Transcript Personal Health Records

Personal Health Records:
a systematic review
Biostatistics and Medical
Informatics Department
Authors: Maria João Xará, Nivalda Pereira, Sandra Fontes, Anabela Maio,
Maria João Pinto, Cristina Gomes, Hugo Cunha Tiago Adrego, Paulo Pancrácio
Supervisor: Dr Ricardo Correia
Class 21
Structure
• Introduction
– Objectives
•
•
•
•
Methods
Results
Discussion
Conclusions
Introduction
Why PHR’s now?
There has been a tremendous progress in medicine as
well as in informatics during the last decades.
Haus, Reinhold; 2006
Recently there has been a remarkable upsurge in
activity surrounding the adoption of personal health
record (PHR) systems for patients and consumers.
Tang PC, Ash JS, Bates DW, Overhage JM, Sands DZ
What is a PHR?
PHR is a collection of important information
about individual’s health or the health of someone
he is caring for (such as a parent or a child) that
he actively maintains and update.
American Health Information Management Association, 2006
PHR is a medical historial made by the patient and that
is not controlled by the health professional.
PHR's systems are more than just static repositories for
patient data.
What kind of information can a PHR contain?
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Personal identification;
List and dates of significant illness and surgeries;
Current medications and dosages;
Immunizations and their dates;
Allergies;
Organ donor authorization;
Opinions of specialists;
Important test results;
Eye and dental records;
Any information that the user think is important for his health.
American Health Information Management Association, 2006
Why using PHR?
Potential Advantages
• Lower chronic disease management costs
• Lower medication costs
• Lower wellness program costs
Tang PC, Ash JS, Bates DW, Overhage JM, Sands DZ.; 2006
• To improve communication between the user and his providers
• To reduce or eliminate duplicate procedures or processes
Lawrence Gostin, JD;1997
Objectives
To evaluate the impact of
PHR's’ utilization in the
users’ health care.
Start
Primary search schoolar.google: “Personal Health Records”
Methods
Articles reading
Systematic search
Yes
Medline?
No
Query to Medline
Define query to SCOPUS
(“Patient Access to Records” [MeSH] and
“Medical Records Systems, Computerized”
[MeSH]) or (“Personal Health Records” or
“Personal Health Information”)
(“Patient Access to Records” and “Medical
Records Systems, Computerized”) or
(“Personal Health Records” or “Personal
Health Information”)
Apply the query
Apply the query
In English, French or
Spanish?
Yes
No
Common to both
searches?
Excluded
No
Yes
Eliminating the repeated articles
Start reading the abstract
Yes
Revisors agree?
No
3rd revisor
Yes
Included
The article respects all inclusion
criteria?
No
Excluded
Analysis of full-text
End
Start
Primary search schoolar.google: “Personal Health Records”
Articles reading
Systematic search
Yes
Medline?
No
Query to Medline
Define query to SCOPUS
(“Patient Access to Records” [MeSH] and
“Medical Records Systems, Computerized”
[MeSH]) or (“Personal Health Records” or
“Personal Health Information”)
(“Patient Access to Records” and “Medical
Records Systems, Computerized”) or
(“Personal Health Records” or “Personal
Health Information”)
Apply the query
Apply the query
Yes
In English, French or
Spanish?
No
Common to both
searches?
Excluded
In English, French or
Spanish?
Yes
No
Common to both
searches?
Excluded
No
Yes
Eliminating the repeated articles
Start reading the abstract
Yes
Revisors agree?
No
3rd revisor
Yes
Included
The article respects all inclusion
criteria?
No
Excluded
Analysis of full-text
End
Start
Methods (participants)
n = 364
Common to both
searches?
Yes
Eliminate the
repeated one
No
Excluded
n = 135
Included
n = 229
Abstract analysis
n = 20
Included
n = 209
Excluded
Analisys of full-text
n=4
Included
n = 16
Excluded
End
Analysis’ strategy
• Groups of reviewers with 2 elements: 36 groups;
• Groups analysed between 6 and 8 abstracts;
• Results were expressed in Microsoft Excel which
includes:
–
–
–
–
Title, author, year and origin of the article;
Reviewer group;
Inclusion or exclusion;
Criteria not satisfied for exclusion.
Analysis
Important information:
• Characteristics of the individuals
• Patient responsibility for the prevention or
intervention process
• Implemented system
• Users’ perception
• Health status of the user using the PHR
• Hospital services
Results
Systematic search
(after eliminating
the repeated articles):
n = 229
Systematic search:
n = 364
Articles included:
n = 20
Articles' selection
180
160
140
120
Number of 100
articles
80
60
40
20
0
158
Percentage
Inclusion: 8,7 %
Exclusion: 69 %
51
No abstract: 22,3%
20
Inclusion
Exclusion
Selection result
No abstract
Agreement
Agreement
120
100
100
83,3
80
66,6
Agreement (%) 60
57,1
50
40
20
0
23
7
3
2
1
Number of groups
Number of articles agreed / Total of articles read
Mean (%): 90,2 %
Exclusion
Articles' exclusion
160
151
140
120
100
Number of
80
articles
60
40
20
4
3
2
3
0
1
Exclusion criteria
Legend:
1 – Does not respect both cirteria
2 – Does not present PHR’s evaluation of impact
3 – Does not present PHR’s definition
Included articles
Title
Year
Type of the
Study
Study
Duration
System Objective
Type of
system
Participants
n
Age
South Australian personal
health record:
Determinants
of use (209)
1998
Experimental
randomized
___
Store data related to
child development
Paper (Blue
Book)
315
(GP’s)
500
(parents)
Child: > 10
years
Personal health records:
an evaluation. (152)
1987
Cohort
8-11
months
Store data related to
child development
Paper
167
Child: 0-5
years
Personal health
information management
system and its application
in referral management.
(140)
2004
Experimental
7 months
Web
61
Mean: 47,50
Implementation of
personal health records
by case managers in a
VAMC general medicine
clinic. (94)
2004
Cohort:
2 groups with
and without
PHR’s
14 months
Paper
(Checkbook)
150
patients
and 8
nurses
Mean:
Cohort
1(received):
65 (25-83)
Cohort 2
(didn’t) 66,5
(28-84):
The impact of
utilization of
personal health
records on patient
access to vital
health information
Patients Opinion
Providers Opinion
Patient – Provider Relationship
80% believed the Blue
Book to be acceptable
and useful to their
clinical practice.
Young providers were
more likely to find the
Blue Book acceptable
_____
Article
Utility
South Australian
personal health
record: Determinants
of use (209)
73% think its useful to child
with less than a 6 months
21% think its useful to all
ages
42% - useful to children with
more than 6 months
Personal health
records: an
evaluation. (152)
Yes (75% PHR’s had nine
or more entries)
91% of records had
progress notes made by
nurses
Personal health
information
management system
and its application in
referral
management. (140)
Yes
can be coupled with home
biosensor instruments for
home monitoring of chronic
diseases
Implementation of
personal health
records by case
managers in a VAMC
general medicine
clinic. (94)
45% used PHR
27% updated
Security
____
____
Differences in the
acceptance between
public and private
sectors.
_____
Improve communication
____
Once they
use
checkbook,
there aren’t
privacy
problems.
____
Improve communication
____
Web’s PHR
Article
154 - Personal health
records: evaluation of
functionality and utility.
(2004)
Type of Study
Currently available PHR's demonstrate limited functionality.
Revision (sites)
124 - Patient entry of
information: evaluation of
user interfaces. (2004)
Experimental
110 - Making public health
data available to
community-level decision
makers-goals, issues, and
a case report. (2001)
Main Conclusion
Different types of data entry methods employed by Personal health
records may have an impact on the accuracy of patient-entered medical
information.
Approaches that rely on guided entry of data elements abstracted from
primary source documents may promote more accurate entry of
information.
For the near future, the plan for MICA centers on adding functionality.
?
Editable EHR
Article
128 - Patient participation in
EHR benefits. (2003)
126 - Patient experiences and
attitudes about access to a
patient electronic health care
record and linked web
messaging. (2004)
220 - Use of a patientaccessible electronic medical
record in a practice for
congestive heart failure: patient
and physician experiences.
(2004)
218 - Towards personal health
record: current situation,
obstacles and trends in
implementation of electronic
healthcare record in Europe.
(1998)
Type of the
Article
Opinion Article
Main Conclusion
Patient participation in EHR creation can significantly broaden the
range of healthcare information in the record and, ultimately,
improve clinical decision support.
Patients' attitudes about the use of Web messaging and online
access to their EHR were mostly positive.
Online Survey
Original
Research Paper
(Questionnaires
to users)
These findings suggest a number of potential benefits and few if
any adverse consequences to providing this access.
The electronic healthcare record is a necessary tool supporting the
person (citizen) centred shared care.
Opinion Article
Discussion
• Implemented systems show that PHR’s improve
communication between patient and healthcare
provider;
• PHR’s still have limited functionality;
• PHR’s enable patients to take a more active and
effective role in their health care;
• Since 1987, there hasn’t been any significant
breakthrough in the functionality of PHR’s;
• There are few scientific articles with an objective
evaluation of PHR’s;
• Most of the articles regarding the subject are opinion
articles;
• More experimental evidence is required in order to
assess the full extent of potential benefits mentioned
in several opinion papers.
Acknowledgements
• Professor Doutor Altamiro Manuel
Rodrigues da Costa Pereira
• Doutor Ricardo João Cruz Correia