Integrated PHR

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INTEGRATED PHR Benefits and Barriers

The six goals issued by the Institute of Medicine (IOM) for redesigning health care for the twenty-first century: providing safe, effective, patient-centered, timely, efficient, and equitable health care.1and less mentioned is the IOM’s ten design rule : care based on continuous healing relationships; customization based on patients’ needs and values; the patient as the source of control; shared knowledge and the free flow of information; evidence-based decision making; safety as a system property; the need for transparency; anticipation of needs; continuous decrease in waste; and cooperation among clinicians.[1] For achieving this goal, anew relation between patients and physician must be created, empowerment of patients, patients must play a greater role in making decision concerning their own health, to be a partners in health care not only listeners. One of the information technology approach that can achieve this goals and give the control to patients is personal health record (PHR).

What is PHR?

the National Committee on Vital and Health Statistics (NCVHS) determined that there is no uniform definition of a PHR in industry or government, it noted that “experts often use the concept of the PHR to include the patient’s interface to a healthcare provider’s electronic health record. Others consider PHRs to be any consumer-or patient-managed health record.

This lack of consensus makes collaboration, coordination, and policy making difficult.”[2] but one of the definition that is used is that definition used by e Markle Foundation in their report: "An electronic application through which individuals can access, manage and share their health information, and that of others for whom they are authorized, in a private, secure, and confidential environment."[4]

Types of PHR


there are different types of PHR ,some of them are: Free standing PHR: which may be supplied on CD or a USB drives. that type is under complete control of patients, patients enter their health data manually and they are responsible for its updating and maintaining the data, it is not linked with EHR. Another type is the PHR where patient is allowed to view their own health information within provider’s EHR there is additional functionality in this type such as allowing the patient to request appointments and prescription renewals and providing a communication channel to clinicians.

There is also the hybrid PHR in which PHR is connected to different health care data source, different providers, this type over come limitations of PHR integrated with in a single organization

The integrated PHR is the PHR with the capability of achieving IOM goals , and empowerment of patients , integrated PHR allow active communication between patients and providers.

In the 2003 survey, 65 percent of respondents said that "having their medical records online would give them a greater sense of empowerment regarding their health," 65 percent believed that it would reduce errors, and 54 percent said that it would improve the quality of their care.[1]

Integrated PHR are not just repository of patient data, it may include decision-support capabilities that can assist patients in managing chronic conditions, that will help patients to become active participants in their own care. It also improve the communication between physicians and patients, which may improve the health care and decrease adverse drug event.

As a result of survey done to see percentage of adverse drug event in out patients, (28 % of ADE were ameliorable, this Ameliorable adverse drug events were attributed to poor communication: the physician's failure to respond to symptoms reported by the patient or the patient's failure to report symptoms to the physicians, improving communication between outpatients and providers may help prevent adverse events related to drugs.[5]

A very important point is the potential of PHR to decrease the very high costs of care for patients with chronic conditions and improving the quality of care introduced to them.[3]



Organizational limitation

  • Who will pay? although health care payers and purchasers are the primary beneficiaries ,still the evidence supporting the rationale for payers to provide PHRs is not mature, and they may be reluctant to pay.

Consumer related limitation:

  • patients' health literacy, would the patients understand health information within PHR in a way they can make decisions’?

-Digital divide: PHR will it achieve equality in health care receiving or the opposite?

  • Authentication also presents a particularly problem for PHRs , who controls information in a PHR (privacy) and how it is controlled (security) Authentication is vitally important both in terms of people accessing the PHR and data entering the PHR.

in a 2000 survey of online Americans, 78 percent wanted "to be able to make choices about how their personal health information is used." [1] In the 2003 Markle Foundation survey, 91 percent of patients said that confidentiality of information in a PHR would be "very important" to them. Yet, patients also recognize the importance of critical information to their health: More than 95 percent said that they would be willing to provide their primary care and specialty physicians with access to their health information.[1]

Provider related limitation:

  • Physicians may resist adoption of PHR as it will add extra work with no Reimbursement for online communication
  • there is also the reliability of information entered by patients, can provider depend in their decision on the information’s obtained in PHR by patients?

There also limitations related to understanding the work flow of consumers, provider and how it is effected by PHR . a lot of study show that cpoe implementations failed in some organization due to lack in understanding the organization work flow


  1. The Missing Link: Bridging The Patient–Provider Health Information Gap Paul C. Tang and David Lansky
  2. Electronic PersonalHealth Records Come of Age Transcribed and adapted for publication by Janice L. Clarke, RN, and Deborah C. Meiris, Medical Writers
  3. A Research Agenda for Personal Health Records (PHRs) David C. Kaelber, MD, PhDa,b,c,d,e,*, Ashish K. Jha, MD, MPHd,e,f,g, Douglas Johnston, MTSa,b, Blackford Middleton, MD, MPH, MSca,b,d,f,g and David W. Bates, MD, MSca,b,c,d,f,g
  4. Personal Health Records: Definitions, Benefits, and Strategies for Overcoming Barriers to Adoption Paul C. Tang, MD, MS, Joan S. Ash, PhD, David W. Bates, MD, J. Marc Overhage, MD, PhD and Daniel Z. Sands, MD, MPH
  5. Adverse Drug Events in Ambulatory Care Tejal K. Gandhi, M.D., M.P.H., Saul N. Weingart, M.D., Ph.D., Joshua Borus, B.A., Andrew C. Seger, R.Ph., Josh Peterson, M.D., Elisabeth Burdick, M.S., Diane L. Seger, R.Ph., Kirstin Shu, B.A., Frank Federico, R.Ph., Lucian L. Leape, M.D., and David W. Bates, M.D.

Submitted by :wessam heggy