Electronic Health Records

PHRs to reduce health disparities, collect longitudinal data?

A compelling presentation about the secure exchange of radiological imaging in the cloud from last week’s Information Management Network (IMN) Hospital Cloud Forum included insightful commentary into how personal health records (PHRs) could potentially minimize healthcare disparities.

Before overviewing the strides made by the Radiological Society of North America (RSNA) Image Share (which we covered over on HealthITSecurity), David S. Mendelson MD, FACR, of Mount Sinai Medical Center argued that the adoption and use of PHRs may hold the key to ensuring quality care for those on the lower end of the socioeconomic spectrum:

And there is another argument here. A PHR could serve as a source of establishing a true longitudinal record. In the case of many middle- and upper-class patients — at least socioeconomically — this isn’t the biggest issue in the world. But in fact if you look at the medically-deprived population, often at the lower end of the socioeconomic scale, those people don’t always get care the same way. The moment they have pain, they go to the nearest provider that will accept them. Their medical information is dispersed all over the place. If we had an effective way of moving some of that information into PHR accounts established for those people, it might in fact be the most consolidated record that they have.

Establishing standards and networks for health information exchange (HIE) are intended to streamline the movement of protected health information (PHI) between healthcare organizations and providers.

Many obstacles, however, stand in the way of health information networks (HINs) being able to support efficient and effective HIE. “So as much I would like to believe that the HIE solution can work and will work, I still think if you have a significant illness, you’d like to have it in your hands to just get it to the doctor you chose to see at any given moment in time,” observed Mendelson.

On top of HIPAA requirements for covered entities to sign business associate agreements with subcontractors, there is the matter of patient consent, which varies from state to state and can ultimately determine if sufficient information about a patient is actually authorized for exchange. This is where the patient-centric model of PHR could provide a solution:

You as the consumer are interested in controlling the flow of your data and expediting that flow when necessary. It actually eliminates a whole set of consent issues out there. Once you put the data into the PHR, you as the patient have the ability to distribute and control the distribution. You don’t have to sign consent forms anymore, which just introduces a delay and a bureaucratic step into moving your image around.

According to the RSNA Image Sharing method, patients would be able to deliver pertinent PHI (imaging in this example) to providers at the point of care where it is most needed. “A radiology department would have a business associate agreement with one central clearinghouse and then images are distributed from a clearinghouse to the PHRs,” Mendelson explained of the model which would rely on the patient to open a PHR from a list of select PHR vendors and use a provided password and 8-digit code to authorize the account and choose where images should end up.

Time will tell whether health information organizations (HIOs) or HINs enabling the exchange the health information are capable of overcoming the obstacles challenging their viability — from sustainability to patient consent. It could very well be the case that PHR adoption could pose another threat to the role of these HIE-related organizations. As it stands, true patient engagement will likely come down to enabling individuals to have greater control over their health information. They are the point of care.

For more details about the technical components of the RSNA project, read our coverage over at HealthITSecurity.com.

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