http://www.tedeytan.com/2009/08/19/3353/comment-page-1#comment-5139

More comments are of course welcome as we get closer to September 14!

This is a terrific post and one that I have a lot of interest in and excitement about. I have many thoughts on this topic as I have been consulting in the area now for some time (with HealthString here in Chicago who you posted about earlier this year) and working on a research project with HealthString and a physician in the area who is heading up a RHIO/HIE here in Northern IL where we have created an electronic data exchange between the physician’s EHR and the patient’s PHR utilizing the CCR standard and also using PDF-Healthcare best practice to transport the CCR to the patient and allow them to view and store via PDF although we are also extracting discreet data to the PHR to pre-populate certain fields for the patients. Although PHRs are valuable, I feel that Personal Health Systems or Applications really step it up a notch and take it from just a ‘record’ to more of an interactive tool and support system for patient’s health.

- Corporate side- PHRs that include both Health Risk Assessment (HRA) and nurse coaching are very powerful to educate and motivate employees to learn about their health. My involvement with a PHR and wellness program to a very large manufacturing company based here in Chicago was most interesting and took me by surprise. I didn’t realize that there are still so many consumers out there who don’t have computers or don’t know how to use computers. Many also do not know a think about their health, disease risk factors, and have not been to see their physician in 10+ years! Through the PHR, HRA, and nurse coach roll-out, we were able to teach members not only how to use the PHR and take their HRA, but also how to use a mouse/computer and just the basics of health…. What is blood pressure, why is high cholesterol bad, how can you check to see if you’re diabetic or prevent diabetes. Employees who would have otherwise kept going about their lives, never motivated to learn about their health, make an appointment at the doctor (and many did!), get a screening for the basics (but critical) metrics… BP, Cholesterol, glucose…. decided to finally do it. It was with a lot of effort and determination on the part of the nurse coaches and others who made the phone calls, went to the manufacturing plants, showed compassion and understanding to the employees, showed they cared…. This is what pushed many over the ‘I don’t want to learn about my health and I can’t use a computer” threshold and go them a little excited about taking control of their health. I could go on and on here but it was very exciting and I know will make a big impact on the health of thousands of employees who are now engaged and on the road to learning and leveraging technology to get or stay healthy.

- Provider Side- there are so many benefits here as well. With our data exchange project, we are hoping to motivate those who would otherwise forego using a PHR because it’s too complex and too much work to input all of their personal health info…. e.g. those with chronic disease, on multiple meds, lots of conditions. If we can send a ‘snap shot’ of their visit from the physician’s EHR to the PHR, have the patient review and validate the information, import the ‘cumbersome to enter’ and complex data to the PHR and be able to store the entire file (including images, hospital d/c info, etc…) and, with the help of a nurse coach to teach and guide them, they are more open to trying it and eventually enjoy using it. There has to be value to the patients with health education and behavior change tools and ways to improve communication with their physicians. Ultimately we would like to see the patient sending data back to their physicians or sending to other care providers who are on their care team and helping to improve care coordination with their primary care provider (with the patient at the center and empowered) The process is all very complex and there are still many legal concerns to factor in but we need to begin somewhere. I also see substantial value in the health coaches leveraging the data for risk and disease ID and prevention and have also written on this topic with examples of how this might work. With data from the EHR, self-entered data and talking to the patient, the nurse or health coach is able to identify potential health issues that they can then alert the care providers to observe or test further and, I believe, can assist with disease prevention or helping to keep major and costly complications at bay.

These are a few examples of what PHRs are good. Moreover, including a health/nurse coach, a little motivation and education to get them started, and a way for them to gather and share information outside of the PHR will be key for the patient to realize the most value and continue to use and leverage the PHR to stay healthy. Some patients and consumers just need a little nudge to get them over their fears of both health and technology but it is possible!