Patient health records (PHRs) are coming soon to patients in the Indian Health System (IHS), according to a new system of records notice (SORN) in appearing Oct. 29 on the Federal Registrar. Beginning Dec. 13, 2012, IHS patients will have web access to a portion of their personal medical information contained in the IHS Medical, Health, and Billing Records system. “The IHS PHR system will contain administrative records needed to manage patients’ web access; initially, patients will be granted access to view and print portions of their official IHS electronic health record (EHR) via the Internet,” states the IHS notice.
Originally, use the IHS PHR will be limited to the patients themselves. Similarly, the viewable record represents only a portion of the personal medical medication, not the complete record living in the IHS Medical, Health, and Billing Records system. In fact, the IHS PHR comprises a separate IHS Privacy Act system per previous rulemaking (SORN 09-17-0001-IHS).
However, IHS is currently developing future enhancements to the system expanding both access and usability beyond simply view information:
Future IHS PHR functionality will include providing tools to the patients which they can use to: Improve their own health and increase their knowledge about health conditions; increase communication with their care providers (i.e., secure electronic messaging with their IHS health care providers); request on-line prescription refills and view upcoming appointments; and enter their own medical information in a “self-entered” health information section through a secure and private health space.
With other future system enhancements, patients will have the opportunity upon request to integrate their IHS PHR with their official electronic health record by storing their information in separate database capable of being linked with the EHR.
Additionally, IHS PHR patient users will eventually have the right to elect a representative who can access their personal health information. Until then, IHS patients can make use of the IHS PHR print functionality to share this information with relevant family and representatives per existing IHS clinical practices.
In order to preserve the security and integrity of its Medical, Health and Billing Records system, IHS clearly defines the relationships between the former and the IHS PHR. “The IHS Medical, Health and Billing Records system is the authoritative source of patients’ IHS medical records,” the notice explains. “Once patients print copies of their medical records using the IHS PHR system, the copies will no longer be maintained subject to or protected by the Privacy Act or the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule.” In this way, IHS ensures that it is not liable for lost copies of patient records. Coupled with the apportioned view of the EHR, the federal agency is maintaining a strong barrier in the way of unauthorized access to the genuine EHR article.
Per the Privacy Act, IHS is required to publish a SORN that includes details about the system. The following details are revealed about the IHS PHR:
• The PHS Administrative Records-IHS will be stored at local IHS facilities and the IHS National Data Centers.
• The system will contain record system usage information and personally identifiable information (PII), including registration information (e.g., full name, IHS PHR user identifier, date of birth, email address, telephone numbers, mother’s maiden name, ZIP code, and place and date of registration for IHS PHR.
• Records may be retrieved using an individual’s name, user ID, date of registration for IHS PHR electronic services, ZIP code, the IHS assigned MRN, date of birth and/or social security number, if provided.
The information about the routine uses of records, storage, and retrievability as well as a complete list of technical, physical, and administrative safeguards are available through the Federal Register.