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ANNUAL CONFERENCE

ANNUAL CONFERENCE. INDIANA ASSOCIATION for HEALTHCARE QUALITY May 1, 2008 Personal Health Record and Quality. THE MEDICAL RECORD. Provider Medical Record is their property and maintains their business aspects Only licensed and authorized individuals document in the MR Privacy.

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ANNUAL CONFERENCE

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  1. ANNUAL CONFERENCE INDIANA ASSOCIATION for HEALTHCARE QUALITY May 1, 2008 Personal Health Record and Quality

  2. THE MEDICAL RECORD • Provider Medical Record is their property and maintains their business aspects • Only licensed and authorized individuals document in the MR • Privacy

  3. MEDICAL RECORD • Media is Paper, electronic or hybrid • Electronic EHR/EMR are usually proprietary • Facilities do not share data between

  4. Regional Health Exchange Organization (RHIO) • RHIO share information from those facilities that are shared within their connectivity • Interoperability is the main problem • Currently used only in emergency situations

  5. PATIENT PORTALS • Some facilities with EHR/EMR allow patient access to see information • via patient portals but do not allow them to add to information/record • Patient may be tracking home activities but not remember to provide physicians the information

  6. CONSUMERISM BOOM of INTERNET • General public more informed • Patients research their disorders • Millions of health websites • WebMD, NLM, disease sites, etc • Patients want to be engaged in their own care • Consumer empowerment

  7. Consumer Empowered • Consumers know and control of their financial information but do not control or know about health information

  8. ERA OF TRANSPARENCY Reported data can now publicly viewed • Medical Errors • Patient Safety Concerns • Mortality • Quality Indicators (Core Measures) • Pricing

  9. Healthcare Quality

  10. CURRENTLY Consumer Role HCPs ask patients to provide their health details at the initial patient visit or during an examination

  11. Problem with Current System • Based on recall of patient at that time • Medications • Surgery Dates • Sicker patients have more to recall • Elderly • Updates to the HCPs record are only based on encounters with that particular HCP or facility

  12. The PROBLEM • Incomplete or incorrect patient information can impede HCPs ability to provide quality care • Decentralized Patient Information • Patients see more than one HCP • Mobile society • Select in-network provider • New Insurance • Provider leaves network

  13. Quality Concern • Missing or incorrect information could result in an incorrect Diagnosis • An incorrect diagnosis can result in and incorrect Treatment plan • An incorrect treatment plan could result in poor patient outcome • Medication Reconciliation clarification

  14. Potential Solution • Personal Health Record • Shared during initial visit • Used to update HCP records during subsequent visits • Win-Win • HCP has complete information • Patient is more involved • Patient receives better care

  15. PHR • Not based on memory • Contains additional information • Over the counter medication • Herbals • Exercise habits • Preferences, such as a living will • Home Monitoring • Lifestyle activities/habits

  16. PERSONAL HEALTH RECORD A collection of life-long information about a person’s own health, or the health of someone they care for, such as a parent or child that is needed by individuals to make health decisions. The person actively owns, manages and maintains the PHR which comes from healthcare providers and the individual. The PHR is separate from and does not replace the legal record of any provider.

  17. BENEFITS • Patient empowerment • Improved patient-provider relationships • Enhanced patient safety: • Comprehensive health information in one location • Allergies, medications, and care plans in a PHR are available to each provider. • Health information privacy (Endsley et al., 2006, p. 60).” • Cost savings • The PHR is owned by the patient

  18. PHR MEDIA • Paper – notebook • Electronic CD-Rom, Memory stick, network • Web-based

  19. PHR METHODOLOGY • Tethered – PHR which is linked to a facility and populated by the facility data and housed on their system • Untethered – PHR which can be transmitted or submitted anywhere

  20. Current PHR trend for data Consumer initiated Provider Insurer–based on billing data Employer-based on billing data Medicare- based on billing data

  21. Content Patient identification Providers data Insurance data Family history Patient history Illness Treatment Allergies Immunizations

  22. AHRQ VIDEO ON PHR The AHRQ has provided general education on their website for consumers to learn of the need for the PHR and it’s use http://www.ahrq.gov/consumer/phrvid.htm

  23. AHIMA Video The American Health Information Management Association is conducting a consumer education program http://www.myPHR.com AND has forms for paper or electronic PHR available for consumers to use

  24. Harris Interactive Study (2004) • n = 2,500 • 67% or 1,675 are concerned about privacy/security • 42% or 903 keep PHRs • 58% or 1,597 don’t keep PHRs Those who keep a PHR: (n = 903) • 86% are on paper • 14% are electronically

  25. Harris Interactive (Cont) Likelihood to start a PHR for those who don’t keep a PHR (n=1,597) 40% Likely 39% Not very Likely 20% Not at all Likely

  26. Health issues and Aging Population • Over 65 population will nearly triple – over 70 million • More than 6 of every 10 Boomers will be managing >1 chronic disease • More than 1 out of every 3 Boomers will be clinically obese (21 Million) • 1 of every 4 Boomers will be livin with diabetes (14 M) • Nearly 1 out of every 2 Boomers will be living with arthritis • 8 times more knee replacements will be performed than in 2007 • 62% of 50 to 64 yr report having at lease 1 of 6 chronic conditions (hypertention, Hi Cholestrol, arthritis, diabetes, HD, or Cancer) Amer Hosp Assocation and First Consulting Group. “When I’m 64: How Boomers Will Change Health Care” AHA Washington DC 2007

  27. ERA of Virtual Caregiving? • Health Technology will move into home • Remote monitoring, wearable devices and communication links • Technologies will keep people out of hospital, or avoid need to come to clinic • Less invasive surgical options w/ new tech • But service demand exceeds supply of caregivers AHA and First Consulting Group. 2007

  28. Future As patients begin using: • Education of providers on importance and use of PHR • Education on retention and dating of PHR • Connectivity and interoperatability to the EHR/EMR • Home monitoring devices integration with PHR

  29. Continuity of Care Record (CCR) EMR and PHR comparisons for http://www.centerforhit.org/x2022.xml

  30. Nursing Initiative Workgroup • Consumer Empowerment/Personal Health Record Collaborative  • The Consumer Empowerment/Personal Health Record Collaborative was formed to:  • Establish efforts to develop health information literacy with the public and healthcare consumers. • Work with Personal Health Record (PHR) advocates and developers to optimize PHRs as they relate to nursing. http://tigerphr.pbwiki.com/

  31. QUESTIONS ????

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