Your patient has a Personal Health Record

Posted: April 4th, 2019

Your patient has a Personal Health Record…Now what?
Discussion
Purpose
This week’s graded discussion topic relates to the following Course Outcomes (COs).
Preparing the Discussion
• Discussions are designed to promote dialogue between faculty and students, and students and their peers. In discussions students:
o Demonstrate understanding of concepts for the week
o Integrate outside scholarly sources when required
o Engage in meaningful dialogue with classmates and/or instructor
o Express opinions clearly and logically, in a professional manner
• Use the rubric on this page as you compose your answers.
• Best Practices include:
o Participation early in the week is encouraged to stimulate meaningful discussion among classmates and instructor.
o Enter the discussion often during the week to read and learn from posts.
o Select different classmates for your reply each week
Discussion Question
Case Study: A 65-year-old woman was just been diagnosed with Stage 3 non-Hodgkin’s lymphoma. She was informed of this diagnosis in her primary care physician’s office. She leaves her physician’s office and goes home to review all of her tests and lab results with her family. She goes home and logs into her PHR. She is only able to pull up a portion of her test results. She calls her physician’s office with this concern. The office staff discussed that she had part of her lab work completed at a lab not connected to the organization, part was completed at the emergency room, and part was completed in the lab that is part of the doctor’s office organization.
The above scenario might be a scenario that you have commonly worked with in clinical practice. For many reasons, patients often receive healthcare from multiple organizations that might have different systems.
As you review this scenario, reflect and answer these questions for this discussion.
• What are the pros and cons of the situation in the case study?
• What safeguards are included in patient portals and PHRs to help patients and healthcare professionals ensure safety?
• Do you agree or disagree with the way that a patient obtains Personal Health Records (PHRs)?
• What are challenges for patients that do not have access to all of the PHRs? Remember, only portions of the EHRs are typically included in the PHRs.

First, while portals and personal health records aim to increase patient access and engagement, the situation described highlights some of the challenges in achieving this goal. When a patient receives care from multiple different providers and organizations, as is often the case, consolidating records can be difficult. This limits the patient’s ability to get a full picture of their health history and care in one place.
However, safeguards do exist to help address privacy and security concerns. For example, patients typically must register and authenticate their identity before accessing a portal. Within portals, access controls are in place to prevent others from viewing records without consent. Auditing also monitors portal usage. When records are consolidated from different sources, proper matching of patient data is important to avoid mixing up records between patients (Halamka, Mandl & Tang, 2008).
In this case, only having partial access to records would understandably be frustrating for the patient. While privacy laws aim to protect sensitive health information, the fragmented nature of care delivery in this situation works against the goal of empowering the patient through access. Some potential solutions to explore could include: working to standardize record exchange between organizations using technologies like FHIR; investing in master patient indexing to more accurately match records from multiple sources; and providing patients with easy ways to request records from other providers be linked to their portal.
Overall, the ideal is for patients to have a comprehensive view of their health information to facilitate informed decision making and engagement with their care team. However, achieving that goal requires overcoming technical, legal and organizational barriers inherent in today’s healthcare system. Continued focus on interoperability standards and policies that put the patient’s needs and rights at the center could help address challenges like those faced by the patient in this case study.