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Personal Health Records: Will Doctors Connect?

By JANE SARASOHN-KAHN

What doctors are most likely to use patients’ personal electronic health records? Fewer than 1 in 2 are willing to. Those who most likely would include Hispanic physicians, doctors who practice in rural areas, those employed in hospitals, and surgeons.

As part of the HITECH Act included in the American Recovery and Reinvestment Act (ARRA) 0f 2009, U.S. physicians have the opportunity to receive a portion of the $20.8 billion carved out as incentive payments to those who adopt and “meaningfully use” electronic health records (EHRs).

Many EHRs include portals which allow patients to access a slice of their personal health information. Some patients create their own personal health records that might be as simple as an Excel spreadsheet or as robust as Kaiser Permanente’s My Health Manager or the VA’s MyHealtheVet.

The format of the personal health record (PHR) aside, researchers from the AMA, University of Chicago and the Markle Foundation wondered how willing physicians would be to use patients’ PHRs. The results of their survey are published in the February 2011 issue of Health Affairs.

The bottom line is that physicians’ willingness to connect with patients’ PHRs varies by the doctor’s gender, clinical specialty, race, geographic location, size of the practice, and whether they are already using an EHR. The chart details these findings by physician characteristic.

The physicians who would least likely embrace patients’ would most likely practice in suburban geographies, in solo or duo practices, be female, and be in primary care or pediatrics. And those who don’t use an EHR currently are much less likely to be unwilling to use a patient PHR.

JANE’S Hot Points: Physicians most willing to use PHRs tend to see PHRs as tools that empower patients “to participate in care.” At the same time, a majority of physicians most willing to use PHRs are also concerned that patients might omit important information in their PHR, that the PHRs might contain incorrect information, that they might be held liable for knowing all information in that PHR, and that the PHRs might lack sufficient privacy protections.

Part of meaningful use under the first-year definition of MU for stimulus funding is that physicians who adopt EHRs begin to digitally communicate patients’ personal health information back to them. Doing so provides a key building block for participatory, connected health. As patients have access to “their numbers,” they can more fully participate in their own care, feeling more empowered and knowledgeable about their health status and the therapeutic regimens their clinicians may prescribe for them. This survey raises some key barriers preventing some physicians from the full embrace of digital data for patients’ use. Even the most EHR-experienced physicians remain unconvinced about the value of patients accessing their data — based on current experience. Physicians perceive the key risks in doing so involve privacy, accuracy and liability. The researchers rightly conclude that optimal benefit from personal health information sharing is in the partnership of doing so — that is, in the connection between patient and clinician.

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4 replies »

  1. Despite valiant attempts by many to broaden the definition of “PHR” to include a spectrum ranging from the stand-alone to the tethered to the integrated – the word is a synonym for the failed efforts and business models of portal operators who offered stand-alone PHR’s that were completely disconnected from the provider’s workflow.

    Availability of a PHR tethered to a physician’s EMR (aka a patient portal) is, today, a function of EMR adoption. No EMR? No PHR. But does that mean that patients and provides are not communicating online?

    Manhattan Research’s “Taking the Pulse 10.0” found that more than 40% of physicians communicate with their patients using electronic media including email, secure mail, text and instant messaging.

    Clearly, patients and physicians are more certain of “what” they want to do than they are about ”how” they do it. Additionally, though clinicians are expressing real and valid concerns about the risks of opening up their charts to patients, their desire to share clinical, administrative, and financial information online is increasing. Meaningful Use incentives (and penalties) are pulling EMR adoption and, with it, regulations to share health information and education with their patients in an electronic format.

    Strip away the term PHR and ask physicians if they think it is important to share data electronically with their patients, as Markle did in its 2010 PHR efficacy study, and you’ll see a resounding affirmative from the majority (three in four).

    Perhaps it is time to find a new word to describe the process. Our attempts to put a label on it aren’t doing it justice.

  2. Interesting post, but reference links are for tables and data avialable ONLY by subscription. That is MOST annoying and occurs in enough HCB posts to be recurrently annoying. HCB should have a rule that if data supporting a post is important enough to cite, it should be included in the post or at least available to any reader.

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