Evaluating Personal Health Record (PHR) Options for Accountable Care Organizations (ACOs)

Whether you are interested in protecting your own and your family's health status or making sure that your health system can successfully transform itself into an accountable care organization (ACO), it is now time to decide what to do with the personal health record (PHR) option found under the umbrella electronic health record (EHR). Can you imagine how the best laid plans of the most progressive health system will be completely unsuccessful if patients aren't engaged in their own health? How can those plans succeed if the health system doesn't have the necessary data to determine whether treatment regimens and lifestyle changes are being incorporated into patients' lives and activities of daily living? How many patients expect and demand a level of connectivity with their health system and will “vote with their feet” if they are disappointed with their options?

Many patients are living what we call a “digital life” in that they are using portable information appliances (and the Internet) in all aspects of their daily living. They are connected with their businesses, friends, sports and hobbies, finances, purchases, and travel needs and getting real-time feedback from just about every industry except, ironically, health care. Have you considered what the next generation of patients will expect and demand? We know that people fail in regard to their health care behaviors primarily because they don't know what to do, they don't know how to do it, and/or they are not motivated to do it. PHRs help create a closed-loop environment for the provision of patient care and a new opportunity for a continuity of care when they are utilized and connected to the other information sources available in most health systems. They make it possible for situational awareness to take place anywhere, from the intensive care unit to the patient's home.

Health systems have a variety of options for PHRs, especially in a capitated funding environment. Level I ACOs currently report quality metrics without the pressure of financial incentives or penalties. In Level II ACOs, a higher level of performance measures is required, whereas Level III ACOs receive capitated funding and are accountable for providing all necessary care for the population. This is a high priority for health systems who are totally responsible for providing all care required like the current level III tier of ACOs operating in the United States where the organization is responsible for all levels of care for a patient population even though it may not have ownership of all of the types of providers found in the continuum of care for that population. This environment promotes integrated health networks and delivery systeMS, with increasing levels of employed providers being utilized.

One option for PHRs can be found in patient-initiated selection. These records are free of charge from over 20 Web-based sources. Alternatively, a patient can purchase a PHR as PC-based software or as a subscription to an Internet site. Using this option, patients are able to aggregate a medical record from all disciplines and specialties caring for their health and control/share this information with whomever they choose. Some of these PHR templates offer the ability to import information and images. Patients can also specify the level of access that medical professionals and other caregivers have to these records. This access can come in the form of simple printouts or on-line browser-based access that allows either read-only or edit capabilities.

Increasingly, health information systems (HIS) and electronic medical record (EMR) vendors are offering PHR add-ons to their products that engage patients in their own care. These products promote participatory health care and complement the patient-centered medical home movement taking place in this country. PHRs offer the advantage of easy movement of health provider-generated documentation to the PHR. In addition, patient-recorded vital signs and health outcomes data are transmitted back to the EMR via a clinical data repository. The consumer electronics industry is creating a variety of wired and wireless products that facilitate data collection and transmission from the patient's location to the health care system. Simple USB cables or more sophisticated Bluetooth connectivity can make a health system aware of potential problems in near real-time.

Another option that health systems are employing to connect providers and patients is the use of portals. These portals operate through a secure Internet browser environment and provide patients with access to the health system for several purposes that include scheduling appointments, viewing test results, requesting prescription refills, and asking nonurgent questions related to their health. The typical user of these portals is older than you might imagine, with mid-50s being the average age. Health systems need to determine whether this patient portal will be branded with the imprimatur of the organization to create affinity and loyalty with their patient population. The idea of a branded portal would be to create the impression that the health system offering the portal knows more about that individual patient than any other competing health system would know.

We recommend that health systems evaluate their options and advocate patient use of these important tools for seamless connectivity of critical information in the form that is most appropriate to their needs. One thought leader even suggested that the URL of the PHR could become the national health ID for health information exchange purposes. For example, http://www.healthvault.com/felkebg could be used as the link for all people who care for this individual. Pharmacists in all practice settings can advocate the importance of the PHR to patients and their families. Lower recidivism can be the immediate return on investment for this effort. As always, we welcome your thoughts and comments. Please e-mail Bill at felkebg@auburn.edu or Brent at foxbren@auburn.edu.