Ever have one of your patients enter your office with a binder of medical paperwork? They have old X-rays, MRIs, and reports, articles downloaded from the Internet, and copies of correspondence between their GP and four different specialists.
A PHR is the electronic version of the binder I just mentioned; the digital archive of your patient's health history gathered from all of their health care providers. The good thing is that it is more organized, concise and easily navigable to review than a giant binder. Rather than weighing pounds, it weighs nothing and is accessible to your patient via a dedicated PHR device, a cell phone, Net book or anything that connects to the Internet. It may contain digital versions of their radiography, history of successive lab tests, dosages of their medications and the recommended date for their first colonoscopy. It may contain end-of-life preferences and special directives in case of emergencies. It has all the security and privacy found in an electronic health record (EHR) but communicates in layman's terms. It's a lifelong resource of health care information, built just for them.
A PHR shouldn't be confused with an EHR, which is managed by the patient's multiple providers. The EHR is contained in a clinic's network and contains the records of everything necessary to care for that patient within that facility, including daily patient notes, history, radiology reports, lab tests and correspondence between providers if co-care is necessary or preferred. Depending on what the patient wants, there may be a lot of data overlap between the EHR and the PHR. The key distinction is that the patient controls their PHR, while the EHR is under the control of the doctor.
Of course, the data in the EHR ultimately can be requested and obtained by the patient, as they have the right to a digital copy of your EHR record of their care. A PHR gives the patient the power to actually assemble the data that belongs to them in a way that's convenient and instantaneous. It also saves them significant time and avoids redundant entries from filling out numerous new-patient intake forms as they go to new doctors. They now can import that data to the doctor who has an EHR. Patients are already expecting this kind of technology when they go to a doctor's office for the first time. They are tired of filling out the same paperwork over and over. There's also one other major distinction between the PHR and that binder; in the near future, the PHR will provide guidance with treatment options. It isn't just an archive.
In my interaction with our profession, my goal is always to communicate the real meaning behind the coming changes in practice technology. It's easy to get lost in the "wow factor" of the features (the how) and forget the reason behind the technology (the why). For example, we often focus on digital storage of data with the EHR rather than the powerful data analysis it gives us for case management. The same temptation is there for the PHR. The novelty of portable, patient-managed records shouldn't overwhelm the revolutionary part of this coming technology; the way the PHR is going to interact with the patient to help them manage their own care.
The same motivation driving the patient-centered medical home model, which I covered in my previous two columns, is the same motivation driving PHR technology: improving the management of complex cases and potentially controlling costs. A well-built PHR will help close a major gap in the doctor-patient relationship by guiding the patient once they have left the office. As the number of Americans with chronic diseases continues to climb, this function is going to be critical. Since lifestyle choices can be even more important than treatment in determining outcomes in chronic cases, anything that can encourage patient compliance is extremely important. The concept is to empower the patient with accessible information that is just one click away from their Facebook login or their mobile-phone contact list.
Imagine the possibilities of an interactive PHR for a chiropractic patient. Can you see patients downloading exercises for postural rehab based on diagnosis codes? Can you see educational videos on tissue-healing cycles and phases of recovery? Do you get a glimpse of patients pulling up recommended recipes for an anti-inflammatory diet rich in omega-3s? Can you imagine a calendar of chiropractic appointments, with a migraine symptoms diary, a daily VAS score or a multitude of other ways to chart their progress?
A patient with a quality PHR is more than just a patient with a digital archive of their history and more than just a patient hooked up to your care plan. A PHR could also be a way for you to be rated as a provider and profiled for your outcomes with certain symptoms. Can you imagine a patient launching a PHR-based search for chronic neck pain? Instead of finding your average search engine info, they find the following: a regional list of providers provided by their PPO, treatment options from injections to adjustments with best-practices data for each, and a provider rating based on data collected by the networks in which the provider participates. These capabilities haven't been realized yet, but they're on the horizon.
Health care data in the hands of patients is both an empowering and challenging proposition. Will we see competing PHR devices given out by pharmaceutical companies, HMOs, PPOs or hospitals? Will there be regulation of PHRs to provide accurate data across the health care spectrum? Is it possible that just as the Internet has exposed more of America to CAM-oriented health care options, that the future of PHRs could mean more exposure of chiropractic due to the data we have supporting us? Or will our slowness to adopt this technology cause us to lose the ability to engage in this coming data exchange?
The complex case with years of medical paperwork in tow is going to become a thing of the past. Not because complex cases will disappear, but because every patient is going to have the capability to carry their own personal health history on a thumbnail drive or their cell phone. More than just a digital archive, a PHR has the potential to be a bridge between patient education in your office and self-care at home. Further, it may even be an interactive tool that helps patients make decisions on what treatment to seek, which providers to choose, or even what intervention isn't indicated based on their demographics. No, these capabilities aren't in place yet, but the technology to make it all possible is already in existence. It's coming and it's coming fast.
While a PHR with all the bells and whistles won't be every patient's interest, one thing is certain: A patient with a PHR could be a new breed of patient who really does take responsibility for their health and wants the data to help them do it. In that sense, patients with a PHR could be the ideal chiropractic patients, provided we have the technology necessary to engage them. The clinic of the future needs to be the clinic of right now.
Click here for previous articles by Steven Kraus, DC, DIBCN, CCSP, FASA, FICC.