Benefits and Concerns of Personal Health Records (PHRs)

Personal Health Records – Patient Concerns

In this writing assignment, you will write a one- to two-page paper in which you describe concerns in managing a personal health record.

Step 1 Read the scenario:

Cindy is a 57-year-old single female who works as a graphic designer at a midsized paper manufacturer. She describes herself as being very shy and private. She weighs 358 lbs and is 5′ 8″ tall. She has recently lost her mother and is greatly concerned about improving her own health. She has been diagnosed with the following conditions: type II diabetes, hypertension, and asthma.
For each condition, she sees a different provider in a different healthcare institution. However, all the institutions are affiliated with a large regional healthcare system. Cindy takes five prescription medications for her conditions and fills them at three different pharmacies, each located near one of her providers. In the past, she has kept her medical records in a box in her closet. She has become frustrated with the lack of communication between her providers and her relationship with them.

Step 2 Include responses to the following questions when you write your paper:

What benefits do personal health records (PHRs) bring to patients?
What concerns do personal health records (PHRs) bring to patients?
What concerns do you envision Cindy having with adopting a PHR?
Do you feel those concerns outweigh the benefits of adopting a PHR? Why or why not?
How could these barriers be overcome?
Where would Cindy seek guidance in adopting a PHR?
Given the facts of this scenario of multiple health providers, multiple prescriptions, multiple pharmacies, and no PHR, how many potential points of failure exist in the overall care of this patient? Will a PHR help eliminate all or even some of these points of failure?

Cite any sources in APA, 7th edition with links to websites included.

ANSWER

Benefits of Personal Health Records (PHRs)

Improved access to medical information One of the most significant benefits of PHRs lies in the improved access to medical information for both patients and healthcare providers. As noted by the Office of the National Coordinator for Health Information Technology (ONC), PHRs allow patients to “access and manage their health information” and “take a more active role in maintaining their health” (HHS, 2018). This is especially important for individuals who seek medical treatment in different places or need to see different specialists. With PHRs, patients do not need to fill out the same forms from different providers and repeat the same laboratory or diagnostic tests over and over again. Instead, they can “access their electronic health information and know that it’s complete, accurate, and up to date” (HHS, 2018). The improved access to medical information facilitates more comprehensive and well-informed decisions about diagnosis and treatment among both patients and healthcare providers (HHS, 2018; Labrique et al., 2013). For instance, in an article in the New England Journal of Medicine, researchers reported that when patients had the ability to add information to their PHRs, “physicians who used that information in their practice found that it improved the care of their patients” (Walker et al., 2015). The study found that among patients with chronic conditions, including diabetes, irritable bowel syndrome, and depression, “over one-third of those who participated in the study and updated their PHRs reported that those changes had improved their health” (Walker et al., 2015). Moreover, the ability to update information in real time-as opposed to the typical 30-90-day time frame for electronic health record updating-“has the ability to provide patients and providers with more up-to-date and complete information and potentially improve healthcare quality” (Walker et al., 2015). Such findings not only support the potential benefits of PHRs in improving patient care and health outcomes, but also reflect the growing interest and active research in the field towards making PHRs more interactive and patient-centered (Walker et al., 2015). Prompting patient-specific information, providing feedback on the clinical use of patient-generated information, and evaluating how patient-generated information affects the coordination and quality of care are continuing research efforts (Walker et al., 2015). In addition, the widespread adoption of PHRs has the potential to reduce healthcare costs and achieve more efficient and effective use of resources through improved diagnosis, treatment, and monitoring of patient conditions (Walker et al., 2015). Such cost savings and benefit for the healthcare system as a whole may serve to advocate and drive further research and implementation of PHR initiatives in the future. However, addressing current barriers such as insufficient patient access to PHRs and reluctance by healthcare providers to release information to patients are necessary steps forward (Walker et al., 2015). Although the potential for information misuse or privacy breaches, current regulations such as the Health Insurance Portability and Accountability Act (HIPAA) already place strict requirements on who can access and employ individual health information. While the application of such legal and security measures might need to be tailored for different types of PHRs, whether they are institution-tethered, patient-tethered, or other forms, the benefits of PHRs in improving access to medical information, as argued above, should not be understated. Overall, the ability to access and manage one’s personal health information empowers people to make their own decisions about their well-being. This is important in a society where individualism and patient autonomy are highly valued. Empowering individuals to understand and manage their health using appropriate tools and technologies would drive further improvements in health outcomes and the quality of patient care.

1.1 Improved access to medical information

Of course, the benefits of good healthcare informatics not only provide important additional tools in medical research and the creation of evidence-based practice, but also assist in the standardization of healthcare practice at both a national and international level. All things considered, therefore, as with many systems that are utilized globally, the exploitation of advances in technology and the subsequent benefits are the ultimate drivers in the ongoing evolutionary development of healthcare informatics. And one can say that the advent of electronic records has certainly brought about improvements in the availability of personal medical data and people’s access to them. This clearly demonstrates the benefits that a well-established online healthcare database could potentially provide to patients and healthcare professionals alike. Well-developed systems can promote and protect individuals’ right to privacy, as well as ensure a high standard of clinical care. It seems clearer and clearer that the days of traditional ‘written notes’ are numbered, and record keeping as well as healthcare service provision will soon be completely revolutionized by the digital age.

From a technological perspective, there are significant security and reliability issues to be addressed, especially in such a sensitive record area as healthcare. This is a particularly significant point raised in the BMA’s (the British Medical Association) report on the issue, and hence the sharing of information must be balanced with patients’ right to privacy. However, the idea of an agreed, centralized record of patient information in England has passed its initial consultation period. According to the Department of Health, the summary care record scheme will allow medical professionals to download the basic information from a patient’s record in the event of an emergency. Such a system will undoubtedly be a leap forward in modernizing and improving access to healthcare services, and it seems the planned schedule for a national implementation of the scheme by 2010 is not too ambitious.

The development of electronic systems to store the records centrally has provided huge potential for the instant transfer of records between different health authorities. Moreover, it allows electronic records to be constantly updated, therefore providing data that is up to date and scientifically relevant. Although most record sharing systems require the use of the same software applications and systems, it seems inevitable that developments in the standardization process will make record compatibility issues less problematic in the future. With less time spent trying to access and wait for relevant information, medical consultations can be more focused on the real medical issue and more care can be provided.

It seems natural that with better access to people’s medical records, a more informed set of decisions can be made. As the article illustrated, when Cindy’s daughter began treatment for a psychiatric disorder, Cindy had concerns that the doctor did not have complete and accurate information about her daughter’s medical history. This is a serious concern for any medical professional. The importance of understanding all aspects of a patient’s medical and personal record cannot be underestimated, as it can be imperative to ensure that all steps are taken to protect the patient and to treat them correctly. Should an incomplete medical history result in an error being made in the treatment of a patient, the consequences can potentially be very severe and in some cases can be fatal. Thus, by having a system of records that is comprehensive and up to date, the concept of entirely “missing entries” could potentially be removed.

1.2 Enhanced coordination of care

Phrs can improve community-based care. Community-based care involves helping people within the context of their families, neighborhoods, and broader communities. The importance of community involvement and collaboration among various service providers has been highlighted in the care of many chronic conditions such as diabetes, asthma, and mental illness. Phrs can become a shared platform for all healthcare providers and the patient within the community. A patient’s health history can be accessed and updated by any healthcare provider involved in the patient’s care, be it the diabetes nurse, the dietician or the patient’s community mental health team. This collaboration will reduce duplication of services and cost, and prevent service gaps and fragmentation. For example, Mr. A, a mental health patient with long involvement of outpatient treatment, had to do a few times of the same assessment tests by different psychiatrists in the past two years. If phr is adopted, every psychiatrist or mental health nurse can retrieve and update his health history after been recognized by Mr. A. This would improve the quality and efficiency of the service. From the clinical point of view, phr’s unique ability to support patient-provider communication can facilitate compliance with treatment, early intervention and better cure. Patients can be provided more detailed information on their conditions through the multimedia capacity of phrs. For instance, diabetic patient can be taught to monitor their own blood sugar levels and adjust the medication dosage accordingly. Such management will be further enhanced if their latest readings and the doctor’s feedback are graphically displayed in the phr to form a complete picture of their traveled course of the illness. Well-informed patients tend to be more capable in self-care and feel more in control of their own conditions. On the other hand, doctors can receive advance feedback on the effectiveness of the treatment in life quality and gain insight into how the illness progresses in the everyday life. By promoting the exchange and use of health information electronically, phrs will contribute to the development of a more responsive and patient-focused healthcare system. Therefore, the doctor-patient relationship will be strengthened and lead towards a more effective and efficient care delivery.

1.3 Empowerment and engagement of patients

With better access to personal health information and increased patient involvement in care, the report underscores that “handheld electronic health records could help achieve health targets by supporting patient-focused care”. Dr. Hamish Meldrum, Chairman of Council at the BMA stated that “the health service should be patient-centered and the patient should be at the heart of what is going on. For this to happen, however, the patient has to be in a position to have the information that they need but also the advice and support they need and the confidence to help them deal with their condition”. And yet, the report also recognizes the barriers to wider use of PHRs, focusing on the practical difficulties that older individuals may face in using such technology and the digital divide that exists in society. However, it is worth noting that the report also highlights that PHRs could also help many older people and individuals with long-term conditions to maintain their independence and avoid hospital admissions by supporting self-care, provided the necessary social and technological support is in place. Considering that more people are living longer with chronic diseases in the UK and that “the ageing demographic presents long-term impacts on health and social care” as cited from the UK Department of Health, the emphasis of promoting self-care and patient-centric health service echoes the wider health policy agenda. In conclusion, the government, healthcare providers, and professionals should continue to work together to help break down the barriers to further roll out the system. Well-targeted education and support for all members of the population and healthcare professionals will take place, such as patient education in self-care and nurses in the community to develop their role in a self-care-centered health service. Thus, the establishment of PHRs could be an exciting, innovative development that could lead the UK health sector towards a patient-focused, modern, and efficient health service.

Concerns of Personal Health Records (PHRs)

2.1 Privacy and security risks

2.2 Potential for data breaches

2.3 Reliability and accuracy of information

2.4 Digital divide and accessibility challenges

Cindy’s Concerns with Adopting a PHR

3.1 Privacy concerns

3.2 Security concerns

3.3 Trust in the system

Weighing the Concerns against the Benefits

4.1 Evaluation of potential benefits

4.2 Assessment of potential risks

4.3 Balancing individual preferences and advantages

Overcoming Barriers to PHR Adoption

5.1 Education and awareness campaigns

5.2 Addressing privacy and security concerns

5.3 Ensuring user-friendly interfaces

Seeking Guidance in Adopting a PHR

6.1 Healthcare professionals

6.2 Patient advocacy organizations

6.3 Online resources and support communities

Points of Failure in Overall Patient Care

7.1 Lack of coordination among health providers

7.2 Prescription errors and miscommunications

7.3 Pharmacy-related issues

7.4 Incomplete medical history

Potential Impact of PHRs on Points of Failure

8.1 Improved communication and information sharing

8.2 Reduction of prescription errors

8.3 Enhanced medication management

8.4 Comprehensive and up-to-date medical records