Portable Personal Health Record
In 2001, the Institute of Medicine published "Crossing the Quality Chasm." They suggested that health care should be "patient centered". At the same time. electronic health records were being developed and improved. However, compatibility from system to system has remained a large problem despite attempts at standardization such as HL7. So the electronic health record has been helpful to physicians within their own groups while unavailable to other providers. Possibly of greatest concern has been how to obtain data in an emergency.
In 2010, "meaningful use" standards were developed in order for physicians to obtain incentive ARRA money. One of the requirements appears to be the patient being provided access to their medical record electronically. In a study in the AMIA Annual Symposium Proceeding in 2006, a study was performed to evaluate the use of PHR's in the elderly. They described multiple barriers to their use including:
- access to PHR systems
access to computers or devices cognitive disabilities physical disabilities low computer or reading literacy They were able to use a PHR but the great majority required supervised help.
One suggestion for increasing the availability of information when it is needed is the Portable Personal Electronic Health Record (PPEHR). This can consist of a flash drive with a USB port or a credit card sized card with either a USB connection or possibly a magnetic strip or chip. This has been sold commercially and has been offered at very limited cost to patients who belong to certain medical practices such as Kaiser Permanente in California or Connecticut Multispecialty Group in Connecticut.
As an example, Kaiser is able to put the following information on it's drive: Patient Demographics Language Preferences. Contact Information for Family and Friends. Active Medication Problem Lists Allergies. Immunization Records Lab Results from the past year. Medications prescribed in the past year. Clinic Visit Information with diagnoses and procedures in the past year. Hospitalizations with diagnoses and procedures. Most recent EKG's and chest x-rays-both readings and images.
These drives offer many advantages. They are completely portable and can be with a patient at all times. They can be readby anyone with the appropriate password. They are upgradable with minimal effort. Patients need no computer expertise. They simply have to remember a password. If a patient is unable to give any information, a family member is able to provide a password if this has been planned beforehand.
Security however remains a concern. They must be encoded adequately with secure passwords. In addition, they can be easily lost or stolen. Biometrics such as fingerprint identification could be used with some of these devices possibly along with an alternative digital password.
References: 1.A New Health System for the twenty-first Century. Washington. National Academies Press;2001. Crossing the Quality Chasm. 2. Kim E,Modi S, Fang D, Soh CB, Kim Y. Web-based Personal-Centered Electronic Health Record for Elderly Population; D2H2 Conference, 2005. 3.Tan PC, Ash JS, Sands DZ. Personal health records: definitions, benefits, and strategies for overcoming barriers to adoption. JAMIA. 2006 Mar-Apr; 13(2): 121-6. Epub 2005 Dec 15. 4. Shetty, R. Portable Digital Personal Health Record: To Bridge the Digital gap in Medical Information Storafe of Individuals with PErsonal Health Records in Flash Drives. The Internet Journal of Health. 2007 Vol 5 (2) 5.Cushman, R. Primer: Data Protection and the Personal Health Record. UM-Miller School of Medicine Project Health Design ELSI Team, University of Miami.
Submitted by Fred Rubin
BMI 512
