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The Electronic Personal Health Record (ePHR)

The Electronic Personal Health Record (ePHR). Beth Friedmann CS - 6125 Spring 2007. Consumer Driven Health Record. Consumer takes on added responsibility for maintaining personal record Consumer participates in creating aspects of the personal health record Journal entries

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The Electronic Personal Health Record (ePHR)

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  1. The Electronic Personal Health Record (ePHR) Beth Friedmann CS - 6125 Spring 2007

  2. Consumer Driven Health Record • Consumer takes on added responsibility for maintaining personal record • Consumer participates in creating aspects of the personal health record • Journal entries • Collecting some objective clinical data – eg. BP • More collaborative • More “real time” (daily assessment rather than weekly appointments) • Improved Collaboration • Improved Complianc

  3. Medical problem list Medical history Medication Laboratory tests Family history List of providers Major illnesses Social history Immunizations Home monitored data such as blood pressure and glucose measures Allergy data Recent hospital admissions Claims data Information in an ePHR

  4. Types of ePHR: Stand Alone • Advantages • Stored on a portable drive • Responsibility for updating and maintenance can be difficult (Lab, Radiology, physicians and therapists etc.) • Disadvantages • Update and maintenance can be overwhelming (particularly for someone very ill) • Objectivity and Accuracy • Still requires access to a chart • Difficulty interfacing with other systems

  5. Tethered PHR • Often supplied by insurance company or a particular vendor or large health organization (eg. A hospital). Often use a web portal • Advantages • Cannot lose it (Think VA during Katrina) • Maintained by larger organization • Disadvantages • Silos of information • Might have multiple ePHRs

  6. Integrated ePHR • Model is based on the Common Framework (Markle Foundation • Sharing of Data across multiple institutions • For now mostly large institutions, more are coming • Overcomes interfacing problem • Data can be centralized, although Common Framework is based on a federated model, SOAP 1.1 and HL7 2.4

  7. Barriers to Adoption • Expensive to create and business model is not clear yet • Concerns about patient Privacy • HIPAA • Identity Theft • Conflict of interest for employee or insurance supported PHR • Debates regarding a national patient identifier

  8. Common Framework • Sub Networks (SNO) • Inter SNO Bridge (messaging, authentication etc) • RLS – Record locator service (accepts updates and queries) • PHR- Consumer based SNO

  9. Advantages of Common Framework • Minimum Standards • Goal is to use existing technologies • Data functions are at application level • Federated model- data resides with institution

  10. Query <soapenv:Body> <nhin:NHINQuery> <nhin:EvaluationSettings> <nhin:MaxResponseInterval>60</nhin:MaxResponseInterval> <nhin:ResponseStyle>I</nhin:ResponseStyle> </nhin:EvaluationSettings> <nhin:Query format=”HL7” version=”2.4”> <QBP_Z01 xmlns="urn:hl7-org:v2xml"> … </ QBP_Z01 > </nhin:Query> </nhin:NHINQuery> </soapenv:Body>

  11. Response <soapenv:Body xmlns:nhin=”http://www.nhin.gov/messaging” > <nhin:NHINResponse> <nhin:EvaluationSettings> <nhin:MaxResponseInterval>60</nhin:MaxResponseInterval> <nhin:ResponseStyle>I</nhin:ResponseStyle> </nhin:EvaluationSettings> <nhin:Response format=”HL7” version=”2.4”> < RSP_Z01 xmlns="urn:hl7-org:v2xml"> … </ RSP_Z01 > </nhin:Response> </nhin:NHINResponse> </soapenv:Body>

  12. PHR examples

  13. Example 2

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