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PHR, PP, HRB
Personally Controlled Health Record
Patient Portal
Health Record Bank
But First
A Scripps Update
Scripps HIE
Scripps IDN
Hospitals
Foundation Medical
Groups
Affiliated Physicians
Community
Beacon
Direct
Other
Scripps Medical
Foundation
Allscripts
Scripps
Scripps
Hospitals
HIE
Transmit
• Store
•
Affiliated Physicians
Imaging
Allscripts
Lab
Pharmacy
Affiliated Physicians
Other EHR
Scripps Update
Scripps IDN
Hospitals
Foundation Medical
Groups
Affiliated Physicians
Community
Beacon
Direct
Other
Key Requirements
Efficient Clinical
Workflow
Embedded Clinical
Decision Support
Semantic
Interoperability
Scripps Vendor Process
Survey 1
Survey 2
Survey 3
Survey 4
Have you; do you; are you?
Medical records scattered across
many providers
Gone to ED, not remember info
Want 2B notified, loved one in ED
Not refilled RX on time; problems?
Requested MR, no longer available
Denied life insurance because of
inaccurate data in your records
Had a shot, because you couldn’t
remember
Have a chronic condition
Do you want a convenient place to
store your health values
Wary of insurance companies, the
government, or employers
managing your health records
Believe that providers can give
better care if they have more
comprehensive information
Today
What are they?
Key Functions
Difference
PHR
Patient Portal
Health Record Bank
Two Proofs of Concepts
References
Organization
Definition
HIMSS
An electronic Personal Health Record (“ePHR”) is a
universally accessible, layperson comprehensible,
lifelong tool for managing relevant health information,
promoting health maintenance and assisting with
chronic disease management via an interactive,
common data set of electronic health information and
e-health tools. The ePHR is owned, managed, and
shared by the individual or his or her legal proxy(s)
and must be secure to protect the privacy and
confidentiality of the health information it contains. It
is not a legal record unless so defined and is subject to
various legal limitations. (HIMSS.org)
AHIMA
Markel Foundation
HHS
AHIP
Personally Controlled Health Record
Integrated Delivery
Systems
Providers
Hospital 1
Hospital 2
Hospital …
1. Allergies
2. Medications
3. Problems
4. Results
Individual
Physicians
5. Immunizations
Wellness
6. Etc
7. Genetics
Community
Clinics
Rx, lab,
YOU
payor, home
devicesCopyright 2009 mdb healthcare IT solutions
Disease
management
Patient Portal = Tethered PHR
“Enterprise HIE”
Scripps
Hosps
HIE
Affiliated
“Enterprise HIE”
“Community HIE”
Scripps
Hosps
HIE
Beacon
HIE
Affiliated
“Enterprise HIE”
“Community HIE”
“Enterprise HIEs”
All the IDNs are doing it!
Scripps
Hosps
HIE
Beacon
HIE
Affiliated
Other San Diego
IDNs & Providers
• PPH
• Kaiser
• Physician Groups
• Childrens
• Sharp
• UCSD
• VA
• DoD
• etc
“Enterprise HIE”
“Community HIE”
“Enterprise HIEs”
All the IDNs are doing it!
Scripps
Hosps
HIE
Beacon
HIE
Affiliated
Other San Diego
IDNs & Providers
• PPH
• Kaiser
• Physician Groups
• Childrens
• Sharp
• UCSD
• VA
• DoD
• etc
“Enterprise HIE”
“Community HIE”
“Enterprise HIEs”
All the IDNs are doing it!
Scripps
Hosps
HIE
Beacon
HIE
Affiliated
Patient Portal
Personal
Health
Records
© 2010 mdb healthcare IT solutions
Other San Diego
IDNs & Providers
• PPH
• Kaiser
• Physician Groups
• Childrens
• Sharp
• UCSD
• VA
• DoD
• etc
Patient Portal vs PHR
What’s the Diff?
What’s the diff?
Feature
Patient Portal
Personal Health Record
© 2010 mdb healthcare IT solutions
What’s the diff?
Feature
Patient Portal
Personal Health Record
Accessible
Web, phones, more
Web, phones, more
© 2010 mdb healthcare IT solutions
What’s the diff?
Feature
Patient Portal
Personal Health Record
Accessible
Web, phones, more
Web, phones, more
Comprehensive Data
1 organization/IDN
Data from all providers
© 2010 mdb healthcare IT solutions
What’s the diff?
Feature
Patient Portal
Personal Health Record
Accessible
Web, phones, more
Web, phones, more
Comprehensive Data
1 organization/IDN
Data from all providers
Data Sharing Control Organization
Patient
© 2010 mdb healthcare IT solutions
What’s the diff?
Feature
Patient Portal
Personal Health Record
Accessible
Web, phones, more
Web, phones, more
Comprehensive Data
1 organization/IDN
Data from all providers
Data Sharing Control Organization
Patient
Opportunity to audit
Yes
Yes
© 2010 mdb healthcare IT solutions
What’s the diff?
Feature
Patient Portal
Personal Health Record
Accessible
Web, phones, more
Web, phones, more
Comprehensive Data
1 organization/IDN
Data from all providers
Data Sharing Control Organization
Patient
Opportunity to audit
Yes
Yes
View Control
Organization
Patient
© 2010 mdb healthcare IT solutions
What’s the diff?
Feature
Patient Portal
Personal Health Record
Accessible
Web, phones, more
Web, phones, more
Comprehensive Data
1 organization/IDN
Data from all providers
Data Sharing Control Organization
Patient
Opportunity to audit
Yes
Yes
View Control
Organization
Patient
Patient input
Rarely
Always
© 2010 mdb healthcare IT solutions
What’s the diff?
Feature
Patient Portal
Personal Health Record
Accessible
Web, phones, more
Web, phones, more
Comprehensive Data
1 organization/IDN
Data from all providers
Data Sharing Control Organization
Patient
Opportunity to audit
Yes
Yes
View Control
Organization
Patient
Patient input
Rarely
Always
Data Entry
Automatic for patient
Mostly manual by patient
© 2010 mdb healthcare IT solutions
What’s the diff?
Feature
Patient Portal
Personal Health Record
Accessible
Web, phones, more
Web, phones, more
Comprehensive Data
1 organization/IDN
Data from all providers
Data Sharing Control Organization
Patient
Opportunity to audit
Yes
Yes
View Control
Organization
Patient
Patient input
Rarely
Always
Data Entry
Automatic for patient
Mostly manual by patient
eMail Provider
Usually
Sometimes
© 2010 mdb healthcare IT solutions
What’s the diff?
Feature
Patient Portal
Personal Health Record
Accessible
Web, phones, more
Web, phones, more
Comprehensive Data
1 organization/IDN
Data from all providers
Data Sharing Control Organization
Patient
Opportunity to audit
Yes
Yes
View Control
Organization
Patient
Patient input
Rarely
Always
Data Entry
Automatic for patient
Mostly manual by patient
eMail Provider
Usually
Sometimes
Disease Mgt
Increasing
Increasing
© 2010 mdb healthcare IT solutions
What’s the diff?
Feature
Patient Portal
Personal Health Record
Accessible
Web, phones, more
Web, phones, more
Comprehensive Data
1 organization/IDN
Data from all providers
Data Sharing Control Organization
Patient
Opportunity to audit
Yes
Yes
View Control
Organization
Patient
Patient input
Rarely
Always
Data Entry
Automatic for patient
Mostly manual by patient
eMail Provider
Usually
Sometimes
Disease Mgt
Increasing
Increasing
Wellness
Increasing
Increasing
© 2010 mdb healthcare IT solutions
What’s the diff?
Feature
Patient Portal
Personal Health Record
Accessible
Web, phones, more
Web, phones, more
Comprehensive Data
1 organization/IDN
Data from all providers
Data Sharing Control Organization
Patient
Opportunity to audit
Yes
Yes
View Control
Organization
Patient
Patient input
Rarely
Always
Data Entry
Automatic for patient
Mostly manual by patient
eMail Provider
Usually
Sometimes
Disease Mgt
Increasing
Increasing
Wellness
Increasing
Increasing
Lifetime Record
Organization controls
Patient controls
© 2010 mdb healthcare IT solutions
What’s the diff?
Feature
Patient Portal
Personal Health Record
Accessible
Web, phones, more
Web, phones, more
Comprehensive Data
1 organization/IDN
Data from all providers
Data Sharing Control Organization
Patient
Opportunity to audit
Yes
Yes
View Control
Organization
Patient
Patient input
Rarely
Always
Data Entry
Automatic for patient
Mostly manual by patient
eMail Provider
Usually
Sometimes
Disease Mgt
Increasing
Increasing
Wellness
Increasing
Increasing
Lifetime Record
Organization controls
Patient controls
Scheduling
Yes
Rarely
© 2010 mdb healthcare IT solutions
What’s the diff?
Feature
Patient Portal
Personal Health Record
Accessible
Web, phones, more
Web, phones, more
Comprehensive Data
1 organization/IDN
Data from all providers
Data Sharing Control Organization
Patient
Opportunity to audit
Yes
Yes
View Control
Organization
Patient
Patient input
Rarely
Always
Data Entry
Automatic for patient
Mostly manual by patient
eMail Provider
Usually
Sometimes
Disease Mgt
Increasing
Increasing
Wellness
Increasing
Increasing
Lifetime Record
Organization controls
Patient controls
Scheduling
Yes
Rarely
© 2010 mdb healthcare IT solutions
A Successful Patient Portal
Kaiser
Registration drives use
51.5% of all eligible
members who have
access to the internet
54% of members signed
on to My Health Manager
5+ times in 2008
84% choose one-step
activation in 2008
37
Activated Users
3,000,000
2,750,000
2,500,000
2,250,000
2,000,000
1,750,000
1,500,000
1,250,000
1,000,000
01
/07
03
/07
05
/07
07
/07
09
/07
11
/07
01
/08
03
/08
05
/08
07
/08
09
/08
11
/08
More than 3.2 million
Kaiser Permanente
members have
registered and
activated as of Aug
2009
2008 Satisfaction Survey Summary
Very dissatisfied .8%
Dissatisfied 2.4%
Neutral
6.1%
Very satisfied
44.5%
Satisfied 46.2%
38
90.7% of
kp.org users
are in the top
2 boxes
5% more are
in the very
satisfied than
in 2007
Hey What about Google?
Adam Bosworth
“the service could not overcome
the obstacle of requiring people to
laboriously put in their own data”
Health Record Banks
A whole lot of PHRs, managed by an
entity responsible for electronically
getting data in, consent management,
security, access control, privacy
www.healthbanking.org
Video
Health Record Banking Alliance
HRB is a central place for your PHR maintained by an
entity like a bank maintains your money
Integrated Delivery
Systems
Providers
Hospital 1
Hospital 2
Hospital …
1. Allergies
2. Medications
3. Problems
4. Results
Individual
Physicians
5. Immunizations
Wellness
6. Etc
7. Genetics
Community
Clinics
Rx, lab,
YOU
payor, home
devicesCopyright 2009 mdb healthcare IT solutions
Disease
management
Barriers to Adoption of PHRs
1.
2.
You have to put the data in
Financial sustainability model for a
company to host
HRBs
can solve #1
working on solving #2
Health Record Banks
Two Proof of Concepts
Need to Prove
1. Will Consumers Use One
Yes, Kaiser et al have proven this.
2.
Will Consumers Pay for Services
Jury is still out, however promising pilots in
Washington (3)
One of the Beacons
Ocala, FL
HRBs and HIEs
Simpler
Cheaper
As or more Secure
For Life
Resources
Meaningful Use presentations et al
http://healthit.hhs.gov/portal/server.pt
HIMSS Web Site on PHRs (member) especially the physician workflow
when an EMR and PHR are involved
http://www.himss.org/content/files/PHR_FAQ_090109.pdf
Book: “Personal Health Records..” Yasnoff, Miller, Burde
HRBA Web site www.healthbanking.org
Legal, Ethics, doctor-patient relationship: Dr. Wynia
http://www.medscape.com/viewarticle/579181
(you now have to sign up to see this article) or Google him
Try setting up a PHR from one of the free sites – it is enlightening
Kaiser eMail study published in American Journal of Managed Care
http://ckp.kp.org/newsroom/national/archive/nat_070705_secure.html
Today
What are they?
Key Functions
Difference
PHR
Patient Portal
Health Record Bank
Two Proofs of Concepts
References
Mark Branning [email protected]