Personal Health Records: Its Time

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Personal Health Records Its TimeBut what
should it be?Who should it be for really?

• Marc Pierson, MD
• Whatcom County, WA
• PeaceHealth

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Who is We?Where is Home?
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Boundary of a System

• The boundary of the system to be described may
  be drawn around a single company, or around an
  industry, or as in Japan in 1950, the whole
  country. The bigger be the coverage, the bigger
  be the possible benefits, but the more difficult
  to manage.
• Deming, The New Economics, p. 55
• Some things can be easily managed at a large
  scale while others cannot. Look for those that
  can and should scale to the community level.
• Me

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The Big Idea

• Communities and states support interoperable,
  standards based PHR for all citizensdesigned by
  patients (citizens) and controlled by patients
• THEN AND ONLY THEN let market respond by creating
  plug-ins that add value for anyone and everyone

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A Shift in FocusTwo Focuses Will be Better than
One

• EMRs focus on the physician or hospital
  enterprise
• Personal health records can focus on the
  individual and their network of supporters.
• PHRs can be a quick path to very useful health
  information integration focused on the patient.
• PHRs can support the patients side of the
  partnership for their health.

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A Patient Health Record, of a particular kind

• Shared Care Plan ( http//www.sharedcareplan.org
  )
• Supported by RWJF, Whatcom County patients and
  providers, including PeaceHealth. Software
  available for other communities for free
• Patient designed for self management and
  communication
• Invite providers, family, friends
• Includes
• Patient preferences, goals, plans, actions
• Medications (linking to EMRs supported by AHRQ)
• Diagnoses
• Linked to Healthwise
• Medical history (in Oct., 04)
• Advanced directives
• Future--Test results images
• We are committed to standards for
  interoperability
• Continuity of Care Record as future standard?
• 800 users in Whatcom

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PURPOSE 1995 until today

• EVERYONE has the
• INFORMATION they need
• WHEN and
• WHERE they need it.
• PATIENTS are at the center.

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A Shift in PerspectiveToward the Patients real
Home 1995 to today
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A Shift in PerspectiveToward the Patients real
Home 1995 to today
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A Shift in PerspectiveToward the Patients Real
Home

• They want us to be a part of their world.
• Are we inadvertently trying to keep them as a
  part of our world?
• E.g., Medical Home, Compliance, Good Patient
  / Bad patient

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Debilitating Assumptions

• Chronic care is like acute care
• Old people are incompetent
• Doctors and hospitals are the center of health
  caring
• People cannot get access to the web
• Everyone needs to work on line and work from a
  computer
• Business medical records must be adopted before
  personal health records/support systems
• Everyone must adopt PHRs before they are useful
• Its OK for every business to provide a
  different PHR

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IOM

• Not an indictment of physicians, nurses, or,
  indeed any of the people who give or lead care.
• futile to seek the improvement by further
  burdening an overstressed health care workforce
  or by exhorting committed professionals to try
  harder.
• A redesigned health care system can offer the
  health care workforce what it wantsa better
  opportunity to provide high-quality care.

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Robert Wood Johnson FoundationTransform
American Health Care

• Give me a break!
• or
• Take it seriously?

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P2 Participating Orgs

• Family Care Network
• Sea Mar Community Health Clinics
• North Cascade Cardiology
• St. Joseph Center for Senior Health
• St. Joseph Hospital
• Group Health Cooperative
• Community Health Plan of Washington
• AND LOTS OF PATIENTS

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In Whatcom County, WA we invited patents to
redesign the system to support those with chronic
conditions. They created the Shared Care Plan,
a personal health communication tool.
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We offered them our business records.They had a
choice and the politely declined.Then they
created a personal health record
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For Four YearsWhatcom County, WA patients with
diabetes and/or congestive heart failuredesigned
and use their own Shared Care Plan, a personal
health record.
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PATIENTS EXPERIENCE
http//www.wwpp.org/media/fla/whatcomProf/whatcomP
rof.html
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Rebecca Brysons Conditions and Virtual Care Team
Pursuing Perfection in Whatcom CountyApril 2003
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Rebeccas Communication Burden
Pursuing Perfection in Whatcom CountyApril 2003
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Rebeccas Communication Burden

Shared Care Plan
Pursuing Perfection in Whatcom CountyApril 2003
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Information for a Care System
Patient centeredness -Personal preferences
-Personal goals -Next steps to those goals
-Care team members including fm fr -Patient
possession of accurate medication list -Useful
measures for patient-centered approach Patient
activation Health status -Depression
-Physical functioning -Health related
QOL Virtual team functioning
development Quality of care transitions Lab
values Demographics Diagnoses Medications Images
Transcriptions, orders, coding, billing, etc
PHR (Shared Care Plan) for Virtual Care Teams
Old Business EMRs
HInet (WAN)
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Involving Patients in the Process
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Patient Action Advisory Committee
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Patient Designed Features

• Control of access
• Audit trail
• Advanced directives
• Printing for refrigerator, purse and glove
  compartment
• Printing for wallet
• Connection to EMR medications for
  reconciliation
• AHRQ single accurate medication list

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Any Solution Should Accommodate these Facts

• Americans get their care from multiple
  organizations
• Our payers change frequently
• We dont all have payers
• We need to be active in our own health no matter
  who delivers our care or who pays for it.
• It is a matter of global competitiveness and for
  a matter of national security in the broadest
  sense
• Any successful solution must also provide some
  value to physicians and purchasers

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Integrating Community (families and their
supporters) with Professional Health Care

• Meaningful
• Interesting
• Hopeful
• (papoose or partners)
• Stimulates accountability and competence in the
  community
• Patient Activation (PAM)
• Tools for cooperation with patients
• E.g. Medication reconciliation
• Necessary
• Look at the demographics of population and
  healthcare workers

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How to Make this Valuable for Physicians

• Medication reconciliation
• The only possible accurate medication list
• Office clip board function
• Like airlinesdo it at home before coming to
  office
• Emergency Medical System support

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How to Make it Valuable for Purchasers

• Activated patients do better
• Fewer visits to ER and Hospital
• Hopefully earlier thought about end of life
  choices will result in lower costs

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Whos First

• People with chronic and complex conditions
• Their social support network
• Influences these people as well

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Who Might be Second and Third

• Children (grandchildren)
• Finally healthy adults

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Approaches for Widespread Adoption

• EMS support and use
• Physician workflow integration
• Integration with community-wide e-prescribing
• Clip board function integrated with the PHR
• EMR interoperability through secure web services
• Hospitals support
• Payers collaborate on the same PHR
• Capable of proprietary plug-ins

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You Have to Know What Is Most Important

• Its not us geeks and our toys
• Its BEHAVIOR CHANGE
• Its not so much about data or databases or even
  electronics
• Its about missing conversations that result in
  behavior change
• Its about Patient Activation
• Which results in better health outcome and lower
  costs

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So What?

• Dont mess PHRs up so that they dont lead to
  behavior change
• Computer interface design with and for the actual
  patient and family usersnot by or for doctors,
  administrators, researchers, etc.
• Ideally it is not an extension of a business
  medical record reaching out for patients.
• It is actually theirs, reaching out to us and to
  everyone they want to be helping them.
• Do provide paper artifacts that lead to
  conversations which lead to changed behavior

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Lets Give Them a Chance

• With the devastating knowledge from the McGlynn
  reports.
• Lets empower patients and their social networks
  in order to get this nation above 55 reliability
  in health care
• Lets let them help us make it safer
• Lets let them help us with the very difficult
  job of delivering health care
• Lets invite them in as full partners
• It is virtually free

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Missing Conversations

• The focus shifts
• from EMR
• (organization specific business medical records)
• to include PHR
• (patient health records)

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Screen Shots
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Screen ShotsAudit Trail
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Screen ShotsAudit Trail
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Activated PatientsBetter for Everyone
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PHR

• Will become much more than a record or document
• Home support platform
• Communication and messaging platform
• Base for home monitoring devises
• Workflow and decision support features build in
  and under control of users.

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My Recommended Links

• http//www.wwpp.org/media/fla/whatcomProf/whatcomP
  rof.html
• http//www.wwpp.org/media/fla/BonnieWWPP2/TestVid.
  html
• https//www.peacehealth.org/apps/Forms/Default.asp
  ?FormID1191
• http//www.wwpp.org/users/0000002/
• www.sharedcareplan.org
• www.wwpp.org
• www.connectingforhealth.org/resources/wg_eis_final
  _report_0704.pdf