Maybe I need new glasses? Blurring the lines between PHR and EHR

By Barbara L. Massoudi, RTI International, BreathEasy Principal Investigator.

For the past few years whenever I’ve given presentations about PHRs and EHRs I’ve made an upfront distinction between the two by saying that PHRs are patient-centered and patient-controlled, while EHRs are provider-centered and provider or institutionally controlled. I think it might be time to update my slides…

Last week AHRQ released a request for task order under the National Resource Center for Health Information Technology requesting proposals to help improve patient literacy of EHRs. At first glance this seemed perplexing. Why would patients be using EHRs and what would they be using them for? It’s been tough enough getting clinicians to acknowledge that patients can be the recipients of information about their health through PHRs and patient portals.

EHRs as a Patient Education Tool
It turns out that AHRQ wants proposals related to making the patient education materials provided through EHRs more accessible to patients of all health literacy levels. Much of the patient education materials accessible through EHRs, if they even exist, fail miserably when measured against current health literacy strategies like chunking information and writing at a sixth grade or lower reading level. And yet, providing patient education at the point of care to reinforce information shared during the office visit makes good sense. EHRs might even become an interactive tool, providing diagrams, videos and other visual aids to increase comprehension and information retention.

Making it Meaningful
The meaningful use movement focuses on making health information available at the point of care to facilitate better clinical decision-making. Although CMS acknowledged that “Providing patients with information and education that is relevant to their condition, actionable, culturally competent, and of the appropriate health literacy level is a critical component of patient engagement and empowerment,” objectives related to this were not part of the proposed meaningful use rule because materials just don’t exist right now. The AHRQ work should be a great start to developing and promoting recommendations to improve EHR patient education related capabilities and features. Add to this a system by which you can accurately rate the clarity of health information and a repository of actionable health education materials developed specifically for use with EHRs and we’re headed in the right direction.

What are your Thoughts?
Our hope within Project HealthDesign is that observations of daily living will enhance PHRs by transforming them into springboards for action and improved health decision-making. It seems like this new EHR work can help benefit the PHR and patient portal world as well. What do you think?

Comments

[Vince Kuraitis]

Barbara,

I've also wrestled with this distinction between what's an EHR vs. a PHR.

One increasingly common perspective (that I agree with) is that there is one common data base (i.e., data about THE PATIENT) and that an EHR is simply a clinical view + clinical apps running on that platform, while a PHR is a patient view + patient apps on the same platform.

This perspective hasn't been possible until fairly recently. In the past the data and apps have been woven together in vendor offerings.

In the work being done by ONC in implementing HITECH, one of the clear directions for the future is the separation of the underlying data from any applications that use the data.

While this is an emerging POV, there clearly is no consensus and common understanding of how PHRs and EHRs interrelatate -- so keep up the dialogue!

[Sherry Reynolds]

Actually a couple of million people have had this shared view of their medical records for the past couple of years.. It is a false construct to have a bifurcated EHR/PHR model and CMS is missing a huge opportunity.

Group Health Cooperative with over 580,000 members gave the member / patients access to their EHR first! before the providers. The patients were able to write to their charts via email and they can view labs, make appts, see their after visit summaries etc and they have the highest rates of adoption by patients of any system in the country (over 58%).

One key piece that is missing is the financing. At Kaiser and Group health the providers are paid the same whether the patient is in the room, on the phone or via email. The EHR vendor used at Kaiser and GHC have over 25% of all doctors in the country on their system and they could open up their API (pipe) to 25% of all patients as well without any change in technology.

Check out the demo of the system via the link or send me an email if anyone has more questions how we did this and case studies.