How to choose your Personal Health Record Manager
From Open MedicDrive
How to choose your Personal Health Record Manager-A Step by Step Guide.
Foreword
21st Century is the era of information technologies. The rapid stride in technological innovations has an impact on all aspects of our lives. In health care industry, technologies have always played a significant role in patient-physician relationship. Innovations in communications and information technologies such as the pagers, mobile phones and personal digital assistants have significantly changed the way interactions between physicians and patients are performed and also have increased the level of healthcare providers’ service. With the burgeoning growth of technologies, enhanced patient-physician relationships could be possible. The major drawback in medical industry has been the implementation of Information technology for enhanced patient care.Mainly, in implementation of digital personal health care records. Most people do not carry medical records when they leave home. They do not realize that in an emergency, which no one can predict, these medical records can make a big difference. In fact, they could save a life. Previous medications, history of allergy to medications, and other significant medical or surgical history can help a physician to optimize treatment. I have had first hand experience with very sick individuals who had no records immediately available of previous medications or treatments. Since these patients were from a foreign country, language and culture barriers added to the difficulty in retrieving information about previous medical histories. A solution to this ever rising problem is the introduction of a digital personal record in a portable format. This would enable individuals to have medical records with them at all times. The growth of Personal Health Record implementation in digital format will aid in optimum patient care in the future.
Rahul C.Shetty M.D Canada.
October 01, 2007
Introduction
This short e-book was written with the objective for provision of information about storage of health information in portable format utilizing the latest information technologies in portable format. Electronic healthcare record will be a necessary tool supporting the health care industry in forthcoming years. Design and development of an ideal storage drive with easy to use application program will provide significant benefits to health care professionals in delivery of optimal health care and also reducing incidence of medical errors. Health care industry can gain financial benefit from these systems by lowering the cost of health care delivery to individuals. Personal health care records in digital format will be the future of health care industry.
Since, the dawn of modern health care services, vital health records of an individual were maintained on paper based records. Despite the tremendous leap in technology in other industries, health care providers continue to utilize the archaic concept of paper based records even today. One of the pitfalls of increased dependence on paper based records is medical error, which could be due to lack of rapid information access about patient’s medication details or their allergic history in emergency. In health care industry, the adoption of information technology (IT) is around 5%.Unlike the local neighborhood grocery store or fast food restaurant which utilizes around 40% of IT resources for database management. Today in medical field there is burgeoning growth of knowledge and also patient data. The enormous quantity of information that health care providers need to handle every day makes their task extremely difficult. The resulting huge gap in storage of health care record and retrieval rapidly has a increased the number of medical errors, which effects around 100,000 patients annually in US as was shown in the landmark study by Institute of Medicine in 1999. It not only affects the patient’s lives, but also has an increased financial impact on health care industry. When we compare this to the aviation industry, it is akin to a small mid sized aircraft crashing down every day!
Can Technologies Aid Medical Industry?
Technologies have always played a significant role in patient-physician relationship. Previous innovations in communications like telephone and pager have significantly changed the way interactions between physicians and patients are performed and also have increased the ease of accessibility to health care providers’ service. With the growth of computer technology new means of interaction and communication could be possible. Introduction of computerized portable personal health recording system, which enables individuals to carry around their medical records in an offline stored digital format can offer benefits of rapid access to medical information. Every year thousands of people worldwide are affected due to medical related errors. Quality and efficacy of the healthcare system are the important steps in improving the economic health of any country. Improved access to patient health care records is the primary step to be taken to enhance health care services. The increased awareness among consumers about their health needs has resulted in the need for an optimum, easy accessible medical record in the past several years. This has resulted in upsurge of activity around the early adoption of electronic personal medical records among physicians and consumers.But, the adoption of Digital Personal Health records much slower than anticipated. Definition of Personal Health Record: Personal health records are the complete health data copy owned by an individual. It could be either paper based or stored electronically on patient’s computer locally or distally at another server and accessed through internet. The health data could be entered by individuals or by their health care provider. It is generally viewed on paper or electronically, contains patient’s personal data (name, date of birth and other demographic details).It also includes patient’s diagnosis or health condition and details about the various treatment/assessments delivered by health professionals during an episode of care from health care provider.
While there is no standard accepted definition of personal health record, according to US based The Markle Foundation's Connecting for Health collaborative, a public-private endeavor-"An electronic application through which individuals can access, manage and share their health information, and that of others for whom they are authorized, in a private, secure, and confidential environment”. The Markle Foundation is helping to define the Portable Digital Personal Health Records, with the main goals of improving quality of care, reducing medical errors, lowering costs, and empowering patients.
There are many ways of storing an Individual’s Personal Health Record: It could be either online or offline. Both offer significant advantages and also have some share of disadvantages.
Why Portable Personal Health Records?
Imagine you’re travelling and you are on number of medications, you fall sick and you are admitted to an emergency care center. Your emergency physician will not know your medical history as you are unconscious or be able to communicate. You will not be in a position to retrieve your previous medical information from your primary health care provider. It is also technically not feasible to retrieve the information through fax or even email. How will the doctors treat you optimally? Portable Digital Personal Health Record can play a key role in solving this puzzle. It will provide physicians with instant access to patient’s medical history-including their past medical history, diagnosis, allergies and prescriptions. Doctors can treat these patients immediately without relying on patient’s ability to communicate or waiting for fax or email from family physician. In the fragmented health care service today, there is no comprehensive record sharing between different health care centers especially when you are traveling overseas. These are the situations when you should carry a personal health record of your self and your family with you always. Paper based records are an easy option, but they have their limitations.
The different methods of storage of your health records are on online web-based storage and off line in your personal computer .Web based storage medium have certain disadvantages of security and also difficulties in connecting on to the health information stored server in medical emergency. Personal Digital Personal Health Records offer a better short term solution. They enable one to carry entire individual health care information along with all the necessary investigation reports. These can be handy in emergency situations when the information from them can be easily accessed utilizing any standard computer with a USB or optical storage drive if they are stored in a USB flash drive or CDs or DVDs without the need for accessing internet.
What are Portable Digital Personal Health Records?
Storing Vital Health Record in a paper based system has been practiced for many years, ever since the dawn of modern health care system was started. But, these records have some limitations as they are not secure and they cannot be carried by an individual with them always. Portable systems of carrying health records in digital format are an option as they offer rapid and easy method of storing large medical documents and imaging files and rapid method of accessing vital health information. The need for portable system of record is especially heightened during medical emergencies. There are many ways of storing one’s medical record and other health related information. They could be stored in an online medium or in an offline medium. The offline medium of storage of records involves uploading of vital health information on a optical disk storage system like CDs or DVDs. The information could also be stored in Flash drive media like USB drives or other memory storage devices. Optical storage media like CD or DVD have certain limitations in that these have to be used with rewritable discs in order to continuously update the information. The ease of transferability of files form the computer onto these optical discs are not easy as they require special programs to burn or write on these discs. Optical storage devices also usually are slower than their flash-based counterparts. And, compact discs with a 12 cm diameter can be inconveniently large and, unlike flash drives, cannot fit into a pocket or hang from a key chain.
Flash drive or USB (Universal Serial Bus Drives): These are currently the most popular based storage media. These are Flash memory storage devices which work on USB interface of any Standard Computer. These are small, lightweight, portable and can have enormous data capacity ranging from few megabytes to several gigabytes.
USB flash drives offer potential advantages over other portable storage devices, particularly the CDs or DVDs. They are more compact, generally faster, hold more data, and are more reliable (due to both their lack of moving parts, and their more durable design) than floppy disks or optical storage medias.
To access the data stored in a flash drive, the drive must be connected to a computer, either by plugging it into a USB host controller built into the computer, or into a USB hub. Flash drives are active only when plugged into a USB connection and draw all necessary power from the supply provided by that connection. Some flash drives feature encryption of the data stored on them, generally using full disk encryption system below the file system. This prevents an unauthorized person from accessing the data stored on it. The growth of computer industry in the past several years has decreased the cost price of the storage devices while increasing their memory capacity. Computers are now widely used in the market, and many individuals have a basic working knowledge of a computer. USB or Universal serial buses are the standard feature in many current computers. These factors will make a broader segment of the consumer population prefer to have their complete medical record with them at all times in near future in Digital format.
A Digital Personal Health Record should contain the health care information about an entire individual’s lifetime and should not only provide support to continuity of care and education but also ensure confidentiality of health data at all times. This will be able to provide quality health care delivery to the individual over their life time. The portable device should have the facility to store and retrieve health care records in a rapid, secure and highly user friendly method. Individuals can store in their Digital Personal Health storage devices not only their illness information but also can maintain a wellness health record over a period of time.
Benefits of Digital Personal Health Records?
The world health organization (WHO) estimates that one in ten patients worldwide are affected by medical errors. These medical related errors are preventable and they occur mainly due to incomplete information about patient’s health records.Computerisation of medical records enables health care providers to provide optimum health treatment by obtaining a full overview of patient’s histories, which will help them to make accurate diagnosis and also provide cost effective care.
Digital Health records should enable health care professionals to efficiently deliver quality health services through:
- Audit and monitor of care provided.
- View health care history of an individual over a period of time.
- Research and analysis of a disease pattern
- Avoid repeat investigation.
In today’s health care system, it is difficult to find and effectively interpret information about patient’s illness. This is mainly due to the result that the record maintenance is done using paper based format. Patients are also frustrated due to lack of communication and compatibility of health care records between various health care professionals and hospitals across different hospitals and medical centers.
In addition, there is also lack of standardization in common health data which is used across various health information networks. As a result there is little integration between an individual’s health record and medical centers.Digital Personal Health Record can aid in providing solution to these issues.
Security of personal health data
Protection of health information of an individual is the fundamental principle of all health system. In an online environment it is difficult to control the flow of information. Any breach in the security system will result in loss of vital personal health information and personal demographic profile. This may also precipitate identity theft. Therefore, it is of importance to note that the health information should be stored in an encrypted storage drive to prevent unauthorized access to the data. Since; patients will control the data with them always; it is possible to provide safety net with portable personal health record unlike the web-based method of storage.
The web based health record storage system, enables the user to access the health information anywhere, anytime but there is a risk of safety of the data according to patient privacy rights organization. This prevents the widespread use of Web based health records. The server wherein the information resides should have an uptime of nearly 99.99% since this contains critical health information and also be in a secure area with uninterrupted power supply. The bandwidth for the flow of information has to be by using at least OC 768 connection (39,813.12 Mbit/s (payload: 38,486.016 Mbit/s; overhead: 1327.104 Mbit/s) to maintain large volume of internet traffic and also to prevent any down times. In addition these servers should be fire walled to prevent any outside unauthorized intrusion with also use of Secure Socket Layered (SSL) protocol.
Providing Secure Health Data through:
- Authentication, being the process of ensuring that the communicating party is the one it claims to be
- Authorization, being the process of ensuring that the communicating party is eligible to request for a specific action
- Audit trails are needed to ensure accountability of actions of individual persons or entities, such as obtaining informed consent or breaching confidentiality.These audit trails can be used to reconstruct, review, and examine transactions; track system usage; control authorized users; and detect and identify intruders.
Architecture of Portable Digital Personal Health Record
Any portable digital personal health record should be built on the following platform:
- 1. Modular architecture – to enable additions of new data over period of years.
- 2. Inter interoperability among different software used by hospitals and physicians.
- 3. Easy to use format-with anytime, any where availability.
- 4. Should be able to function even if physicians do not use any specialized Electronic medical Records software.
- 5. Support of multimedia clinical data.
- 6. Provide secure communications with health care providers.
- 7. To allow information concerning different kinds of health data over a period of time to become contained in a single record.
Other Parameters:
Knowledge acquisition, including in just-in-time decision support
The individual will maintain his or her own personal health records, controlling data content and who has access to the data Portable Models: Shrink-wrapped versus Web-accessed and maintained at a distant server Archival storage location for longitudinal accumulation of ones own patient records
Wellness, Illness, and Education Modules:
Well care: health risk appraisal; health maintenance/immunization records; exercise logs; patients own health journal
Illness care: chronic illness management; telemedicine; reporting adverse reactions; research protocols maintenance.
Health care education and Life style management information delivery through multimedia format.
An Ideal Portable Digital Personal Health Record features
• The emergency file should contain information such as the patient’s name, insurance company details, medical conditions, medications, allergies, emergency contacts, advance directives, and so on. If desired, patients can and should consult with their Primary care provider about exactly which types of information should be included in the file.
• The patient creates the emergency file with the understanding that it will not be protected or secure. The application will immediately pull up and present to the viewer the emergency medical information. The file is not protected so as to allow ER personnel to rapidly access the important health data if a patient is unconscious.
• Patients should be able to leave the information on their personal computer and refer to it and update it as needed.
• Store health data on a USB drive itself. If the patient information is contained on the USB drive, the application will automatically save a backup copy on the individual’s home computer in case the USB drive is lost or stolen, the patient will have their record in an emergency if needed and they will have it if they go to a new physician on a new USB drive.
• The USB should be encrypted in order to safeguard the privacy and information of the patients. So that in case the USB is misplaced or stolen the data cannot be retrieved easily.
• User friendly application program of the Portable Health Storage system without the need to install any specialized software program in the computer. The learning curve is decreased considerably by using Graphic User Interface Design.
• The Software is able to work on both Mac and Windows and also Linux operating system, regardless of the processor speed of user computer.
• Should have features to store in health fitness profile of an Individual over a period of time.
• Audit trailing of health record data entry by individuals or health care professionals
• Ability to synchronize the data between different computers across hospitals.
Conclusion
Personal Health Records provide tools to physicians in enabling them to enhance their relationship with patients. They prevent duplication of testing and also over prescription of medications. By offering patient-specific reminders and health care information, they also help in better collaborative management of chronic diseases like hypertension and diabetes and also tracking of patients.
During emergency circumstances, the individual doesn’t have the time or the ability to call a phone number and wait for a fax or an email to retrieve their vital health information from their health care providers.DPHR aids physicians in emergency room by providing instant access to patients past medical history and other relevant medical information. This improves the quality of health care delivery and also reduces the cost of health care provision in the long term. Various polls show that people, want technologies to be a part of their health care relationship with their physicians. As Personalized Health Records gain widespread usage, they could help not only in reduction of cost but also in saving more lives. Establishing new infrastructure models will take time; especially in the healthcare IT world. In order to get started, a patient can begin creating their own Personal Health Record (PHR) using existing applications and carry it in a portable format and subsequently the complexity of the applications could be added on in the future.
The ultimate beneficiary will be patients as it will empower them to have control of their personal health information within their finger tips.
Tips for creating you own simple personalized portable health care record manager
- Start developing your own portable health care record manager today after discussing about it with your primary care physician.
- Make a list of your known allergies and also medications and carry it always with you in a card format, just like your business card.
- Record your vital health information by entering a list of your previous medications and also illness along with your primary physician provider contact details on your cell phone or on a USB drive in .doc or.txt format.
- File all information about your family medical history and all your over the counter medications,excercise and dietary habits in a single folder
- Research internet for some free tools about personal health care information applications programs.
- It is always ideal to store all your vital health information on a portable storage media like USB drive since many computers nowadays have an USB port and also it is easy to carry around unlike the CDs or DVDs disc.
- Remember always to protect your personal health information, encrypt your USB drive so that unauthorized access to it is not possible but make sure that sure a trusted party has access to it if you are incapacitated.
- consider using an easy to use application program which enables you to store all your health data information including imaging files in a portable memory device.
Health E life Today = Better Quality E life tomorrow.
Sources:
1. Kohn LT, Ed, Corrigan JM, Ed, Donaldson MS, Ed. To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press; 1999
2. Connecting for Health. The personal health working group final report. Markle Foundation; 2003 Jul 01.
3. Wikipedia contributors. USB flash drive. Wikipedia, the Free Encyclopedia. Available at: http://en.wikipedia.org/w/index.php?title=USB_flash_drive&oldid=113503143. Accessed June 2, 2007.
4. Demystifying the Electronic Health Record. Nursing Now. Issues and Trends in Canadian Nursing. No 13.April 2002.Canadian Nurses Association. Ottawa.
5. Rahul Shetty: Portable Digital Personal Health Record: To Bridge the Digital gap in Medical Information Storage of Individuals with Personal Health Records in Flash Drives. The Internet Journal of Health. 2007. Volume 5 Number 2.
6. Dimitrios G.Kathekasis Manolis Tsiknakis ELECTRONIC HEALTH RECORD. Wiley Encyclopedia of Biomedical Engineering, Copyright & 2006 John Wiley & Sons, Inc.
7. Wikipedia contributors, "Portable Digital Personal Health Records," Wikipedia, The FreeEncyclopedia,http://en.wikipedia.org/w/index.php?title=Portable_Digital_Personal_Health_Records&oldid=128368214 .Accessed June 2, 2007.
8. Carol Cronin. Personal Health Records: an Overview of What Is Available To the Public Research Report. Access at http://www.aarp.org/research/health/carequality/2006_11_phr.html.
9.The Glossary of Managed Care Terminology: Published by Pam Pohly Associates Year 2007
10.American Health Information Management Association’s guide to managing your personal health information.http://www.myPHR.com
11.The Personal Health Technology Initiative is a major effort by the Markle Foundation Health Program to advocate for patient empowerment through (PHRs) and other health information technologies.http://www.connectingforhealth.org/phti/index.html
12.The Institute for Health Freedom is a source of information about policies that affect your freedom to choose your health care treatments and providers and to maintain your health privacy.http://www.forhealthfreedom.org
Glossary of Health IT terms
Chronic Care or Chronic Case - Long term care of individuals with long standing, persistent diseases or conditions. It includes care specific to the problem as well as other measures to encourage self-care, to promote health, and to prevent loss of function Emergency - Sudden unexpected onset of illness or injury which requires the immediate care and attention of a qualified physician, and which, if not treated immediately, would jeopardize or impair the health of the Member, as determined by the payer's Medical Staff. Significant in that Emergency may be the only acceptable reason for admission without pre-certification.
Electronic Medical Record (EMR) – A computer-based record containing health care information. This technology, when fully developed, meets provider needs for real-time data access and evaluation in medical care. Together with clinical workstations and clinical data repository technologies, the EMR provides the mechanism for longitudinal data storage and access. A motivation for healthcare entities to implement this technology derives from the need for medical outcome studies, more efficient care, speedier communication among providers and management of health plans. This record may contain some, but not necessarily all, of the information that is in an individual's paper-based medical record. This record is usually maintained in the hospitals and medical centers or at physician’s offices using specialized software.
Health - The state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. Health Information Network (HIN) – A computer network that provides access to a database of medical information. Also known as a health data network.
Health Insurance Portability and Accountability Act of 1996 (HIPAA) – A US government Federal law that allows persons to qualify immediately for comparable health insurance coverage when they change their employment relationships. This legislation sets a precedent for Federal involvement in insurance regulation. It sets minimum standards for regulation of the small group insurance market and for a set group in the individual insurance market in the area of portability and availability of health insurance. As a result of this law, hospitals, doctors and insurance companies are now required to share patient medical records and personal information on a wider basis. This wide-based sharing of medical records has led to privacy rules, greater computerization of records and consumer concerns about confidentiality.
Medical Error - A mistake or negligence that occurs when a planned treatment or procedure is delivered incorrectly or when a wrong treatment or procedure is delivered
Primary Care Provider (PCP) – The provider that serves as the initial interface between the patient and the medical care system. The PCP is usually a physician, selected by the patient upon enrollment, who is trained in one of the primary care specialties who treats and is responsible for coordinating the treatment of members assigned to his/her plan.
Personal Health Record-Personal health records are the complete health data copy owned by an individual. It could be either paper based or stored electronically on patient’s computer locally or distally at another computer and accessed through internet. The health data could be entered by themselves or by their health care provider.
Portable Digital Personal Health Record- Personal health records which are stored in optical or flash drives in an encrypted format.
SSL -Secure Sockets Layer- This is a protocol which enables transmission of private documents via the Internet using a cryptographic system that uses two keys to encrypt the data- a public key known to everyone and a private or secret key known only to the recipient of the message. Websites that use confidential user information need to have a secure server, The URL of these SSL coonection start with https: instead of http
Web based health record storage-The Information is stored in a distant server and individuals access their health information through the Internet. The information is accessed through a pass word protected service.
Wellness - A dynamic state of physical, mental, and social well-being; a way of life which equips the individual to realize the full potential of his/her capabilities and to overcome and compensate for weaknesses; a lifestyle which recognizes the importance of nutrition, physical fitness, stress reduction, and self-responsibility.
- The Glossary of Managed Care Terminology: Published by Pam Pohly Associates Year 2007
