Personal Health Records

Personal health records allow the patient to access and interact with their own medical information. However, few physicians incorporate these records into daily practice and many fear that PHRs might threaten patient care.

Electronic medical records and other forms of health information technology are touted to become the best way to manage and communicate patient data in the coming years. Foreseen as ways to reduce inefficiencies and improve quality, financial incentives exist to encourage physicians to transition to the electronic era. Personal health records (PHRs) represent a patient-oriented variant of the electronic medical record.

PHRs can represent something as simple as patient access to their “official” electronic medical record as maintained by a clinician. Alternatively, a PHR might be a medical record system managed by the patient him- or herself with supplemental information downloaded from providers.

This study conducted a random survey of US physicians – 700 from all specialities, 700 from OB/GYN, 700 psychiatrists. Only 856 physicians completed the survey with older physicians, US medical graduates, and smaller practices most likely to respond.

The definition of personal health record as used in this study was: an “electronic repository of medical information, often on a portable drive or an Internet site.” The outcome of interest was the willingness of physicians to incorporate a PHR into practice.

Sixty-four percent of physicians have never used a personal health record; only fourteen percent of physicians use PHRs daily. While unadjusted estimates indicate that up to 42 percent of physicians would be willing to use PHRs, a multivariable model predicts which subsets of physicians would be most likely to utilize the technology.

Women (OR 0.23, 95 percent CI 0.18-0.30), suburban physicians (OR 0.25, 95 percent CI 0.20-0.32), and those whose see more than 35 patients per day (OR 0.23, 95 percent CI 0.15-0.35) are least willing to use PHRs.

Rural physicians (OR 11.18, 95 percent CI 7.07-17.68), international medical graduates (OR 3.16, 95 percent CI 2.42-4.10), and those in group (OR 1.55, 95 percent CI 1.24-1.93) or hospital-based practice (OR 5.34, 95 percent CI 3.85-7.40) are the most likely to utilize a patient’s PHR. Specialists and doctors with fewer minority patients were also statistically more likely to use a patient’s PHR.

The researchers cite multiple reasons why clinicians fear that PHRs are inappropriate for use. The major concern (shared by 85 percent of physicians) was that patients might omit important information from their PHRs. A majority of physicians were similarly concerned that PHRs might contain inaccuracies. Seventy-six percent of physicians worried that they might be held liable for information contained within a patient’s PHR while nearly two-thirds felt they would not be compensated for reviewing  the information.

Commentary

Medicine is one of the final industries to . A recent report from National Ambulatory Medical Care Survey demonstrates that just over 48 percent of office-based physicians have some form of electronic system (as of 2009) to maintain medical records. However, only 14 percent of US doctors are using personal health records as part of routine medical practice (as of 2008-09).

Many reasons explain the reluctance of physicians to incorporate the personal health record into standard medical record-keeping. First of all, patient managed PHRs duplicate standard medical records maintained by physicians. Second, inaccuracies in PHRs may threaten care. Lastly, the multitude of PHR providers create unnecessary complexity to an already overcrowded EMR environment.

Despite the downsides, the benefits of a PHR might include a patient-centered way of transmitting information and improving communication between physicians. However, the goals of for electronic records should obviate the need for PHRs.

What is critically important is allowing the rapid, complete, and concise transfer of patient information among clinicians.

Patients have the right and the responsibility to ensure the completeness and accuracy of their medical history.

Wynia MK, et al. Many physicians are willing to use patients’ electronic personal health records, but doctors differ by location, gender, and practice. Health Affairs. 2011. 30 (2): 266-73.

by

Cedric K. Dark, MD, MPH