Adequate health literacy is essential for patients responsible for self-managing chronic conditions. Complex care demands patients to access, understand and analyze various sources of health information. Patients are empowered through self-management education programs by giving information and skills that can enhance self-care and allow patients to live functional lives. One growing trend to self-management is the use of Electronic Personal Health Records (PHRs). PHRs offer a unique platform to store, manage, retrieve and share clinical records within a secure environment. It provides a dynamic interface where health practitioners and the patient can share, communicate and handle health records. With scientific and technological advancements, traditional healthcare systems are being replaced with modern systems such as PHR. Besides the importance of PHR, there are various aspects of the system that need to be examined. These aspects include the historical trends of PHR in the United States and the types of PHRs.
Historical Trends
A clear understanding of the history and trends of PHRs can contribute to their development and growth boost their adoption and expansion. PHRs have a relatively short history (Kim, Jung & Bates, 2011) . However, to date, many efforts have focused on health management and recording of disease treatment protocols. The history of PHRs has shown an upward trend in the adoption of the system by consumers. The adoption rate of PHRs has been projected to hit 75% by 2020.
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The advent of the internet transformed the storage of medical records and the level of interest among people on health records. This led to an increase in interest in PHRs. The increase was because of the acknowledged importance of PHRs among researchers who saw the need for a patient safety approach in treatment.
Information stored in PHRs varies from one person to another and is depended on the type of system. However, data in a typical record include allergies, immunization, family history and treatment records among many others. PHRs have been in existence since the 1990s, but it was until 2007 when technology companies such as Google and Microsoft started creating and rolling out PHR products. The first Microsoft web-based PHR model known as the HealthVault was released in 2007 (Kim, Jung & Bates, 2011). Anyone with access to the internet can register with HealthVault to keep, organize and track their health data. Google’s PHRs are no longer available.
In 2008, other companies including AT&T, Intel and Walmart created a web-based framework of PHRs called Dossia. Dossia offers an untethered PHR that comes from multiple sources of data and enables patients to keep their PHR even when there is a change in health plans (Kim, Jung & Bates, 2011). Since then there has been a debate on what constitutes a PHR. Other examples of web-based PHRs include Health Manager and MyPHR.
Today, with an increased focus on the technology and medical industries, PHRs are being developed to reach a stage where clinical consumers can select them. It is important for healthcare stakeholders to understand the history and trends as this will enhance their efficiency for public use. An in-depth and accurate understanding of expert opinion can boost the growth of PHRs and improve their expansion and adoption.
It is also important for PHRs to be certified as it is necessary to guarantee quality and future usage. The recommended certification by the certification commission for health information include security, functionality, interoperability and privacy (Kim, Jung & Bates, 2011). Adoption of national standards is necessary as the PHRs will become vital for safety and transportability. It is thus essential for relevant stakeholders in the healthcare industry to consider to develop, implement and expand PHRs and aim to boost the recognition of their ability for health consumers, more so those with chronic illnesses.
Types of PHRs
There are two types of PHRs: tethered and untethered. To have a clear understanding of the PHR system, it is crucial to understand certain aspects related to each type of PHR. Some of these aspects include the patient’s user experience and the experience of the provider of the two types of PHRs.
Tethered PHRs
Tethered PHRs are offered to people by a healthcare provider such as a clinic. It is tightly incorporated into the system used by the healthcare provider to manage their organization. An example is a patient portal given by the supplier of the healthcare facility’s electronic records.
It is important to understand a patient ’s user experience on tethered PHR. The user experience depends on the available functionality from the provider’s system supplier. The user experience will change in case the system supplier is changed by the provider. It may require the patient to access different PHRs to manage their care in case of being treated by multiple providers (Vydra, Cuaresma, Kretovics & Bose-Brill, 2015). The provider organization controls the PHR; hence the patient lacks control and cannot choose what to do with the data. The user experience on the tethered type of PHR means that the patient’s interaction with the PHR is limited.
The PHR can minimize the integrated work required for implementing the PHR. The tethered provider has a single supplier with a commercial relationship for the supply of its system and PHRs. The tethered provider will depend on a single supplier which increases the risk of becoming a vendor (Vydra et al., 2015). A tethered provider will base their engagement plans with patients on what is available from the supplier.
Untethered PHRs
Untethered PHRs are stand-alone systems which are offered by a healthcare provider or an outside company. Untethered PHRs give personal control over the collated and stored information. This system gives patients control over who they want to share the information with, including healthcare providers (Vydra et al., 2015). An example is a medical data store on a phone which people can use to share their health information with other people or applications.
The user experience of untethered PHR by patients depends on the available functionality from the PHR. It is not restricted by the functionality of the internal systems of an organization, for example, electronic medical records. The patient ’s user experience will not change in case of a change in the internal system by the provider. An untethered provider can have different suppliers who are independent for its internal systems and personal health record thus providing flexibility to implement the most appropriate approach (Vydra et al., 2015). The provider may face more work and expenses to integrate the systems if the PHR supplier has not integrated with the internal system previously. The untethered supplier can also develop their PHR plans separately from their internal systems plan.
Untethered Integrated PHRs
Untethered integrated PHRs are applications through which healthcare practitioners can see data contributed by a person without accessing a different system to the one used to see clinical data. Integrated PHRs allow patients to periodically receive data into their health records from a healthcare provider to develop a complete view of their health including information recorded individually. Integrated PHRs allows patients to reuse information across other applications thereby saving them from data duplication. Integrated PHRs control what applications and people have access to a patient’s information stored in the PHR (Vydra et al., 2015) . Providers are allowed by the PHRs to use off-the-shelf applications with people and integrate the data into the social care system of the clinic. Providers can perform one integration with the PHR information platform. The providers can access data offered by a person and the data in their internal system including electronic methods. Also, through integrated PHRs, providers can access a person’s data and the effect the care has on the health of the person.
Untethered Stand-Alone PHRs
This system rarely integrates with internal systems of healthcare professionals. To access this system, professionals have to log into a separate system if allowed by the user . It enables individuals to select the best healthcare applications that suit their needs (Vydra et al., 2015). Individuals may be required to enter the same information several times in each application they use. Individuals using stand-alone PHR applications may create and remember separate logins for each application they use which might be challenging to manage.
Stand-alone PHR can be used without integration. Physicians must use separate access details such as username and password to access the health records of a patient for each application. Stand-alone applications store information outside the care record forcing other professionals to use different applications to view the report (Vydra et al., 2015). It also isolates information in the stand-alone applications thereby making it unavailable to the provider thus preventing an individual’s full view.
Benefits of the PHR
When PHR is fully functional, it provides immense benefits than manual records. One of the most vital benefits of PHR id greater access by patients to a broad scope of credible health data, information and knowledge. Patients can use that access to manage their diseases and enhance their health. Such data can be customized to make personal health records more useful. Patients with chronic illness can track their ailments with their providers thereby promoting early interventions when a problem is encountered. Communication barriers between healthcare providers and patients can be lowered through collaboration disease tracking. Enhanced communication will allow patients and caregivers to consult, set up appointments, request for referrals and highlight problems (Tang, Ash, Bates, Overhage & Sands 2006) . For instance, communication barriers contribute to various adverse drug situations in the outpatient setting. PHRs are vital as they offer an ongoing connection between patient and a healthcare provider which helps shorten the tie to address a problem when it arises (Tang, Ash, Bates, Overhage & Sands 2006). There is still limited evidence to support the benefits of PHRs. However, many consumers are high levels of satisfaction with early versions of PHRs. Consumers mainly place value on the ease of access to measure outcomes and effective communication with clinicians.
Challenges Facing Personal Health Records
Clinicians and patients have reported certain barriers when using PHRs. One of the main concerns is the risk of a security breach. This is because not all parties have the legal obligation to respect a patient ’s privacy. Patients’ autonomy may be threatened by PHRs as well as control by certain providers. Consequently, PHRs vendors have had to deal with a balancing challenge act of integrity and its importance to the provider and consumer (Alanazi & Anazi , 2019) . Most consumers want control over the information in the PHR and who views it. This becomes a challenge because if a physician thinks a PHR is inaccurate and is denied the opportunity to hare and consult with colleagues on the case, then the information on the PHR will less likely be used by the physician. This will curtail the intention of technology as it will not accomplish its intended use. Also, medical practitioners and patients are restricted from sharing data contained in the PHRs with other organizations.
Quality is essential when it comes to the usefulness of PHRs for healthcare consumers and providers. Doubts have been raised regarding the extent of PHRs’ access and form of control by individuals. Certain PHRs have allowed users read-only access whereas others have given the user total control.
Regarding cost, patients have accessed and managed PHRs free of charge. However, the time needed to analyze the PHRs and add data and use it to make medical decisions comes at a fee. Inaccurate and unverifiable PHR information can lead to liability concerns thus the need for high interpretation costs (Alanazi & Anazi , 2019) . The PHRs cost can be balanced through fewer administrative charges and better medical activities.
Another challenge facing PHRs is the issue of reimbursements which has led to hesitation by some physicians to adopt the system. Physicians have raised concerns about not being compensated for the time spent to update the PHRs (Alanazi & Anazi , 2019) . PHRs have also been found to increase the workload of physicians. This is an issue among most physicians which has posed a challenge to the PHRs.
Conclusion
Personal Health Records (PHRs) can support the self-management programs of patients. Applications provide software decision-support tools which promote collaboration and collaboration as well as support access to different sources of information. The history of PHRs has come a long way; from manual records to electronic records. It worth noting that the adoption of PHRs has been projected hit 75% by 2020, which is tremendous growth in its history. The paper has also examined the different types of PHRs with each type being explained fully. These are tethered PHRs and Untethered PHRs. PHRs are beneficial in various ways. PHRs play a crucial role in the treatment and management of chronic diseases. This is achievable through effective collaboration and communication between the patient and the physician. Challenges of using PHRs can arise when there is a communication breakdown between a patient and a physician. Other challenges which have been associated with PHR include the costs of examining information and reimbursement of physicians. Without a doubt, PHRs are the new approach to the management of personal health records. Organizations and people individuals should adapt to this system to revolutionize healthcare delivery across the United States.
References
Alanazi, A., & Al Anazi, Y. (2019). The Challenges in Personal Health Record Adoption. Journal of Healthcare Management , 64 (2), 104-109.
Kim, J., Jung, H., & Bates, D. W. (2011). History and Trends of Personal Health Records. Healthcare informatics research , 17 (1), 3-17.
Tang, P. C., Ash, J. S., Bates, D. W., Overhage, J. M., & Sands, D. Z. (2006). Personal health records: definitions, benefits, and strategies for overcoming barriers to adoption. Journal of the American Medical Informatics Association , 13 (2), 121-126.
Vydra, T. P., Cuaresma, E., Kretovics, M., & Bose-Brill, S. (2015). Diffusion and use of tethered personal health records in primary care. Perspectives in health information management , 12 (Spring).
