendors, cont.
• Microsoft HealthVault PHR - http//www.healthvault
  .com
• Connection with Hospitals
• iHealth Record - http//www.ihealthrecord.org/
• Allscripts
• Google Health
• Regulatory Agencies
• Medicare PHR Recommendation -myPHR.com (AHIMA) -
  http//myphr.com/

8
When is the PHR the LHR?

• Value of the PHR
• To Consumers

PLUS MINUS
Desire for Control of Healthcare Dont forget the healthcare professionals knowledge is still key
Establish Maintain Goals
Manage who is allowed Access (family members, providers, insurers) Relationships change. No assurances information was not saved by others or printed into hard copy. Use discretion when permitting access.
Allows for Accumulation or a variety of healthcare resources Increase exposure of PHI to third-parties. Awareness of data security is key.
Test Results available Providers Insurers must participate
Centrally located Limited access to Internet regularly
9
When is the PHR the LHR?

• Value of the PHR
• To Providers

PLUS MINUS
Reduce Unnecessary OV New Task- Email
Reduce Phone Calls 24/7 Expectation
Prescription Refills
Ongoing Family History Requires Frequent Review for new details
Appointment Management Requires Practice Management Application
Integrated Record Validation of Health Status Required Can I trust the information as fact? Data Retention requirements What happens when the Patient disassociates?
10
When is the PHR the LHR?

• Value of the PHR
• To Insurers¹

PLUS MINUS
Reduction in Medical Errors All parties involved in care must participate in PHR
Key to prevention and maintenance of chronic conditions
Conduit to provide wellness and other program announcements If access cannot be limited to specific health information individual privacy rights in jeopardy
Portability from one insurer to another Fear of premium adjustment
¹ http//www.ahip.org/search/default.aspx
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When is the PHR the LHR?

• Value of the PHR
• To Regulatory Agencies¹

PLUS MINUS
Availability of records during a Disaster Standards for accumulating information must be followed or value is diminished
Resource for Public Health Background information related to certain disease categories Fear governmental agencies will have too much information about individuals
Development of Health Risk Appraisal for consumer health management Consumer concerns may be used for purposes of Research without consent
¹ http//www.insurance.ca.gov/0400-news/0100-press
-releases/0070-2008/release040-08.cfm
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When is the PHR the LHR?

• Proxy PHR Users
• Determination Requirements
• Varies from State to State
• Documentation is not always required
• Verification prior to communicating
• Ownership of Relationship
• Consumer is the ultimate owner
• Maintaining current relationship access
• Insurers, Providers may share Responsibility if
  integrated

13
When is the PHR the LHR?

• Electronic Messaging within the PHR
• Patient to Provider / Provider to Patient
• Secure Messaging capabilities (iHealth)
• Encrypted
• Patient education for appropriate use
  non-urgent only
• Clinic vs. Acute Care Setting
• Establish Reporting Periods
• Patients with chronic conditions can report to
  the provider on a pre-arranged schedule
• Prompt Response is key
• Billable Services
• Patient Education
• Must understand when a communication becomes a
  Visit
• Ability to Refuse
• Insurance Verification
• Patient Pay Accounts Receivable Management

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When is the PHR the LHR? EXAMPLE LHR
Data Viewing Source Systems ADT
Demographics (IDXtend/ FlowCast) Laboratory (Cerne
r Classic) Pathology (PathLogics ) Pharmacy
(Extreby) Radiology (RadNet Emageon
PACs) Transcription HP, OP Reports,
Consultations, Clinic Notes (MedQuist)
Current State CIS On-Line Clinical
Documentation E-Sign CPOE Assessment Nursing
Notes Vital Signs Ancillary Notes Physician
Clinic Notes
Partial Electronic Health Record Clinical
System Repository CIS ALLSCRIPT/ TouchWork
I n t e r f a c e
On-line Data Entry
Hybrid Legal Health Record H-LHR
Paper Documentation / Optical Archiving Front
Cover Summary/Med List Handwritten Clinic
Notes Handwritten Progress Notes Handwritten
Nurses Notes/ Orders Handwritten Ancillary
Notes Laboratory-Anatomical Laboratory-Clinical Di
agnostic Imaging Other Handwritten
Documentation Hospital Records Consents Advance
Directives Outside Record
Paper/ Optical Imaging ALLSCRIPT/ TouchChart
Stand Alone Applications Home Health (Misys) Elysi
um (Data Repository)
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When is the PHR the LHR? EXAMPLE LHR PHR
Data Viewing Source Systems ADT
Demographics (IDXtend/ FlowCast) Laboratory (Cerne
r Classic) Pathology (PathLogics ) Pharmacy
(Extreby) Radiology (RadNet Emageon
PACs) Transcription HP, OP Reports,
Consultations, Clinic Notes (MedQuist)
Current State CIS On-Line Clinical
Documentation E-Sign CPOE Assessment Nursing
Notes Vital Signs Ancillary Notes Physician
Clinic Notes iHealth Health Profile Prescription
Requests Email Messages
Partial Electronic Health Record Clinical
System Repository CIS ALLSCRIPT/ TouchWork
I n t e r f a c e
On-line Data Entry
Hybrid Legal Health Record H-LHR
Paper Documentation / Optical Archiving Front
Cover Summary/Med List Handwritten Clinic
Notes Handwritten Progress Notes Handwritten
Nurses Notes/ Orders Handwritten Ancillary
Notes Laboratory-Anatomical Laboratory-Clinical Di
agnostic Imaging Other Handwritten
Documentation Hospital Records Consents Advance
Directives Outside Record
Validation
Paper/ Optical Imaging ALLSCRIPT/ TouchChart
Stand Alone Applications Home Health (Misys) Elysi
um (Data Repository)
16
When is the PHR the LHR?

• Concerns
• Technology Compatibility
• Not all EMRs are Built the Same!
• Once a patient connects with a provider
  information is considered available.
• Knowledge of information that is not utilized
  elevates risk for liability
• PHR includes allergies not included in the
  clinicians chart
• Clinician accepts PHR connection
• Prescribed medication causes and adverse event
• AB1298
• Who is responsible when a Breach occurs

17
When is the PHR the LHR?

• Ongoing Dialog
• World Wide Web World Wide Access
• Ownership Does it mean Responsibility for Data
  Security? Confidentiality? Integrity?
  Availability?
• Do Consumers perceive the PHR as a value added
  experience?
• When consumers are comfortable with an activity,
  such as they were with searching for cause and
  treatment information, their perceived
  effectiveness is higher, their trust is higher
  and their likelihood to exhibit desired behavior
  is higherall by significant margins. Sites that
  expect end users to perform activities that are
  less familiar than healthcare information
  searching are going to have to be simpler and
  easier to use.¹

¹The Consumer Experience of Online Healthcare
available at www.changesciences.com
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When is the PHR the LHR?

• Conclusions
• No Clear Standard
• Entities must analyze value to current business
• Model of the LHR Hybrid
• Keep it Simple
• Consumer Awareness of liability
• Manage partnerships How many PHR flows can a
  Covered Entity manage?