A personal health application (PHA) is a consumer-centric information system that helps improve healthcare delivery, self-management and wellness by providing clear and complete information, which increases understanding, competence and awareness.
The objectives of a PHA are to inform, empower and enable consumers to make better decisions and act responsibly. This includes enabling consumers to:
- Be helpful and proactive in managing their health, rather than passive and reactive.
- Make wise decisions when agreeing to specific treatment options and living health lifestyles
- Carry out strategies for remaining healthy longer
- Comply with plans of care when ill to speed recovery, avoid complications, and achieve the best possible quality of life
- Deal effectively with personal problems and life stressor to maximize one's overall well-being.
Implications of PHAs
- Incorporate sick-care data currently found in electronic health records (EHRs) used by healthcare providers and personal health records (PHRs), and add well-care data focusing on prevention, self-management, and emotional well-being
- Give a high-definition, big picture, whole-person view of a person's physiological & psychological risk factors, current health, health trends, and projected health status.
- Reveal the interventions that are effective for an individual by integrating and analyzing a lifetime of data about health status & quality of life, conventional and complementary & alternative medicine (CAM) treatments received, and the clinical outcomes of that care.
- Enable the exchange of patient data with providers' EHRs, as well as obtaining data directly from lab, pharmacy or hospital systems.
Whereas today's PHRs present narrow views of a person's general health information, PHAs would provide clear, comprehensive views of the whole person-mind, body, spirit and environment-showing risk factors, current health status, health trends, and projected one's future health status. Revealing such trends and predicting one's health condition under different scenarios can be powerful motivators for health living, as well as offering important clinical insights for healthcare providers.
Furthermore, PHRs do little to inform a person about treatment efficacy and the value of CAM approaches. PHAs, on the other hand, would provide this information by collecting and analyzing a lifetime of detailed health data to show what works for the person and what doesn't.
The personal health record is a legacy term which soon will be replaced with Patient centric health information system. The modern patient has more to do than keep records. Information technology holds great promise in empowering patients to manage their health, but the patient must become the focus of the design if the technology is to be used in a manner to improve the coordination of care.
Steele, Min and Lo described eleven functional capabilities of PHR. They are-Access control(including privacy and security), Health data integration with patient health records, Interoperability and data exchange, Data availability at the point-of-care, Audit management, Information sharing on demand for research or statistical purposes, Accessibility of information(knowledge)/Help for medical, health and computer readability, Health behavior management, Secure communications, Fault tolerance, Data management, storage, sustainability, backup and recovery.
Dr. Krist and Woolf have described the functionality of patient centered health information system at five levels. LEVEL 1 Collect patient information, such as self-reported demographic and risk factor information (health behaviors, symptoms, diagnoses, and medications). LEVEL 2 Integrate patient information with clinical information through links to the electronic medical record and/or claims data. LEVEL 3 Interpret clinical information for the patient by translating clinical findings into lay language and delivering health information via a user-friendly interface. LEVEL 4 Provide individualized clinical recommendations to the patient, such as screening reminders, based on the patient’s risk profile and on evidence-based guidelines. LEVEL 5 Facilitate informed patient action integrated with primary and specialty care through the provision of vetted health information resources, decision aids, risk calculators, personalized motivational messages, and logistical support for appointments and follow-up.
An ideal system helps patients to manage preventive and chronic care, collects relevant demographic and risk factor data from patients at the first level and clinical data from electronic health records at the second level, interprets the findings in lay language and an attractive user interface at the third level, personally advises patients of tests and other services recommended for their risk profile by the US Preventive Services Task Force and other major groups at the fourth level, and provides reference information from reputable sites, and adds tailored, motivational messages—all with the imprimatur of sponsoring primary care practices at the fifth level.
Dr. Yasnoff has proposed that system to be a patient-centric community health record banks (HRBs). Health record banks are community organizations that put patients in charge of a comprehensive copy of all their personal, private health information, including both medical records and additional data that optionally may be added by the patient. The patient explicitly controls who may access which parts of the information in his or her individual account. Assumptions about the community-wide deployment of required technologies such as hardware, software and internet accessibility are implicit in the architectural selection of PHRs and these dependencies have not been fully appreciated. There are significant infrastructural implications of PHRs that can influence the selection of PHR architecture and design. Functional requirements of PHRs such as access control, data sharing and integration, data exchange and information search may depend on a PHR’s architectural design and its infrastructure, for example, web-based and online, standalone or hybrid.
In essence, PHR system should be a combination of data, knowledge and software applications; rather than simply a static patient data repository. The most valuable function that patients need in the PHR system is the ability to compile readily understandable and useful health knowledge that is related to their health in addition to having the existing basic and advanced functions described above.
References- 1 Krist AH, Woolf SH. A vision for patient-centered health information systems. JAMA. 2011;305(3):300-301. 2 Office of the National Coordinator for Health Information Technology. US Department of Health and Human Services. Nationwide Privacy and Security Framework for Electronic Exchange of Individually Identifiable Health Information 2008. 3 Ammenwerth E, Schnell-Inderst P, Hoerbst A. The impact of electronic patient portals on patient care: a systematic review of controlled trials. J Med Internet Res. 2012 Nov 26;14(6). 4. Personal health record architectures: Technology infrastructure implications and dependencies: Steele, Robert Min, Kyongho Lo, J Am Soc Inf Sci Tec Volume 63, Issue 6, pages 1079–1091, June 2012
Submitted by Ajay Dhawan
PHAs also bridge well-care and sick-care:
- Sick-care focuses on the treatment of diagnosed physical & psychological problems
- Well-care focuses on preventing serious illnesses and complications, and increasing people's well-being and quality of life through self-management and healthy lifestyles.